title: Transcatheter Fontan takedown.
abstract: Early failure of the Fontan circulation is rare in the current era but remains associated with a high mortality rate. Surgical Fontan takedown has evolved as one of the strategies to stabilize the circulation, improve survival, and allow for a future attempt at Fontan completion. We have completed Transcatheter fontan takedown in three patients with extracardiac conduits 0.8-6 months following their Fontan operations. Superior vena cava flow was redirected into only the pulmonary arteries by occluding the conduit with a vascular plug between the pulmonary arteries and fenestration and unrestrictive inferior vena cava flow was redirected into only the atrium by stenting and enlarging the fenestration. There were no procedure related complications. All patients had resolution of large-volume chylous pleural effusions. One patient had resolution of protein-losing enteropathy, two patients had improvement of plastic bronchitis. Two of three patients remain alive at latest follow-up (4-24 months). This early experience suggests that Transcatheter fontan takedown is technically feasible and may be an alternative to surgical takedown in select patients with early failure of the Fontan circulation.
authors.affiliation: Division of Cardiology, the Children's Hospital of Philadelphia, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania.|Children's Heart Center, Skane University Hospital, Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Hallbergson
authors.affiliation: Division of Cardiothoracic Surgery, the Children's Hospital of Philadelphia, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Mascio
authors.affiliation: Division of Cardiology, the Children's Hospital of Philadelphia, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D002675:Child, Preschool; D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017023:Coronary Angiography; D003326:Coronary Circulation; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D011504:Protein-Losing Enteropathies / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011652:Pulmonary Circulation; D020127:Recovery of Function; D012039:Regional Blood Flow; D015607:Stents; D017211:Treatment Failure; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
keywords: congenital heart disease; heart failure; hemodynamics; pediatric intervention; surgery