title: Modified Technique to Create Diabolo Stent Configuration.
abstract: Diabolo stent configuration aids in stent positioning, stability, and creating a controlled defect with a predetermined size. A number of techniques to create the diabolo configuration have been previously described. The indications for creating a controlled "defect" are rapidly growing and include the Fontan circulation, patients with severe end-stage pulmonary hypertension, restrictive atrial communication in the setting of hypoplastic right or left heart syndrome, and diastolic left heart failure. We describe an alternative technique using a prefabricated readily available tool (gooseneck snare) to create a diabolo stent configuration. The chosen balloon expandable stent is mounted on a 5-mm gooseneck snare centered on an angioplasty catheter larger than 5 mm diameter. When deployed, the snare restricts the central waist to 5 mm and both ends expand to a larger diameter creating a dumbbell/diabolo configuration. A total of six diablo stent configurations were successfully implanted in four patients with failing Fontan physiology; five to create a transcatheter fenestration and one to relieve atrial septal restriction. Data expressed as median and IQR. Their weight was 24.8 kg (19.6-46.95), and age years was 9.2 (6.28-13.23). There were no complications and a consistent diabolo configuration with a 5-mm central waist was created in all patients. The snare serves as a sterile, preconfigured, radiopaque, readily available tool of adequate length and strength, to create consistent diabolo stent configuration without any modifications. This technique is a simple, reproducible, and easy to learn.
authors.affiliation: Stead Family Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA. Osamah-aldoss@uiowa.edu.
authors.forename: Osamah
authors.initials: O
authors.lastname: Aldoss
authors.affiliation: Stead Family Department of Pediatrics, Division of Pediatric Cardiology, University of Iowa Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
authors.forename: Abhay
authors.initials: A
authors.lastname: Divekar
mesh_terms: D000293:Adolescent; D054087:Atrial Septum / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D002648:Child; D004867:Equipment Design; D018729:Fontan Procedure / Q000592:standards*; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007484:Iowa; D012189:Retrospective Studies; D015607:Stents / Q000592:standards*
keywords: Diabolo stent; Failing fontan; Fenestration; Snare