title: Stenting the Fontan pathway in paediatric patients with obstructed extracardiac conduits.
abstract: An unobstructed extracardiac conduit (ECC) is essential for optimal Fontan haemodynamics. We aimed to evaluate the feasibility and results of percutaneous transcatheter stenting of the ECC in paediatric patients with a significant Fontan pathway obstruction.
  
  
  
  Our institutional database was searched to identify all Fontan patients who had a stent placed in their ECC. Medical records, cardiac catheterisation data and echocardiographic investigations were reviewed. Vessel diameters were normalised to account for differences in body surface area.
  
  
  
  Nineteen Fontan patients (age 6.5±3.2 years; male 78.9%) with a significant stenosis of their Dacron ECC graft were identified. Seven patients presented with protein-losing enteropathy (36.8%). An ECC obstruction was suspected on echocardiography in only 6/19 patients (31.6%). The mean minimum diameter of the ECC was 8.3±2.4 mm. A stenosis of >45% was seen in the majority of patients (n=12, 63.1%). Significant correlations between the severity of the ECC obstruction and Fontan pathway vessel diameters were found (all p<0.05). Stenting was successful in all children. The ECC diameter increased significantly after stenting (p<0.0001). An acute clinical benefit of ECC stenting was observed in 18/19 (94.7%) patients. ECC patency was good during a mean follow-up of 1.8±0.9 years.
  
  
  
  The feasibility and acute results of percutaneous transcatheter ECC stenting are promising and may provide a good alternative to postpone surgery to a later age. The mechanisms contributing to the development of ECC stenoses are likely multifactorial.
authors.affiliation: Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.|Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Floris E A
authors.initials: FEA
authors.lastname: Udink Ten Cate
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Trieschmann
authors.affiliation: Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Germund
authors.affiliation: Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hannes
authors.affiliation: Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Emmel
authors.affiliation: Department of Cardiac Surgery, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Gerardus
authors.initials: G
authors.lastname: Bennink
authors.affiliation: Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Narayanswami
authors.initials: N
authors.lastname: Sreeram
mesh_terms: D000792:Angiography; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents
keywords: Fontan – total cavopulmonary connection – extracardiac conduit –stenosis – protein-losing enteropathy