A stepwise approach to conduit puncture for electrophysiological procedures in patients with Fontan circulation

In patients with Fontan circulation, the conduit may be punctured for electrophysiological procedures. We evaluated the feasibility and safety of a stepwise approach to conduit puncture in adults who have undergone Fontan operation. We included 13 consecutive patients with lateral tunnel or extracar...

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Bibliographic Details
Published in:Europace (London, England) England), 2018-06, Vol.20 (6), p.1043-1049
Main Authors: Uhm, Jae-Sun, Kim, Nam Kyun, Yu, Hee Tae, Yang, Pil-Sung, Kim, Jung Ok, Kim, Tae-Hoon, Song, Mi Kyoung, Lee, Sang-Yun, Joung, Boyoung, Pak, Hui-Nam, Choi, Jae Young, Jung, Jo Won, Lee, Moon-Hyoung
Format: Article
Language:English
Subjects:
Adolescent
Adult
Blood Circulation
Electrophysiologic Techniques, Cardiac - methods
Feasibility Studies
Female
Fontan Procedure - methods
Heart Defects, Congenital - diagnosis
Heart Defects, Congenital - physiopathology
Heart Defects, Congenital - surgery
Humans
Male
Outcome Assessment (Health Care)
Postoperative Period
Punctures - methods
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Summary:In patients with Fontan circulation, the conduit may be punctured for electrophysiological procedures. We evaluated the feasibility and safety of a stepwise approach to conduit puncture in adults who have undergone Fontan operation. We included 13 consecutive patients with lateral tunnel or extracardiac conduit Fontan circulation [median age (interquartile range), 24.0 (16.0-25.0) years; seven men] who had undergone electrophysiological procedures. We performed a stepwise approach to conduit puncture: 1st, Brockenbrough needle; 2nd, Brockenbrough needle with snare; 3rd, extra-steep Brockenbrough needle with/without snare; 4th radiofrequency transseptal needle with/without snare; 5th, wiring through the puncture; 6th, conduit dilation with angioplasty balloon; 7th, non-compliant or cutting balloon; and 8th, Inoue dilator. In 12 patients, conduit puncture was successful. In two, one, and two patients with a lateral tunnel made of the pericardium or right atrial wall, conduit puncture was performed by steps 1st, 2nd, and 4th, respectively. In one, three, two, and one patient with the Goretex lateral tunnel or extracardiac conduit, conduit puncture was performed by steps 1st, 6th, 7th, and 8th, respectively. Puncture time was significantly longer in patients with Goretex conduits than with pericardial conduits [62.0 (50.0-120.0) and 11.5 (10.0-14.8) min, respectively; P 
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/eux126