Fenestration in extracardiac conduits in children after modified Fontan operation by implantation of stent grafts

Three patients (ages 3, 5, and 8 years) with various forms of functionally univentricular heart lesions received a total cavopulmonary connection with an extracardiac conduit as a final reconstructive procedure. Failure of the Fontan circulation occurred immediately after surgery because of spontane...

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Bibliographic Details
Published in:Pediatric cardiology 2005-02, Vol.26 (1), p.93-96
Main Authors: Michel-Behnke, I, Luedemann, M, Bauer, J, Hagel, K-J, Akintuerk, H, Schranz, D
Format: Article
Language:English
Subjects:
Blood Vessel Prosthesis Implantation
Cardiac Catheterization
Cardiac Output
Cardiac Output, Low - surgery
Care and treatment
Case studies
Catheterization
Child
Child, Preschool
Complications and side effects
Coronary Angiography
Electrical conduits
Fontan Procedure
Heart
Heart diseases
Humans
Infant
Male
Pleural Effusion - surgery
Radiography, Interventional
Stents
Surgery
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Summary:Three patients (ages 3, 5, and 8 years) with various forms of functionally univentricular heart lesions received a total cavopulmonary connection with an extracardiac conduit as a final reconstructive procedure. Failure of the Fontan circulation occurred immediately after surgery because of spontaneous closure of surgical fenestrations in two children and absent fenestration in one. As an emergency procedure, in all patients the conduit was perforated by transcatheter intervention in order to create a connection to the anatomical right atrium. Following balloon dilatation of the perforated conduit, in all three patients covered stent grafts were placed in the newly created defect to attain a reliable communication. Patency of the fenestration was demonstrated by angiogram and any leakage was ruled out. Cardiac output improved and severe pleural effusion and ascites subsided. Right-to-left shunt could be demonstrated by echocardiography at follow-up after 7 months (median) in all three patients. Oxygen saturation remained stable between 85 and 90%. These preliminary results suggest that stent graft fenestration can serve as a valuable tool in failing Fontan circulation, particularly in patients with an extracardiac conduit. Covered stents have the potential to reduce the acute risk of bleeding and they help to prevent early spontaneous closure of the newly created fenestration.
ISSN:0172-0643
1432-1971
DOI:10.1007/s00246-004-0693-6