Cardiac catheterization and test occlusion of the interatrial communication after the fenestrated Fontan operation

Bridges, Nancy D.; Lock, James E.; Mayer, John E.; Burnett, Janice; Castañeda, Aldo R.

doi:10.1016/0735-1097(95)00055-9

Cited by 74 publications

(37 citation statements)

References 18 publications

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“…ic effects of test occlusion and selection of patients for transcatheter closure, 15,20 the methodology for transcatheter closure of fenestrations with the use of several different devices, 13,17,21,22 and the short-term follow-up of those patients. The present study, although significantly increasing the number of patients available for analysis, does not substantively alter the conclusions of those prior studies: generally, test occlusion modestly increases O 2 saturations, modestly increases right-sided pressures, and modestly reduces cardiac output.…”

Section: Previous Workmentioning

confidence: 99%

Clinical Outcome of Fenestrated Fontan Patients After Closure

et al. 2000

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Background —The late clinical status of Fontan patients after fenestration closure is unknown. Data are now available on all patients who underwent closure from 1989 to 1999. Methods and Results —All patients who underwent catheter closure of a Fontan fenestration were enrolled in either the Clamshell (1989 to 1994) or CardioSEAL (1996 to 1999) regulatory trials. Physiological values obtained at catheterization helped assess the hemodynamic effects of fenestration occlusion. In addition to survival, outcomes assessed included O 2 saturations, medication use, significant clinical findings (eg, heart failure, protein-losing enteropathy, or new arrhythmias), and somatic growth. Of 181 patients who underwent closure, 27 had additional significant leaks. The remaining 154 patients constituted the study group. Median time from closure to latest follow-up was 3.4 years (range 0.4 to 10.3 years). Fenestration closure increased O 2 saturation 9.4% on average ( P <0.001). The numbers of patients receiving digoxin or diuretics decreased at the most recent follow-up compared with baseline ( P <0.001), but use of antiarrhythmic agents increased marginally ( P =0.05). Height and weight percentiles rose (medians of 2 and 4, respectively; P <0.001). Clinical decompensation during follow-up of 154 patients was rare (4.5%), with 2 deaths, 3 Fontan revisions, and 1 patient each with protein-losing enteropathy and ascites. No other patient developed chronic congestive symptoms; 21 patients developed new arrhythmias, and 2 had a stroke or transient ischemic attack. Conclusions —Fenestration closure in Fontan patients was followed by improved oxygenation, reduced need for anticongestive medication, and improved somatic growth at latest follow-up. Death (1.3%) or chronic decompensation (3.2%) was rare.

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Section: Previous Workmentioning

confidence: 99%

Clinical Outcome of Fenestrated Fontan Patients After Closure

et al. 2000

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“…6 -8 Stenotic lesions of the pulmonary arteries can contribute to significant downstream hypoplasia of pulmonary arteries, ventilation/perfusion mismatch, impaired postsurgery revascularization, thromboembolism, limited exercise capacity, increased atrial level shunting, atrial/ventricular arrhythmias, and protein-losing enteropathy, all important concerns during and after surgery and for the quality of postoperative life. 4,9,10 Surgical patch augmentation of the left pulmonary artery (LPA), 11,12 balloon angioplasty, and fenestration 13 are common interventions used to overcome elevated Fontan baffle pressures and poor left lung perfusion, which are associated with stenotic pulmonary arteries. In this study, to compare the hemodynamic outcomes associated with these options, LPA augmentation and fenestration were performed virtually in a computer medium on idealized models and on a selected patient-specific extracardiac TCPC.…”

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confidence: 99%

Total Cavopulmonary Connection Flow With Functional Left Pulmonary Artery Stenosis

et al. 2005

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Background-In our multicenter study of the total cavopulmonary connection (TCPC), a cohort of patients with long-segment left pulmonary artery (LPA) stenosis was observed (35%). The clinically recognized detrimental effects of LPA stenosis motivated a computational fluid dynamic simulation study within 3-dimensional patient-specific and idealized TCPC pathways. The goal of this study was to quantify and evaluate the hemodynamic impact of LPA stenosis and to judge interventional strategies aimed at treating it. Methods and Results-Simulations were conducted at equal vascular lung resistance, modeling both discrete stenosis (DS) and diffuse long-segment hypoplasia with varying degrees of obstruction (0% to 80%). Models having fenestrations of 2 to 6 mm and atrium pressures of 4 to 14 mm Hg were explored. A patient-specific, extracardiac TCPC with 85% DS was studied in its original configuration and after virtual surgery that dilated the LPA to 0% stenosis in the computer medium. Performance indices improved exponentially (R 2 Ͼ0.99) with decreasing obstruction. Diffuse long-segment hypoplasia was Ϸ50% more severe with regard to lung perfusion and cardiac energy loss than DS. Virtual angioplasty performed on the 3-dimensional Fontan anatomy exhibiting an 85% DS stenosis produced a 61% increase in left lung perfusion and a 50% decrease in cardiac energy dissipation. After 4-mm fenestration, TCPC baffle pressure dropped by Ϸ10% and left lung perfusion decreased by Ϸ8% compared with the 80% DS case. Conclusions-DS Ͻ60% and diffuse long-segment hypoplasia Ͻ40% could be considered tolerable because both resulted in only a 12% decrease in left lung perfusion. In contrast to angioplasty, a fenestration (right-to-left shunt) reduced TCPC pressure at the cost of decreased left and right lung perfusion. These results suggest that pre-Fontan computational fluid dynamic simulation may be valuable for determining both the hemodynamic significance of LPA stenosis and the potential benefits of intervention. (Circulation. 2005;112:3264-3271.)

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“…The tradeoff of low cardiac output for full oxygen saturation is often not beneficial for the patient, because tissue oxygen delivery (the product of oxygen content and cardiac output) is usually less after elimination of the shunt, as has been demonstrated with a number of other congenital malformations. 6 In the unusual case of an adult patient presenting with a small RV volume, tricuspid regurgitation, and true right-sided heart failure symptoms, surgical reconstruction or replacement of the TV in the annular position is probably the best option. 7 An alternative surgical approach, which has been used primarily in children, is the "11/2 ventricle repair," in which a bidirectional Glenn shunt is performed (superior vena cava disconnected from the RA and anastomosed directly to the right pulmonary artery).…”

Section: Indications For Interventionmentioning

confidence: 99%