Catastrophic Transcatheter Baffle Fenestration for Failing Fontan Physiology

Henneveld, H; Hutter, Paul A.; Hitchcock, F; Sreeram, Narayanswami

doi:10.1016/s0003-4975(97)01265-4

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…Although the fenestrated ASO device was designed to maintain a persistent fenestration [10], both individuals in whom one was placed required stent placement within the fenestration to maintain patency. Although catastrophic complications have been described during atrial septal fenestration procedures [28, 29], we found the procedure to be safe.…”

Section: Discussionmentioning

confidence: 88%

Results of transcatheter Fontan fenestration to treat protein losing enteropathy

Vyas

Driscoll

Cabalka

et al. 2007

Cathet Cardio Intervent

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Transcatheter fenestration to create an interatrial communication has been used to treat patients with protein losing enteropathy (PLE) after Fontan operation. No systematic data have been reported assessing the results of this procedure. Our institutional database was queried to identify patients after Fontan operation who had transcatheter fenestration to treat PLE. Clinical notes, laboratory data, echocardiograms, and cardiac catheterization data were reviewed. From 1995 to 2005, 16 transcatheter fenestration procedures were performed in seven patients. Median age at fenestration was 18 years (range 13-41 years). Median duration of follow-up was 3.6 years (range 0.2-10.4 years). Techniques for fenestration included blade/balloon septostomy, stent placement, Amplatzer-fenestrated ASD device, and balloon dilation of previous stent. Size of the fenestration created was 5.2 +/- 1.1 mm. Systemic venous pressure remained unchanged after fenestration. Cardiac index increased significantly. Reduction of ascites and edema was noted after 9 of the 16 procedures. Ten of 16 (63%) of fenestrations spontaneously occluded. Three patients are free of ascites although recurrence of PLE occurred in all. One patient with a patent fenestration continues to have ascites. Two patients had Fontan takedown. One patient had conversion to a fenestrated extracardiac conduit Fontan and died postoperatively. The results of transcatheter Fontan fenestration are often disappointing. Maintaining fenestration patency is difficult. Even after "successful" fenestration, resolution of PLE may be incomplete and recurrences have occurred in all. Early consideration should be given to Fontan takedown or cardiac transplant in severely symptomatic patients with PLE who do not respond to fenestration. Transcatheter fenestration may be a bridge to a definitive procedure.

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Section: Discussionmentioning

confidence: 88%

Results of transcatheter Fontan fenestration to treat protein losing enteropathy

Vyas

Driscoll

Cabalka

et al. 2007

Cathet Cardio Intervent

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“…[8][9][10] Redo dilatation after some weeks with a balloon is dangerous: the fenestration will have fibrous walls, which will usually resist dilatation and only give way (rupture) with very big balloons, resulting in a broad tear and excessive (lethal) right to left shunt. 11 Because of the unsatisfactory long term results of fenestrations obtained by balloon dilatation only, stent implantation has been advocated. However, the medium term results were limited because of stent occlusion, stent migration, and difficulties in modifying stent diameter after initial placement.…”

Section: Discussionmentioning

confidence: 99%

Modified technique of stent fenestration of the atrial septum

Stümper

2003

Heart

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Objectives: To develop a modified technique for stenting the atrial septum in the treatment of patients with a failing Fontan operation or pulmonary hypertension. Setting: Two tertiary referral centres. Study design: Prospective collaborative clinical study. Patients and methods: A stent was mounted on a standard valvoplasty balloon catheter which was constricted to a predefined diameter by a loop created from a temporary pacing wire. Full balloon inflation created a diabolo shaped stent configuration. The technique was employed in 12 consecutive patients to relieve symptoms of a failing Fontan circulation (n = 6) or severe pulmonary hypertension (n = 6). Results: Ex vivo studies confirmed that a diabolo shaped stent configuration could be achieved using the above technique. Transcatheter stent implantation was successful in all 12 patients. All six Fontan patients showed significant clinical improvement. Right atrial pressure decreased from (mean (SD)) 16.8 (2.5) to 13.7 (1.9) mm Hg (p < 0.05), and arterial oxygen saturation from 92.8 (1.8)% to 82.7 (3.8)% (p < 0.01). Six patients underwent successful stent fenestration for treatment of pulmonary hypertension. All stents were patent and stable at the most recent follow up (mean 1.75 (1.05) years). No early or late stent related complications were encountered. Conclusions: This new technique allows placement of a diabolo shaped stent with a predefined diameter across the atrial septum. The diabolo shape increases stent stability, facilitates recrossing of the stent during future catheter interventions, and ensures medium term stent patency.

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“…There is one case report about an uncontrolled tear of a baffle, created from native atrial tissue using a 16 mm balloon. 6 This caused the patient’s death after the procedure. 6 The tear was explained due to easy stretchability and subsequent recoil of the native atrium.…”

Section: Discussionmentioning

confidence: 99%

Ablation of atrial flutter in a patient after Fontan procedure: a case report of challenging access to the common atrium

Maslova,

Demming,

Nonnenmacher

et al. 2024

European Heart Journal - Case Reports

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Background In patients with a total cavopulmonary connection in Fontan circulation the access to the common atrium (CA) during a catheter ablation can be challenging, even in the presence of a fenestration in an intra-atrial lateral tunnel (IALT). In our department, the fenestration is typically marked with metal clips (MCs). To the best of our knowledge, there is no previous report of balloonoplasty of clipped fenestration. Case summary A 19-year-old male with hypoplastic left heart syndrome (HLHS) was scheduled for catheter ablation of recurrent atrial tachycardia. He was diagnosed with HLHS prenatally and underwent a stepwise surgical palliation. Fontan circulation was completed with creation of a fenestrated IALT. The fenestration was marked by four metal clips. During the ablation procedure passage of the steerable sheath with mapping catheter to the CA was prevented by a small fenestration size and rigidness of the edges of the fenestration caused by the MCs. Multiple attempts to dilate the fenestration using a peripheric angioplasty balloon failed. Only angioplasty with the «balloon-against-dilator» technique was finally successful. Activation map showed a counterclockwise atrial flutter in the CA; successful ablation was performed. Discussion We present a case of challenging access to the CA through a clipped fenestration in a polytetrafluoroethylene baffle for AT Ablation. Even though a tunnel fenestration in Fontan patients facilitates access to the CA, the passage of a steerable introducer with a mapping catheter may be challenging due to diameter mismatch and the rigidity of its edges caused by MCs. The balloon-against-dilator technique might be helpful when conventional balloon angioplasty fails.

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Catastrophic Transcatheter Baffle Fenestration for Failing Fontan Physiology

Cited by 7 publications

References 4 publications

Results of transcatheter Fontan fenestration to treat protein losing enteropathy

Results of transcatheter Fontan fenestration to treat protein losing enteropathy

Modified technique of stent fenestration of the atrial septum

Ablation of atrial flutter in a patient after Fontan procedure: a case report of challenging access to the common atrium

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