Dilatation and Stenting of the Fontan Pathway: Impact of the Stenosis Treatment on Chronic Ascites

Ovroutski, Stanislav; Ewert, Peter; Alexi-Meskishvili, Vladimir; Peters, Björn; Hetzer, Roland; Berger, Felix

doi:10.1111/j.1540-8183.2007.00323.x

Cited by 22 publications

(23 citation statements)

References 21 publications

(59 reference statements)

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“…The presence of aortapulmonary collaterals, branch pulmonary artery stenosis, atrioventricular valve regurgitation, elevated ventricular end diastolic pressures, APF, and stenosis of venous-pulmonary artery anastomosis can lead to a dysfunction in the Fontan circulation and thus to persistent pleural effusion, ascites, or protein-losing enteropathy. [3] Ligation of the pulmonary trunk in the total cavopulmonary connection has previously been described. [4] Residual pulmonary flow after this procedure causes a rise in pulmonary arterial pressure and hence dysfunction in the Fontan circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Stenosis in the pulmonary arteries or systemic veins, if noticed, should be corrected preoperatively. [3] Stenosis may also develop postoperatively mainly at the anastomosis area. In Fontan circuits, pulmonary artery stenosis causes an increase in blood pressure of the contralateral lung and can result in persistent pleural effusion and ascites.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A different approach to treatment of failing Fontan: Transcatheter covered stent implantation

Yücel

Ballı

Yılmaz

et al. 2016

Arch Turk Soc Cardiol

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Özet-İki yaşında iki yönlü Glenn ameliyatı geçirmiş ve beş yaşında pulmoner trunkus bağlanması ve kalp dışı Fontan ameliyatı geçirmiş çift çıkımlı sağ ventrikül, ventriküler septal defekt ve pulmoner stenozlu bir hasta sunduk. Hasta Fontan ameliyatından üç ay sonra plevra sıvısıyla başvurdu. Fizik muayenesinde pulmoner odakta 3/6 sistolik üfürüm duyuldu. Ekokardiyografik değerlendirimede pulmoner öne doğru akım ve burada 80 mmHg basınç farkı tespit edildi. Kalp kateterizasyonu ve anjiyografi ça-tallanma düzeyinde darlık ve pulmoner öne doğru akımı gösterdi. Her iki patolojiyi de transkateter yolla kaplı stent yerleştirerek giderdik. Kontrol anjiyogramında çatallanma düzeyinde darlığın giderildiği ve öne doğru akımın kaybolduğu izlendi.Summary-A 5-year-old male with a double outlet right ventricle with noncommitted ventricular septal defect and pulmonary stenosis underwent a bidirectional Glenn operation at 2 years and a Fontan operation with ligation of the pulmonary trunk at 5 years. He presented with pleural effusion 3 months after the Fontan operation. Physical examination revealed a grade 3/6 systolic murmur in the pulmonary area. Echocardiographic evaluation revealed an antegrade pulmonary flow (APF) of gradient 80 mmHg across the ventriculopulmonary communication. Cardiac catheterization and angiography demonstrated the presence of residual antegrade pulmonary flow and stenosis at the pulmonary artery bifurcation. Both pathologies were treated using a single covered stent. Relief of the pulmonary artery stenosis and total occlusion of the residual APF was demonstrated on a control angiogram. 256F ontan surgery is the final stage operation of a series of palliative operations. It is performed on patients with complex congenital heart disease who are not suitable for biventricular repair. The procedure diverts systemic venous blood returning to the right atrium via the inferior vena cava to the pulmonary arteries. Since blood is transmitted passively to the lungs in Fontan circulation, pulmonary artery size, preoperative pulmonary arterial pressure, pulmonary vascular resistance, and the presence of branched pulmonary artery stenosis are of great importance, and determine the outcome of the procedure in these patients. Even a minor increase in pulmonary arterial pressure or an alteration in pulmonary blood flow may affect the hemodynamics of circulation and result in complications such as pleural effusion, ascites, or protein losing enteropathy. [1,2] This report describes successful transcatheter treatment using a single covered stent of a pleural effusion from pulmonary artery stenosis and residual pulmonary antegrade flow in a 5-year-old male with Fontan circulation. CASE REPORTA 5-year-old male presented with pleural effusion 3 months after an extracardiac conduit Fontan operation. His initial diagnosis was double outlet right ventricle with noncommited ventricular septal defect and pulmonary stenosis. The patient had undergone a bidirectional Glenn operation at 2 years and an extracardiac conduit Fontan...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A different approach to treatment of failing Fontan: Transcatheter covered stent implantation

Yücel

Ballı

Yılmaz

et al. 2016

Arch Turk Soc Cardiol

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“…They underscored the difficulty of detecting gradients in low-pressure system and the fact that these obstructions may impede passive venous flow, particularly in opposed to the gravitational direction 7 .…”

Section: Discussionmentioning

confidence: 99%

Implante de stents em conduto cirúrgico cavopulmonar: relato de dois casos

Cristóvão¹,

Neto²,

Marques³

et al. 2011

Arq. Bras. Cardiol.

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“…(53,57) (58,59) These narrowed parts of the Fontan circuit would typically be addressed in the catheter laboratory with balloon dilatation or stent implantation in the older child and adult. (30,(60)(61)(62) …”

Section: Thromboembolismmentioning

confidence: 99%

“…In adults catheter based interventions are not common, but may include stenting of branch pulmonary artery stenosis or venous pathway obstruction. (30) Coil or vascular plug embolisation of collaterals may be necessary in the profoundly cyanosed and also in patients with aortobronchial fistula, presenting with haemoptysis. (31)(32)(33) …”

mentioning

confidence: 99%

Management of the Fontan circulation in the adult patient

Clift

2017

SAHJ

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Dilatation and Stenting of the Fontan Pathway: Impact of the Stenosis Treatment on Chronic Ascites

Abstract: Transcatheter treatment of stenosis can effectively improve the hemodynamics in Fontan circulation, even in patients without measurable pressure gradient. In those with low PAP, it may lead to the disappearance of chronic ascites.

Cited by 22 publications

References 21 publications

A different approach to treatment of failing Fontan: Transcatheter covered stent implantation

A different approach to treatment of failing Fontan: Transcatheter covered stent implantation

Implante de stents em conduto cirúrgico cavopulmonar: relato de dois casos

Management of the Fontan circulation in the adult patient

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