Fenestrated Fontan operation with delayed transcatheter closure of atrial septal defect

Kopf, Gary S.; Kleinman, Charles S.; Hijazi, Ziyad M.; Fahey, John T.; Dewar, Michael L.; Hellenbrand, William E.

doi:10.1016/s0022-5223(19)34867-6

Cited by 65 publications

(24 citation statements)

References 14 publications

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“…The current literature, however, is mixed with regard to the effect of single ventricular morphology on Fontan outcomes although several studies suggest that outcomes with systemic right ventricles are equivalent to systemic left ventricles. 14,16 Although the current study does not show a late increasing hazard after 20 years, further follow-up may lead to the characterization of such a phase beyond 25 years or more.…”

Section: Limitationscontrasting

confidence: 57%

The modern Fontan operation shows no increase in mortality out to 20 years: A new paradigm

Dabal

Kirklin

Kukreja

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Section: Limitationscontrasting

confidence: 57%

The modern Fontan operation shows no increase in mortality out to 20 years: A new paradigm

Dabal

Kirklin

Kukreja

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Surgeons in many centers utilize the “fenestrated Fontan” operation for candidates who do not fulfill criteria for a low risk Fontan operation [1]. When compared with the patients who have a Fontan operation without a fenestration, the patients with a fenestration have less chest tube drainage, less need for inotropic drugs, and shorter hospital stays [2–4].…”

Section: Introductionmentioning

confidence: 99%

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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“…A, Bridges et al 3 used an aortic punch to create the fenestration in the intra‐atrial baffle or atrial septal defect (ASD) patch. B, A fenestration was created using a 2.5‐ to 4‐mm aortic punch in the intracardiac lateral tunnel approach 3 . C, Laks et al 4 used an externally adjustable snare encircling an ASD.…”

Section: Figurementioning

confidence: 99%

“…In the lateral tunnel approach, a small incision is made in the medial aspect of the intra‐atrial baffle and a 2.5‐ to 4‐mm aortic punch creates the fenestration 11 . In 1991, Laks et al 4 reported the use of an externally adjustable snare encircling an atrial septal defect, which could be adjusted to allow for variable degrees of left‐to‐right shunting and thus building on the concept that he had originally described for pulmonary atresia with an intact ventricular septum 3 . When Jacobs and Norwood 5 described the two‐staged Fontan procedure around the same time, four to six 2‐mm fenestrations were added at various points along the length of the PTFE baffle using a 14‐gauge needle.…”

Section: Figurementioning

confidence: 99%

The evolution of surgical technique of the fenestrated Fontan procedure

et al. 2020

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Fenestrated Fontan operation with delayed transcatheter closure of atrial septal defect

Cited by 65 publications

References 14 publications

The modern Fontan operation shows no increase in mortality out to 20 years: A new paradigm

The modern Fontan operation shows no increase in mortality out to 20 years: A new paradigm

Results of transcatheter Fontan fenestration to treat protein losing enteropathy

The evolution of surgical technique of the fenestrated Fontan procedure

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