Creation of a transcatheter fenestration in children with failure of fontan circulation: Focus on extracardiac conduit connection

Rupp, Stefan; Schieke, Christin; Kerst, Gunter; Mazhari, N.; Moysich, Axel; Latus, Heiner; Michel‐Behnke, Ina; Akintuerk, Hakan; Schranz, Dietmar

doi:10.1002/ccd.26042

Cited by 31 publications

(17 citation statements)

References 20 publications

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“…[34] As surgical creation of fenestration in Fontan circuit is more morbid, it is often done in the catheterization laboratory using Brokenbrough needle puncture of the conduit followed by stent placement. [567] If the angulation of the conduit from femoral venous route is unfavorable, or if there is lack of femoral venous access as in venous occlusion or left isomerism, transhepatic route gives a more perpendicular access to the conduit for a needle puncture. [89] In our patient, puncture was difficult because of tough ingrowth within the Dacron conduit as seen on the tomographic scans.…”

Section: Discussionmentioning

confidence: 99%

Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Singhi

Sivakumar

2016

Ann Pediatr Card

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Failing Fontan physiology in univentricular hearts manifest with protein-losing enteropathy, plastic bronchitis, low cardiac output, and recurrent effusions. Transcatheter creation of fenestration in a failing Fontan may be useful in alleviating the symptoms by improving the cardiac output. It is traditionally achieved by puncturing through the conduit from femoral or jugular venous access. In the absence of good venous path, transhepatic access provides a direct route for needle puncture of the conduit. If marked intimal ingrowth into the conduit results in increasing rigidity and makes the conduit nonyielding, alternative approaches may be needed. A successful creation of pulmonary artery to atrial roof communication through the potential space of transverse sinus using a covered stent is presented.

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Section: Discussionmentioning

confidence: 99%

Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Singhi

Sivakumar

2016

Ann Pediatr Card

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“…Various methods of achieving this have been described, including conduit puncture and balloon dilation (in lateral tunnel Fontan circulations). More recently, techniques have been described for transcatheter creation of a fenestration in patients with extracardiac conduits, by placing a covered stent between the pulmonary artery and the atrium, for example [358][359][360]. A detailed understanding of the anatomy in this setting is vital, and cross-sectional imaging is useful in planning the best approach.…”

Section: Uncommon Indications For Catheter Interventionmentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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“…It has to be noticed that a diabolo-shaped stent configuration might be intended in some special conditions and is the goal of the procedure, for instance, in preserving communications between Fontan-tunnel and atrium. 6,7 However, in our case series, this diabolo or extreme "dog-bone" configuration was not intended. It seems that stent and balloon design together with balloon-stent length ratio and balloon inflation-deflation behaviour interacts in conjunction with the right ventricular outflow tract anatomy.…”

Section: Discussionmentioning

confidence: 90%

A word of caution: diabolic behaviour of AndraStents®: inflation of supporting balloon leads to “diabolo”-misconfiguration of the stent

et al. 2019

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Aims:Transcatheter implantation of pulmonary balloon-expandable stent-valves requires pre-stenting of the right ventricular outflow tract with large calibre stents. To increase awareness of the associated risks of this part of transcatheter pulmonary valve replacement therapy, we report potential fatal complications during the implantation of AndraStents® in the right ventricular outflow tract in six cases from five different European institutions and their management.Method and result:We present a retrospective case series analysis looking at the time period from 2013 to 2018. Of 127 AndraStents® implanted in the right ventricular outflow tract, in six patients, age from 13 to 71 years, a misconfiguration of the AndraStent® occurred forming a “diabolo”-configuration. During inflation of the balloon, the stent showed extreme “dog-boning”, an expansion of the stent at both ends with the middle part remaining unexpanded. This led to rupture of the balloon and loss of manoeuvrability in four patients. Out of the total six cases, in four patients the stent was eventually expanded with high-pressure balloons, and in one case the stent was surgically retrieved. In one patient, in whom a percutaneous retrieval of the embolised stent was attempted, a fatal bleeding occurred.Conclusions:Pre-stenting of the right ventricular outflow tract by AndraStents® can lead to misconfiguration of the stent with potentially fatal complications. Rescue strategies of misconfigured stents include stent inflation and placement with high pressure non-compliant balloons or surgical backup. Interventional retrieval measures of AndraStents® cannot be advised.

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Creation of a transcatheter fenestration in children with failure of fontan circulation: Focus on extracardiac conduit connection

Cited by 31 publications

References 20 publications

Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Unusual method of creation of a transcatheter fenestration in an extracardiac conduit fontan circulation

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

A word of caution: diabolic behaviour of AndraStents®: inflation of supporting balloon leads to “diabolo”-misconfiguration of the stent

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