Fate of fenestration in children treated with fontan operation

Abstract

Spontaneous closure and favorable result in test occlusion are more common in tube than in window fenestrations. Since most preoperative anatomic and hemodynamic factors were similar in all patient groups, we find it difficult to predict the fate of a window-type fenestration and the result of test occlusion. © 2015 Wiley Periodicals, Inc.

The evolution of surgical technique of the fenestrated Fontan procedure

“…With each modification, fenestration patency has remained a primary concern, as 8% to 40% of fenestrations close spontaneously within 3 months 9,13 . Spontaneous closure rates can increase to 64% in tube fenestrations, compared with window‐type fenestrations 14 . In addition, Bando et al 11 found that despite anticoagulation, 64% of large (>4 mm) fenestrations vs 90% of small (2.5 mm) fenestrations closed spontaneously within 1 year of the procedure.…”

“…9,13 Spontaneous closure rates can increase to 64% in tube fenestrations, compared with window-type fenestrations. 14 In addition, Bando et al 11 found that despite anticoagulation, 64% of large (>4 mm) fenestrations vs 90% of small (2.5 mm) fenestrations closed spontaneously within 1 year of the procedure. While small fenestrations are associated with earlier closure and high systemic venous pressure, large fenestrations are associated with significant arterial desaturation.…”

State of the art of the Fontan strategy for treatment of univentricular heart disease

“…The reported incidence of catheter-based interventions (that is, excluding diagnostic cardiac catheterization without intervention) varies heavily; 3 to 65% of patients require at least one additional catheter intervention following Fontan completion 31 , 56 , 57 , 59 , 71 . The most common catheter interventions are fenestration closure (10 to 64% of patients with a fenestration require catheter-based fenestration closing 56 , 57 , 59 , 72 ), occlusion of veno-venous or aortopulmonary collaterals (incidence of 10 to 20%) 57 , 59 , and stenting and dilation of (all types of) obstructions in the Fontan pathway (incidence of 6 to 19%) 57 , 59 , 73 .…”