Interventional therapeutic procedures in cavopulmonary shunts

Abstract

Background Cavopulmonary shunts are the palliative surgeries of choice in congenital heart diseases with the anatomical and pathophysiological defect of univentricular heart. The objective of this study was to report the results of percutaneous procedures in patients with complications following partial or total surgical cavopulmonary shunts. Methods: The procedures were conducted under general anesthesia and continuous monitoring of hemodynamic and respiratory parameters. The accesses used were the femoral vein (Fontan) or the internal jugular vein (Glenn). The devices were those commonly used for treating vascular obstructions, occlusion of venovenous or arteriovenous shunts, and systemic-pulmonary anastomoses. Results: Ten procedures were conducted in ten patients; in that, four Glenn (Group I) and six Fontan (Group II). The mean age in Groups I and II was 86 months and 106 months, and the mean time since surgery was 24 months and 25 months, respectively. Six patients had obstructive lesions and four had venovenous shunts, systemic-pulmonary anastomosis or a fenestrated cavopulmonary tube. In cases with obstructive lesions, there was no residual gradient; after dilation, there was a significant increase or normalization of vessel diameter. In patients with shunts, there was complete occlusion after deployment of the device. In all cases hemodynamic parameters normalized, clinical status improved and there were no complications. Conclusions: Percutaneous procedures are safe and effective to treat obstructive lesions or shunts in patients with a history of cavopulmonary shunt and presenting such complications.