Partial Fontan: Advantages of an adjustable interatrial communication

Laks, Hillel; Pearl, Jeffrey M.; Haas, Gary S.; Drinkwater, Davis C.; Milgalter, Eli; Jarmakani, Jay M.; Isabel-Jones, Josephine; George, B; Williams, Roberta G.

doi:10.1016/0003-4975(91)91286-5

Cited by 139 publications

(45 citation statements)

References 22 publications

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“…[1][2][3][4] Death and poor outcomes after Fontan-like procedures may be increased by one or more risk factors, including high pulmonary vascular resistance, poor systolic or diastolic ventricular function, hypoplastic or distorted pulmonary arteries, and systemic outflow obstruction. [5][6][7][8] Recognizing that some of these risk factors were transient after surgery, Laks et al 9 used an adjustable atrial septal defect to preserve cardiac output at the expense of oxygenation in high-risk patients in the immediate postoperative period. Based on a growing experience with transcatheter techniques to close various intracardiac defects, 10 -12 Bridges et al 13 described a technique for late postoperative closure of Fontan baffle fenestrations by use of test occlusion and subsequent permanent closure with an intracardiac device.…”

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confidence: 99%

Clinical Outcome of Fenestrated Fontan Patients After Closure

et al. 2000

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Background —The late clinical status of Fontan patients after fenestration closure is unknown. Data are now available on all patients who underwent closure from 1989 to 1999. Methods and Results —All patients who underwent catheter closure of a Fontan fenestration were enrolled in either the Clamshell (1989 to 1994) or CardioSEAL (1996 to 1999) regulatory trials. Physiological values obtained at catheterization helped assess the hemodynamic effects of fenestration occlusion. In addition to survival, outcomes assessed included O 2 saturations, medication use, significant clinical findings (eg, heart failure, protein-losing enteropathy, or new arrhythmias), and somatic growth. Of 181 patients who underwent closure, 27 had additional significant leaks. The remaining 154 patients constituted the study group. Median time from closure to latest follow-up was 3.4 years (range 0.4 to 10.3 years). Fenestration closure increased O 2 saturation 9.4% on average ( P <0.001). The numbers of patients receiving digoxin or diuretics decreased at the most recent follow-up compared with baseline ( P <0.001), but use of antiarrhythmic agents increased marginally ( P =0.05). Height and weight percentiles rose (medians of 2 and 4, respectively; P <0.001). Clinical decompensation during follow-up of 154 patients was rare (4.5%), with 2 deaths, 3 Fontan revisions, and 1 patient each with protein-losing enteropathy and ascites. No other patient developed chronic congestive symptoms; 21 patients developed new arrhythmias, and 2 had a stroke or transient ischemic attack. Conclusions —Fenestration closure in Fontan patients was followed by improved oxygenation, reduced need for anticongestive medication, and improved somatic growth at latest follow-up. Death (1.3%) or chronic decompensation (3.2%) was rare.

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confidence: 99%

Clinical Outcome of Fenestrated Fontan Patients After Closure

et al. 2000

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“…Results of this study [12] indicated that the currently available medical, surgical, and percutaneous interventional strategies are not effective in a large number of these patients and are associated with a high morbidity and mortality. The advantages of a fenestration in patients with Fontan operation have been well described [1][2][3]. Percutaneous creation or reopening of fenestration after Fontan operation has been shown to be technically feasible in previous studies [4 -8] but acute or late spontaneous closure of fenestration has been noted in these patients on follow-up.…”

Section: Discussionmentioning

confidence: 95%

“…At cardiac catheterization, the right atrium was severely enlarged and the mean right atrial pressure was markedly elevated (23 mm Hg), mean left atrial pressure was 17 mm Hg, and pulmonary arteriolar resistance was 1.5 units m 2 . There was no obstruction of the Fontan pathways.…”

Section: Casementioning

confidence: 99%

“…These factors contribute to significant morbidity and mortality. The beneficial effects of fenestration after the Fontan operation have been well described [1][2][3]. Currently, if medical management of PLE and complications related to elevated systemic venous pressure after a Fontan operation is unsuccessful, surgical options for treatment include Fontan revision (with or without fenestration) or cardiac transplantation.…”

Section: Introductionmentioning

confidence: 98%

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Fenestrated Amplatzer device for percutaneous creation of interatrial communication in patients after Fontan operation

Chatrath

Cabalka

Driscoll

et al. 2003

Cathet Cardio Intervent

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A customized Amplatzer septal device with a 5 mm fenestration was used to create an interatrial communication in two patients with previous Fontan operation and clinical indication for fenestration. At follow-up, device fenestration was occluded in both patients. In both patients, the device fenestration was reopened and patency maintained by placement of two stents within the communicating channel.

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“…Creation of a fenestration in the Fontan baffle has been shown to improve immediate postoperative cardiac output and limit Fontan circuit pressure elevation [1,2]. Along with the diversity of methods to complete the Fontan operation, there have also been a number of techniques utilized to create fenestrations.…”

Section: Introductionmentioning

confidence: 99%