Percutaneous fenestration closure with problematic residual native atrial septum

Abstract

A variety of techniques have been utilized to close Fontan fenestrations. Among 20 patients who underwent a cardiac catheterization for fenestration closure, 3 patients had residual native atrial septum, forming an additional intermediate chamber on the pulmonary venous side of the fenestration. Three different methods were used to close these fenestrations.

Tratamento percutâneo de lesões residuais e complicações em condutos de pacientes submetidos a cirurgia de circuito do tipo Fontan

“…Essas próteses ainda são ideais na oclusão de fenestrações de difícil delimitação anatômica, com trajeto tortuoso ou múltiplas. 13 Entretanto, a necessidade de bainhas de maior perfil pode dificultar ou até mesmo impedir a realização do procedimento em crianças menores, de baixo peso. O presente estudo relata a efetividade do procedimento de oclusão percutânea de fenestrações com bons resultados em relação à melhora da saturação sistêmica em todos os pacientes, independentemente do dispositivo utilizado, com apenas um paciente apresentando shunt residual com queda da saturação no seguimento a curto prazo.…”

Advances in Complex Valvular Disease

“…As mentioned, many studies specifically excluded patients with combined aortic stenosis and coronary artery disease, and current guidelines tend to favor surgery considering the limitations of the data [32,33]. Preliminary data also suggests that patients undergoing coronary stenting prior to TAVR may have worse outcomes and increased need for re-interventions due to major adverse cardiac and cerebrovascular events [34,35].…”

“…As long as the process of muscular wall thickening keeps pace with narrowing of the aortic orifice, the 'wall tension' is maintained. Gradually, this results in compensatory concentric left ventricular hypertrophy (LVH) to maintain ejection fraction [35].…”

“…• In patients with symptomatic severe aortic stenosis undergoing aortic valve replacement, reduced GLS (Particularly in the setting of normal LVEF) provides important prognostic information beyond standard risk factors [35].…”

“…Bilateral cerebral perfusion may be useful in patients with carotid artery stenosis, previous stroke or cerebrovascular anomalies (incomplete Circle of Willis). Malvindi concluded in his review that "While both unilateral and bilateral ASCP are acceptable, bilateral antegrade cerebral perfusion is safer, when the antegrade SCP time is more than 40-50 minute" [35].…”