Transcatheter reduction in size of large undesirable fenestrations following extracardiac conduit Fontan surgery with off-label use of Occlutech atrial flow regulator

Sonawane, Bhushan; Sivakumar, Kothandam

doi:10.4103/apc.apc_52_20

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…It is still unclear how lower oxygen saturation can cause increased venous congestion; a suggested mechanism is through a direct increase in pulmonary vascular resistance via induction of pulmonary vasoconstriction 13 . Low oxygen saturation prior to Fontan might also result from Fontan dysfunction, leading to increased flow across the fenestration with more desaturation 14 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of protein losing enteropathy after Fontan completion: An 8-year retrospective study at Sheikh Khalifa Medical City

AbdelMassih

Király

Badaoui

et al. 2023

gcsp

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Background: The Fontan procedure is the final stage of a three-stage palliation process in patients born with a univentricular heart as part of hypoplastic left heart syndrome (HLHS) or other pathologies with a univentricular heart. As essential as this procedure has proven to be for such cases, the Fontan physiology diminishes cardiac output and expands systemic venous pressure, which then leads to venous congestion that can be complicated by protein-losing enteropathy (PLE). This retrospective study aimed to identify the predictors of such complications in all patients who underwent completion of the Fontan procedure at our center (Sheikh Khalifa Medical City/SKMC) in the past eight years. Methods: This study examined the medical records of patients who underwent completion of Fontan repair at our center since the inauguration of the cardiac surgery program of SKMC in the United Arab Emirates (UAE). Exclusion criteria included the absence of any of the required predictors in a medical report. Patients were divided into two groups: those who developed PLE and those who did not. For each group, the following data were collected: degree of AV valve regurgitation, ventricular function, invasive SVC, pulmonary pressure before Fontan completion, and original cardiac diagnosis. Results: Of the 48 included patients,13 (25%) developed PLE. Multivariate regression analysis showed that the best predictors of PLE were AV valve regurgitation (P=0.02), SVC mean pressure (P =0.006), and ventricular function (P =0.02). Oxygen saturation <83% prior to Fontan completion was 92% sensitive in predicting PLE after Fontan completion. Conclusion: This is a single-center study of the predictors of PLE after Fontan procedure and, as expected from similar studies, moderate AV valve regurgutation and a dominant right ventricle were good predictors of Fontan failure. The higher prevalence of PLE in our cohort as well as lower cut-offs of SVC pressure that can predict complications might be related to the predominance of hypoplastic left heart in the operated patients, which has been the main referral center for cardiac surgeries in UAE in the last decade.

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Section: Discussionmentioning

confidence: 99%

Predictors of protein losing enteropathy after Fontan completion: An 8-year retrospective study at Sheikh Khalifa Medical City

AbdelMassih

Király

Badaoui

et al. 2023

gcsp

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“…Regarding desaturation in the early phase, some reports suggest that patients with overly large fenestrations experience severe desaturation and need percutaneous intervention to reduce the fenestration size. 14–17 These reports suggest that fenestration size and desaturation are associated. However, the unresolved question is how large a fenestration should be to influence desaturation in each patient.…”

Section: Commentmentioning

confidence: 96%

“…Some reports suggest that patients with overly large fenestrations experience severe desaturation and require percutaneous intervention to reduce the fenestration size. [14][15][16][17] Another unresolved question is how a large fenestration size influences desaturation in each patient. Therefore, this study analyzed mid-term outcomes following the fenestrated Fontan procedure with a focus on the association between fenestration size and risks of spontaneous fenestration closure or severe desaturation.…”

Section: Introductionmentioning

confidence: 99%

Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Miwa,

Iwai,

Kanaya

et al. 2023

World J Pediatr Congenit Heart Surg

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Background We aimed to analyze mid-term outcomes of the fenestrated Fontan procedure, focusing on the fenestration size. Methods We retrospectively reviewed the outcomes of the fenestrated Fontan procedure. Among 165 patients who underwent the Fontan procedure from 2011 to 2021, fenestration was created in 27 patients with the highest risks, including those with hypoplastic left heart syndrome, hypoplastic pulmonary arteries, heterotaxy syndrome with high pulmonary vascular resistance, and pulmonary arterial pressure >15 mm Hg. The patients underwent the procedure at a median age of three years (body weight, 11.4 kg; body surface area, 0.54 m2). Fenestration sizes were 3.5 to 5 mm. Results Spontaneous fenestration closure occurred within one year postoperatively in nine patients. Among them, three experienced Fontan failure, necessitating refenestration. Although fenestration size did not differ, the size corrected by body surface area at the time of surgery was smaller in patients with fenestration closure (6.4 mm/m2 vs 8.3 mm/m2, P < .05). Patients with a fenestration <7 mm/m2 were more likely to have fenestration closure within one year postoperatively, and those with a fenestration >9 mm/m2 were more likely to have severe desaturation and require home oxygen therapy following discharge. Conclusions Spontaneous fenestration closure affected the frequency of Fontan complications. A very small fenestration size corrected by body surface area was a significant risk factor for spontaneous closure. Conversely, a very large fenestration size corrected by body surface area resulted in severe desaturation. The optimal fenestration size to prevent early spontaneous closure and severe desaturation is approximately 8 mm/m2.

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Transcatheter creation of a pulmonary artery to left atrial fenestration in a failing Fontan circulation using the Atrial Flow Regulator (AFR)

et al. 2021

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Transcatheter creation of an interatrial communication using the Occlutech Atrial Flow Regulator Device for pulmonary hypertension or heart failure is well described. We report a case of an 8-year-old boy with a failing Fontan circulation, in whom the Atrial Flow Regulator was used to successfully create a fenestration between the pulmonary artery and left atrium, improving his clinical condition.

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Transcatheter reduction in size of large undesirable fenestrations following extracardiac conduit Fontan surgery with off-label use of Occlutech atrial flow regulator

Cited by 5 publications

References 8 publications

Predictors of protein losing enteropathy after Fontan completion: An 8-year retrospective study at Sheikh Khalifa Medical City

Predictors of protein losing enteropathy after Fontan completion: An 8-year retrospective study at Sheikh Khalifa Medical City

Impact of Optimal Fenestration Size on Outcomes of High-Risk Fontan Patients

Transcatheter creation of a pulmonary artery to left atrial fenestration in a failing Fontan circulation using the Atrial Flow Regulator (AFR)

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