Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: Medium-term outcomes
Abstract
Objective:
This study was to review an institutional experience with transcatheter closure of Fontan fenestrations and its impact on clinical care.
Background:
An interatrial fenestration improves postoperative outcomes in high-risk children undergoing a Fontan repair. While technical feasibility has been well defined, the clinical impact of subsequent closure is not well defined.
Methods:
Transcatheter closure of a surgically created or additional interatrial communication was attempted in 152 children at a median interval of 13.8 months after surgery. The clinical records were reviewed for demographic and anatomical characteristics, previous surgeries; catheterization data, and status at latest follow-up.
Results:
Mean oxygen saturation and right atrial pressure increased acutely from 87% ± 5% to 96% ± 3% (P < 0.001) and 12 ± 2 mm Hg to 13 ± 3 mm Hg (P < 0.001), respectively. Higher systemic venous atrial pressures after occlusion correlated with higher pulmonary artery pressures (P = 0.05) before the Fontan procedure and with higher right (P < 0.001) and left atrial (P = 0.001) and ventricular end-diastolic pressures (P < 0.001) immediately before occlusion. Complications included device malposition in 2 children, 1 child each had an air embolism and post-procedural bleeding, and each self-limiting and 1 child had acute ST elevation in inferior ECG leads because of occlusion of the acute marginal branch which was treated with angioplasty and placement of a stent. At follow-up (median 4.5 years), the mean oxygen saturation was 95% ± 3%. Residual interatrial leaks were noted echocardiographically in 9%. Two children developed protein-losing enteropathy after fenestration closure. No deaths or strokes were observed in follow-up.
Conclusions:
Transcatheter occlusion of Fontan fenestrations is safe with acute and persistent improvements in oxygen saturations. © 2007 Wiley-Liss, Inc.
