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Ann Thorac Surg 2003;76:1923-1928
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Clipped tube fenestration after extracardiac Fontan allows for simple transcatheter coil occlusion

^a Cardiac Sciences and Department of Radiology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada

Accepted for publication June 30, 2003.

^* Address reprint requests to Dr Sett, Cardiac Sciences, British Columbia's Children's Hospital, 4480 Oak St, Vancouver BC V6H 3V4, Canada
e-mail: ssett{at}cw.bc.ca

BACKGROUND: Expensive devices are increasingly used to close a patent fenestration after a modified Fontan operation. We report our 5-year institutional experience of clipped tube fenestration after extracardiac Fontan operation, which allows for simple transcatheter coil occlusion.

METHODS: We retrospectively reviewed 30 children, median age of 4.0 years (range, 2.4 to 8.8 years) who underwent extracardiac Fontan operation between May 1996 and May 2001, and were fenestrated using a 4- to 8-mm diameter clipped tube graft.

RESULTS: Ten children had a patent fenestration occluded by transcatheter placement of 15 detachable coils (5- to 8-mm diameter). Aortic oxygen saturations increased on average by 5.5% (2% to 14%) and mean pressures in the Fontan circuit by 2.5 mm Hg (0 to 3 mm Hg). Four had immediate complete occlusion angiographically and 6 had trivial residual shunt, but complete occlusion by echocardiography at follow-up. There have been no immediate complications, late coil embolizations, thromboembolic events, or documented hemolysis within a follow-up after coil implantation of 1.7 years (0.4 to 4.5 years). Spontaneous fenestration closure was documented in 8 patients at cardiac catheterization and 9 patients by echocardiography with consistent improvement in resting transcutaneous oxygen saturation. Two children with a patent fenestration have been considered inappropriate for closure, and there was one early surgical death. There have been no complications related to the tube fenestration modification within a follow-up postoperation of 2.6 years (0.1 to 5.5 years).

CONCLUSIONS: Clipped tube fenestration after extracardiac Fontan operation is a useful surgical modification that allows for simple transcatheter coil occlusion.

This article has been cited by other articles:

				R. Prem Sekar and K. M Cherian Device Occlusion of Fontan Fenestration--an Economical Alternative Asian Cardiovasc Thorac Ann, October 1, 2007; 15(5): e55 - e57. [Abstract] [Full Text] [PDF]