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  • Title: [Failed transcatheter creation of fenestration in a Fontan patient with original fenestration closed by AngelWings septal occluder: a case report].
    Author: Ohno A, Hirotaka I, Kobayashi T, Asano H, Kyo S, Senzaki H.
    Journal: J Cardiol; 2007 Oct; 50(4):271-5. PubMed ID: 17987844.
    Abstract:
    The fenestrated Fontan procedure has helped to reduce the mortality and morbidity of pediatric patients who underwent the Fontan operation. We treated a patient (7-year-old, female) who had developed heart failure 1 year after fenestration closure using an AngelWings device, although the patient met the proposed criteria for test occlusion. Hemodynamic evaluation using the ventricular pressure-area relationship revealed that the patient had both systolic and diastolic dysfunction, which were difficult to recognize by conventional hemodynamic indices. We then tried to percutaneously create a fenestration using a Brockenbrough needle, but this procedure failed. The AngelWings device, which may have been covered by pseudointima (composed of fibroelastic tissue), was hard enough to break the Brockenbrough needle. Re-creating a fenestration after device closure in patients after the fenestrated Fontan operation appears to be difficult, so more accurate methods to predict Fontan physiology after fenestration closure are needed.
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