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  • Title: [Safety and efficacy of transcatheter closure of Fontan fenestration with atrial septal occluder].
    Author: Guo Y, Liu TL, Xu XY, Gao W.
    Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2023 May 24; 51(5):476-480. PubMed ID: 37198118.
    Abstract:
    Objective: To assess the safety and efficacy of transcatheter fenestration closure following Fontan procedure with an atrial septal occluder. Methods: This is a retrospective study. The study sample consists of all consecutive patients who underwent closure of a fenestrated Fontan baffle at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine between June 2002 and December 2019. The indications of Fontan fenestration closure included that normal ventricular function, targeted drugs for pulmonary hypertension and positive inotropic drugs were not required prior the procedure; and the Fontan circuit pressure was less than 16 mmHg (1 mmHg=0.133 kPa) and no more than a 2 mmHg increase during test occlusion of the fenestration. Electrocardiogram and echocardiography were reviewed at 24 hours, 1, 3, 6 months and annually thereafter post procedure. Follow-up information including clinical events and complications related to Fontan procedure was recorded. Results: A total of 11 patients, including 6 males and 5 females, aged (8.9±3.7) years old were included. The types of Fontan were extracardiac conduits (7 cases) and intra-atrial duct (4 cases). The interval between percutaneous fenestration closure and the Fontan procedure was (5.1±2.9) years. One patient reported recurrent headache after Fontan procedure. Successful fenestration occlusion with atrial septal occluder was achieved in all patients. Compared with prior closure, Fontan circuit pressure ((12.72±1.90) mmHg vs. (12.36±1.63) mmHg, P<0.05), and aortic oxygen saturation ((95.11±3.11)% vs. (86.35±7.26)%, P<0.01) were increased. There were no procedural complications. At a median follow-up of (3.8±1.2) years, there was no residual leak and evidence of stenosis within the Fontan circuit in all patient. No complication was observed during follow-up. One patient with preoperative headache did not have recurrent headache after closure. Conclusions: If the Fontan pressure is acceptable by test occlusion during the catheterization procedure, Fontan fenestration could be occluded with the atrial septum defect device. It is a safe and effective procedure, and could be used for occlusion of Fontan fenestration with varying sizes and morphologies. 目的： 初步评价应用房间隔缺损封堵器经皮心导管关闭Fontan术后管道开窗的有效性及安全性。 方法： 该研究为回顾性研究。选取2002年6月至2019年12月在上海交通大学医学院附属上海儿童医学中心行经心导管关闭Fontan管道开窗手术的患者。Fontan管道开窗封堵手术的指征为：心功能基本正常，平时不需要口服肺动脉高压靶向治疗药物及正性肌力药物，术中试封堵后Fontan管道压力≤16 mmHg（1 mmHg=0.133 kPa）且较封堵前升高不超过2 mmHg。患者于术后24 h，1、3、6个月及此后每年复查心电图及超声心动图，观察并记录患者介入术前后临床症状的变化及是否有Fontan手术相关并发症。 结果： 共纳入11例患者，男性6例，女性5例，年龄（8.9±3.7）岁。Fontan术式方面，7例采用心外管道，4例采用心房内管道。管道开窗封堵术距Fontan术时间为（5.1±2.9）年。Fontan术后1例患者有间歇性头痛发作。所有患者均成功应用房间隔缺损封堵器完成封堵。与封堵前比较，封堵后Fontan管道压力［（12.72±1.90）mmHg比（12.36±1.63）mmHg，P<0.05］及主动脉血氧饱和度［（95.11±3.11）%比（86.35±7.26）%，P<0.01］均增高。随访时间为（3.8±1.2）年，所有患者均无残余分流，管道血流通畅，无并发症发生。1例术前有头痛的患者术后头痛未再发作。 结论： 封堵试验中Fontan管道压力达封堵指征的患者可应用房间隔缺损封堵器封堵Fontan管道开窗，该方法安全、有效，适合不同大小和形态的开窗封堵。.
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