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Closure of Fontan fenestration with the use of covered stents: short- and mid-term results in a cohort of 50 patients

Published online by Cambridge University Press:  10 June 2014

Sophie Malekzadeh-Milani ,
Magalie Ladouceur ,
Fanny Bajolle ,
Damien Bonnet  and
Younes Boudjemline
Sophie Malekzadeh-Milani
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France
Magalie Ladouceur
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France
Fanny Bajolle
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France
Damien Bonnet
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Younes Boudjemline*
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker Hospital for Sick Children-HEGP, Assistance Publique des Hopitaux de Paris, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
*
Correspondence to: Dr Y. Boudjemline, MD, PhD, Hôpital Necker Enfants Malades, Cardiologie Pédiatrique, 149 rue de Sèvres, 75015 Paris Cedex, France. Tel: 00331 44 49 43 57; Fax: 00331 44 49 5724; E-mail: younes.boudjemline@nck.aphp.fr
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Abstract

Objective: The use of covered stents to close fenestration in total cavopulmonary connection is presented. Methods: We retrospectively reviewed data of all patients undergoing the procedure of a covered stent to close fenestration of total cavopulmonary connection between 2005 and 2012. Results: A total of 50 patients met the inclusion criteria. Median age and weight were 7.7 years and 20 kg, respectively. Median interval between Fontan completion and fenestration closure was 13 months. The femoral vein was used in 42 patients and the jugular vein in eight patients. Of the patients, seven received two stents. Covered stents were CP stents in 42 patients and Atrium Advanta V12 in eight patients. BIB balloons were used in 24 patients and simple balloons in 18 patients. Simultaneous occlusion of venous collaterals was observed in five patients. Median procedural and fluoroscopy times were 49 and 8 minutes, respectively. Mean central venous pressure rose from 10 to 12 mmHg. Mean oxygen saturation increased from 88% to 96%. Full occlusion was confirmed in 47 patients. The remaining had residual shunts: two patients had intracardiac Fontan, and one patient had a stent that could not be fully opened. Following the procedure, five patients had local bleeding, and three delayed discharge 48 hours after the procedure. There was no thromboembolic event after a mean follow-up of 49 months. Conclusion: Covered stent is a good option to close fenestration in extracardiac total cavopulmonary connection. It is safe, easily achievable with low fluoroscopy time, with very low risk of complication or failure. Good results are sustainable when excluding patients with none circular pathway.

Keywords

Total cavopulmonary connectionfenestrationcovered stents
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 868 - 873
Copyright
© Cambridge University Press 2014 

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References

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.Google Scholar
2. Stewart, RD, Pasquali, SK, Jacobs, JP, et al. Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection. Ann Thorac Surg. 2012; 93: 1254–1260; discussion 1261.Google Scholar
3. Lemler, MS, Scott, WA, Leonard, SR, Stromberg, D, Ramaciotti, C. Fenestration improves clinical outcome of the Fontan procedure: a prospective, randomized study. Circulation 2002; 105: 207–212.Google Scholar
4. Bridges, ND, Mayer, JE Jr, Lock, JE, et al. Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 1992; 86: 1762–1769.CrossRefGoogle ScholarPubMed
5. Atz, AM, Travison, TG, McCrindle, BW, et al. Pediatric Heart Network Investigators. Late status of Fontan patients with persistent surgical fenestration. J Am Coll Cardiol. 2011; 57: 2437–2443.Google Scholar
6. Imielski, BR, Woods, RK, Mussatto, KA, Cao, Y, Simpson, PM, Tweddell, JS. Fontan fenestration closure and event-free survival. J Thorac Cardiovasc Surg 2013; 145: 183–187.Google Scholar
7. Boudjemline, Y, Bonnet, D, Sidi, D, Agnoletti, G. Closure of extrocardiac Fontan fenestration by using the Amplatzer duct occluder. Arch Mal Coeur Vaiss 2005; 98: 449–454.Google Scholar
8. Jeong, SI, Huh, J, Lee, HJ, Yang, JH, Jun, TG, Kang, IS. Closure of conduit fenestration after extracardiac Fontan procedure using Amplatzer vascular plug: comparison with detachable coil. Pediatr Cardiol. 2010; 31: 44–49.Google Scholar
9. Cheatham, JP. Stenting of coarctation of the aorta. Catheter Cardiovasc Interv 2001; 54: 112–125.CrossRefGoogle ScholarPubMed
10. Agnoletti, G, Marini, D, Ou, P, Vandrell, MC, Boudjemline, Y, Bonnet, D. Cheatham platinum (CP) and Palmaz stents for cardiac and vascular lesions treatment in patients with congenital heart disease. EuroIntervention 2009; 4: 620–625.Google Scholar
11. Marini, D, Boudjemline, Y, Agnoletti, G. Closure of extracardiac Fontan fenestration by using the covered Cheatham platinum stent. Catheter Cardiovasc Interv 2007; 69: 1002–1006.CrossRefGoogle ScholarPubMed