J Korean Med Sci.  2006 Oct;21(5):859-864. 10.3346/jkms.2006.21.5.859.

Transcatheter Closure of Fenestration with Detachable Coils After the Fontan Operation

• Kim SH
• Kang IS
• Huh J
• Lee HJ
• Yang JH
• Jun TG

• KMID: 1781906
• DOI: http://doi.org/10.3346/jkms.2006.21.5.859

Abstract

We report our experience in 13 patients who underwent transcatheter closure of Fontan fenestration with the Cook(R) detachable coils. These patients underwent the extracardiac type Fontan operation with a short conduit fenestration (n=7) or lateral tunnel type with a punch-hole fenestration (n=6). Fenestration closure was done at the mean age of 5.1+/-2.4 yr, average of 32 months after the Fontan operation. We used one to three coils depending on the fenestration type, size, and residual shunt. Aortic oxygen saturations increased by an average of 5.4 (2-9)% and mean pressures in the Fontan circuit increased by an average of 2.1 (0-6) mmHg. During fol-low-up (median of 23 months), five patients (4 in extracardiac, 1 in lateral tunnel) had complete occlusion of the fenestration on echocardiography. There was no immediate or late complication. Transcatheter closure of fenestration in Fontan operation using the Cook(R) detachable coil is a safe and feasible technique. However, the coil was ineffective for closure of a punch-hole fenestration in the lateral tunnel type operation. In the conduit type fenestration, some modification of fenestration method instead of a short conduit for coil closure or use of new device is necessary to increase complete closure rate.

Keyword

Fontan Procedure; Catheterization; Fenestration; Closure; Coil

MeSH Terms

*Prostheses and Implants
Male
Humans
*Heart Catheterization
Fontan Procedure/instrumentation/*methods
Female
Child, Preschool
Child

Figure

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  Fig. 1 Before and immediately after the fenestration closure and the latest systemic oxygen saturation in the patients with complete closure of fenestration.

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  Fig. 2 Before and immediately after the fenestration closure and the latest systemic oxygen saturation in the patients with incomplete closure of fenestration.

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  Fig. 3 Angiogram after fenestration closure in a patient who underwent lateral tunnel type Fontan operation. One loop of the coil is in the pulmonary atrial side, and the remained two loops are in the IVC-to-PA baffle. There is small residual shunt through the coil. IVC, inferior vena cava; PA, pulmonary artery.

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  Fig. 4 Fenestration closure in a patient who underwent extracardiac type Fontan operation with a short conduit (A) as a fenestration. An angiogram shows the flow through this short conduit (B, arrow). There is small shunt on an angiogram (D) after the first coil detachment (C). Therefore we put the second (E) and the third coil (F) one by one. There is no significant residual fenestration flow after insertion of three coils (G).

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