Transcatheter Closure of Fenestration after Modified Fontan Operation in Children

• Main Authors: Seiied Mahmoud Meraji, Paridokht Nokhostin Davari, Mohammad Yousef Aarabi, Ali Akbar Shahmohammadi, Hojjat Mortezaeian, Ramin Emamzadegan
• Format: Article
• Language: English
• Published: Tehran University of Medical Sciences 2008-01-01
• Series: Journal of Tehran University Heart Center
• Subjects: Fontan procedure; Catheterization; Amplatzer
• Online Access: https://jthc.tums.ac.ir/index.php/jthc/article/view/82
• ISSN: 1735-8620; 2008-2371

Background: Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. Methods: This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Results: Fenestration closure was performed at a mean age of 8 yr (6-12 yr) and average of 15 months after the Fontan operation. Aortic O2 saturation increased by an average of 17.6% (9-26%). During more than a two-year period of follow-up (mean: 27 months), two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. Conclusion: The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O2 saturation and well-being and confers acceptable growth and development in children.