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(Circulation. 1996;94:249-252.)
© 1996 American Heart Association, Inc.

Articles

Transcatheter Coil Occlusion of Surgical Fenestration After Fontan Operation

Robert J. Sommer, MD; Michael Recto, MD; Richard J. Golinko, MD; Randall B. Griepp, MD

the Departments of Pediatrics and Cardiothoracic Surgery, Mount Sinai Medical Center and the Mount Sinai School of Medicine, New York, NY.

Reprint requests to Robert J. Sommer, MD, Director, Pediatric Cardiac Catheterization Laboratory, Division of Pediatric Cardiology, Box 1201, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Background Fenestration of the Fontan circulation that results in a residual right-to-left shunt has improved operative survival rates among high-risk patients. Late closure of the fenestration by use of a transcatheter umbrella device has achieved separation of the systemic and pulmonary venous circulations, "completing" the Fontan pathway. Because use of umbrella devices is restricted, many institutions continue to perform only nonfenestrated Fontan procedures.

Methods and Results Five children 3.5 to 8.3 years old (mean, 5.1 years) underwent cardiac catheterization 0.5 to 24 months (mean, 10 months) after operation for the purpose of occluding a persistently patent Fontan fenestration. Once candidacy was determined, an 8-mmx10-cm Gianturco coil was delivered to straddle the fenestration with established techniques for coil occlusion of patent ductus arteriosus. Complete occlusion occurred in 4 of 5 patients, in 2 of the 4 before they left the catheterization laboratory. One patient had a residual angiographic shunt but had complete closure within 24 hours by echocardiography. In 1 patient who had a residual shunt at 24 hours, the fenestration was completely closed at 1 month after coil placement. One patient had residual shunting at 2 months but saturations have increased 15% to 17% since coil placement. No embolizations (early or late), clinical hemolysis, thromboembolic events, or hemodynamic deterioration occurred among patients during 1- to 14-month follow-up periods.

Conclusions A persistently patent fenestration after Fontan operation may be closed with a Gianturco coil. This universally available alternative to umbrella devices may make the fenestrated Fontan a more appealing option to centers that had not previously considered its use.

Key Words: Fontan procedure • catheterization • shunts • occlusion

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