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Fontan Fenestration Closure

  • Derize E. BoshoffEmail author
  • Marc H. Gewillig
Chapter

Abstract

Fenestrating the Fontan circuit allows a protective right-to-left shunting at atrial level to overcome the period of low output in the postoperative period, decreasing morbidity and mortality. Despite all controversies surrounding routine fenestration closure, it seems reasonable to close fenestrations in patients with favourable haemodynamic assessment and clinically significant desaturation, based on the secondary effects of cyanosis. Timing of fenestration closure remains debatable, but current recommendation is to postpone fenestration closure to a few months after completion of the Fontan circulation, when the patient is free of diuretics, if O2 saturations are <90% and test occlusion is tolerated.

Supplementary material

Video 1a

Patient with situs inversus thoracalis, double discordance, large VSD, PA after extracardiac TCPC (20-mm conduit). Frontal and lateral angiography demonstrate the fenestration in the left sided extracardiac conduit. Frontal view angio fenestration situs inversus LTGA (MOV 196054 kb)

Video 1b

Patient with situs inversus thoracalis, double discordance, large VSD, PA after extracardiac TCPC (20-mm conduit). Frontal and lateral angiography demonstrate the fenestration in the left sided extracardiac conduit. Angio lateral fenestration situs inversus LTGA (MOV 188937 kb)

Video 2

Lateral projection in a patient with an extracardiac Fontan conduit. A 4/4-mm Amplatzer duct occluder type II has been deployed in the fenestration. Angiography is performed via the 4F introducer sheath with the device still attached to delivery cable (MOV 240322 kb)

Video 3

Lateral projection showing angiography via the 4F introducer sheath after release of the Amplatzer duct occluder type II device. There is still some contrast like “smoke” through the device which will disappear within minutes after release (MOV 216232 kb)

Video 4

Stented fenestration with previous attempt of closure with an Amplatzer duct occluder type II. A 45-mm covered CP stent is deployed using a 22-mm BIB balloon (MOV 240322 kb)

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric CardiologyUniversity Hospital LeuvenLeuvenBelgium

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