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Device Closure of Fontan Fenestrations

  • Lisa Bergersen
  • Susan Foerster
  • Audrey C. Marshall
  • Jeffery Meadows

Abstract

Since the late 1980 s, essentially all Fontan operations at Children’s Hospital Boston have been done using a fenestrated technique. The rationale behind this modification is as follows: For a Fontan circulation to function properly, it is critical that the pulmonary vascular resistance be low and that the mean PA pressures also be low. In particular, it is desirable to have a mean PA pressure below 20 mmHg. Cardiopulmonary bypass invariably results in an increase in PVR in the immediate postoperative period. To increase cardiac output and possibly reduce the pressure in the Fontan pathway, a small hole is created in the Gore-Tex baffle that makes up part of the lateral tunnel. This fenestration is 4 mm in diameter and is directed anteriorly and leftward. It allows some of the systemic venous return to enter the systemic circulation (right-to-left shunt across the baffle) and bypass the lungs. This results in maintenance of forward cardiac output at the expense of oxygen saturation. The fenestration technique has resulted in a much more stable postoperative ICU course as well as a decreased incidence and duration of pleural effusion following Fontan surgery (1).

Keywords

Pulmonary Vein Device Closure Test Occlusion Fontan Circulation Lateral Tunnel 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Bridges ND. Fenestration of the Fontan baffle: Benefits and complications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 1998;1:9–14.PubMedGoogle Scholar
  2. 2.
    Bridges ND, Lock JE, Mayer JE, Jr., Burnett J et al. Cardiac catheterization and test occlusion of the interatrial communication after the fenestrated Fontan operation. J Amer Coll Cardiol. 1995;25:1712–1717.CrossRefGoogle Scholar
  3. 3.
    Bridges ND, Lock JE, Castaneda AR. Baffle fenestration with subsequent transcatheter closure. Modification of the Fontan operation for patients at increased risk. Circulation. 1990;82:1681–1689.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Lisa Bergersen
    • 1
  • Susan Foerster
    • 2
  • Audrey C. Marshall
    • 1
  • Jeffery Meadows
    • 3
  1. 1.Department of CardiologyChildren’s Hospital BostonBostonUSA
  2. 2.Washington University in St. LouisSt. LouisUSA
  3. 3.Division of Pediatric CardiologyUniversity of California at San FranciscoSan FranciscoUSA

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