Transcatheter creation of an atriopulmonary communication in the Hemi-Fontan or Glenn circulation

There have been several modifications of the Fontan procedure, which has been used for palliation of the functionally univentricular circulation since its conception in the early 1970s. The development of intrahepatic veno-venous fistulas, pulmonary arteriovenous fistulas, and communications from the hepatic vein to the pulmonary venous atrium, are some of the complications encountered by patients with cavo-pulmonary communications. We describe transcatheter creation of an atriopulmonary communication, with simultaneous implantation of a stent, as a method of reducing or preventing pulmonary arteriovenous fistulas and associated right-to-left shunting in this setting. The intervention has been undertaken in two patients following a Hemi-Fontan procedure, itself created subsequent to a Glenn anastomosis. The combination of these procedures creates communicating atriopulmonary and cavopulmonary circulations.