Transcatheter closure of atypical right-to-left shunts after Fontan surgery

Atypical right-to-left shunts following Fontan surgery were closed by transcatheter techniques using various devices in 4 patients. Three had variants of hypoplastic left heart syndrome, while the other had tricuspid atresia. Large Fontan baffle leaks were present in 2, a residual fistula from the inferior vena cava to the coronary sinus was present in 1, and another patient had surgical tube fenestration of an extracardiac conduit. When careful catheter and transesophageal echocardiographic exploration is performed, the selection of appropriate devices makes closure of these defects feasible.