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Occlusion of Fontan fenestrations using Amplatzer septal occluder
Amira A A H Al-Hay1, Lulu Abushaban, Mustafa A Al-Qbandi
1Departments of Pediatric Cardiology, Chest Diseases Hospital, PO Box 4278, Salmia, 22043 Kuwait. amira_alhay@hotmail.com
Insights
The Amplatzer septal occluder effectively closes Fontan fenestrations, improving oxygen saturation. This transcatheter approach offers a safe and successful treatment for persistent fenestrations, enhancing patient outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Fontan repair is a critical surgery for single-ventricle physiology.
- Persistent Fontan fenestrations can lead to cyanosis and paradoxical embolism.
- Transcatheter closure offers a less invasive option for managing these defects.
Purpose of the Study:
- To evaluate the efficacy and safety of the Amplatzer septal occluder for percutaneous closure of Fontan fenestrations.
- To assess the impact of fenestration closure on arterial oxygen saturation and Fontan circuit pressure.
Main Methods:
- Retrospective review of 26 patients undergoing transcatheter fenestration closure.
- Use of Amplatzer septal occluder devices of varying sizes.
- Hemodynamic assessment and balloon sizing prior to device deployment.
Main Results:
- 100% occlusion rate achieved in all Fontan types.
- Significant increase in mean arterial oxygen saturation post-procedure (84.7% to 95.2%).
- Minimal and acceptable increase in Fontan mean circuit pressure.
Conclusions:
- The Amplatzer septal occluder is effective for Fontan fenestration closure.
- Consideration of longer anti-platelet therapy to prevent thrombosis is advised.
- Long-term echocardiographic monitoring is recommended to assess for complications.
Abstract:
The objective of the study is to assess efficacy and safety of the Amplatzer septal device for percutaneous occlusion of Fontan fenestration. Fenestration improves postoperative outcomes in children undergoing Fontan repair. Many of these fenestrations close spontaneously; persistent fenestrations ultimately cause desaturation and can be a potential cause of paradoxical embolism. This is a retrospective review of 26 consecutive patients who underwent transcatheter closure of Fontan fenestration in a tertiary cardiac center in Kuwait. After assessment of hemodynamic suitability for fenestration closure, appropriate balloon sizing of fenestration was obtained. The median age was 9.2 years (range = 1.5-18.3 years). Occlusion was accomplished using a 4-7 ml single Amplatzer septal device in 12 patients and 8-13 ml devices in the other 13 patients; 2 devices were deployed in one patient. Median fluoroscopic and procedure times were 22 and 143.5 min, respectively. One immediate complication was the embolization and successful retrieval of the Amplatzer duct occluder. The fenestration was subsequently occluded by Amplatzer septal device. A 100% occlusion rate of fenestration was achieved in both lateral tunnel and extracardiac conduit types of Fontans. Mean (SD) arterial oxygen saturation increased from 84.7% (4.7) to 95.2% (1.7, P < 0.001) 10 min after deployment of the occluder; Fontan mean circuit pressure had a minimal acceptable increment from 12.9 mmHg (3.2) to 14.6 mmHg (2.6, P < 0.001). No complications or device failures were seen during follow up. The Amplatzer septal occluder device is effective in closing both Fontan fenestrations. Longer single or dual anti-platelet therapy may be considered to prevent thrombotic events. Long-term outpatients follow up with transthoracic echocardiographic monitoring for systemic venous congestion or thrombosis is warranted.
