Percutaneous transthoracic computed tomography-guided AICD insertion in a patient with extracardiac Fontan conduit

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Procedures

Background:

• Congenital heart disease management often involves complex procedures.
• Extracardiac Fontan conduit patients require specialized cardiac care.
• Automated implantable cardiac defibrillators are crucial for managing life-threatening arrhythmias.

Observation:

• A 26-year-old patient with an extracardiac Fontan conduit experienced two out-of-hospital cardiac arrests.
• Traditional lead placement for defibrillators in such cases may necessitate thoracotomy.
• Computed tomography (CT) guidance offers advanced visualization for interventional procedures.

Findings:

• Percutaneous pulmonary venous atrial puncture was successfully performed under CT guidance.
• An automated implantable cardiac defibrillator was accurately placed using this technique.
• The procedure successfully avoided the need for surgical lead placement via thoracotomy.

Implications:

• This CT-guided percutaneous approach represents a less invasive alternative for defibrillator implantation in complex congenital heart disease.
• It potentially reduces procedural risks and recovery time for patients.
• This technique may expand treatment options for patients with extracardiac Fontan conduits requiring defibrillation.