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Closure of a lateral baffle leak in a Fontan patient with an amplatzer PDA II AS plug
Laura Muino1, Bert Suys, Daniël De Wolf
1Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
Insights
Cyanosis after Fontan surgery is common. A novel Amplatzer PDA II AS plug effectively closed a complex fistula in a pediatric patient, offering a new solution for challenging cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Device Innovation
Background:
- Cyanosis is a known complication following Fontan surgery or total cavopulmonary connection (TCPC).
- Various intracardiac communications like fenestrations, venovenous collaterals, or fistulas can cause post-surgical cyanosis.
- Lateral tunnel TCPC is a common surgical approach for complex congenital heart disease.
Observation:
- An 8-year-old girl experienced worsening cyanosis during exercise, four years after an intracardiac lateral tunnel TCPC.
- Angiography revealed an unusual fistulous tract from the superior vena cava to the right atrial appendage.
- The complex anatomy precluded closure with traditional devices.
Findings:
- A novel Amplatzer PDA II AS plug was successfully used to close the complex fistula.
- This device provided an effective solution where conventional methods failed.
- Successful fistula closure resolved the patient's cyanosis.
Implications:
- The Amplatzer PDA II AS plug represents a promising alternative for managing complex post-Fontan fistulas.
- Device selection is critical in challenging anatomies after TCPC.
- This case highlights innovative solutions for rare but significant complications in pediatric cardiac surgery.
Abstract:
Cyanosis after Fontan surgery or surgery for total cavopulmonary connection (TCPC), due to different types of communications (fenestration, venovenous collaterals or fistula), is not uncommon. We present the case of an 8-year-old girl presenting with increasing cyanosis during exercise 4 years after an intracardiac TCPC with lateral tunnel. Angiography showed a fistulous trajectory originating at the superior vena cava towards the base of the right atrial appendage. Due to the difficult anatomy in our patient, closure with conventional devices was not possible. We finally used a new Amplatzer PDA II AS plug to successfully close the fistula. In conclusion, closure of lateral baffle leak and device choice in case of difficult anatomy can be cumbersome. The new PDA II AS type plug can offer an elegant alternative for successful closure of some fistula.
