Restrictive atrial septum after the Fontan procedure

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Fontan procedure is a palliative surgery for complex congenital heart defects, aiming to redirect venous blood to the pulmonary arteries.
• Postoperative complications following Fontan surgery can significantly impact long-term outcomes.
• Restrictive atrial septum is a potential, though less common, complication that can impede cardiac function.

Observation:

• Three patients with early or late Fontan complications were found to have restriction of the native atrial septum.
• This restriction led to significant obstruction of pulmonary venous return and elevated systemic venous pressure.
• Dobutamine stress testing was utilized in one case to diagnose the atrial septum restriction.

Findings:

• Transcatheter stenting was successfully performed in two of the three patients to relieve the atrial septum obstruction.
• Following the intervention, all patients experienced improvement in their condition.
• Relief of the obstruction normalized pulmonary venous return and reduced systemic venous pressure.

Implications:

• Early identification and intervention for restrictive atrial septum are crucial for managing Fontan post-operative complications.
• Transcatheter stenting offers a viable treatment option for this specific complication.
• Addressing atrial septum restriction can lead to improved hemodynamics and better long-term prognosis for Fontan patients.