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Fate of fenestration in children treated with fontan operation
Jaana I Pihkala1, Merit Järvelä1, Talvikki Boldt1
1Department of Pediatric Cardiology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Tube fenestrations in total cavopulmonary connection (TCPC) are more likely to close spontaneously or be percutaneously closed than window fenestrations. Predicting the outcome for window fenestrations is challenging due to similar pre-operative factors across patient groups.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- Baffle fenestration may improve outcomes after Fontan operation but carries risks.
- Fenestrations can close spontaneously or be percutaneously managed.
Purpose of the Study:
- Review operative history, clinical, and catheterization data of patients with total cavopulmonary connection (TCPC) and baffle fenestration.
- Determine if fenestration fate can be predicted.
Main Methods:
- Categorized patients into spontaneous closure (n=34), patent favorable response (n=36), and patent unfavorable response (n=20) groups.
- Reviewed clinical records for demographics, anatomy, prior surgeries, and catheterizations.
- Analyzed fenestration type (window/tube) and response to test occlusion.
Main Results:
- Tube fenestrations were more common in the spontaneous closure group (14/34) compared to window types.
- All tube fenestrations closed spontaneously or percutaneously.
- Twenty-nine percent of window fenestrations failed test occlusion.
Conclusions:
- Tube fenestrations demonstrate higher rates of spontaneous closure and favorable outcomes compared to window fenestrations.
- Predicting the fate of window fenestrations and test occlusion results is difficult due to similar pre-operative factors.
- Fenestration type is a key determinant of outcome.
Objective:
To review the operative history and clinical and catheterization data on patients treated with total cavopulmonary connection (TCPC) with baffle fenestration and to study whether it is possible to predict the fate of fenestration.
Background:
A baffle fenestration may improve postoperative outcomes after Fontan operation but is later associated with cyanosis and thromboembolic risk. Fenestration may close spontaneously or it can be closed percutaneously in patients with favorable hemodynamics.
Methods:
Patients were divided into three groups: those with spontaneous closure of fenestration (group S, n = 34) and those with patent fenestration and favorable (group F, n = 36) or unfavorable (group U, n = 20) response to fenestration test occlusion. Clinical records were reviewed for demographic and anatomical characteristics, previous surgeries, and catheterizations.
Results:
Predominant ventricular morphology was right ventricle (RV)/left ventricle (LV)/undeterminate in 19/14/1 patients in group S, 14/22/0 in group F, and 14/6/0 in group U. No differences were detected between groups in pre-TCPC catheterization data. Type of baffle fenestration was window/tube in 20/14 in group S, 28/8 in group F, and 20/0 in group U. All tube fenestrations either closed spontaneously or could be closed percutaneously. Twenty-nine percent of patients with window-type fenestrations failed the test occlusion.
Conclusions:
Spontaneous closure and favorable result in test occlusion are more common in tube than in window fenestrations. Since most preoperative anatomic and hemodynamic factors were similar in all patient groups, we find it difficult to predict the fate of a window-type fenestration and the result of test occlusion. © 2015 Wiley Periodicals, Inc.
