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Stenting the Fontan pathway in paediatric patients with obstructed extracardiac conduits
Floris E A Udink Ten Cate1,2, Uwe Trieschmann3, Ingo Germund1
1Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany.
Insights
Percutaneous transcatheter stenting of extracardiac conduits (ECC) is a feasible and effective treatment for Fontan pathway obstruction in children. This procedure significantly improves ECC diameter and offers acute clinical benefits, potentially delaying further surgery.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Optimal Fontan hemodynamics depend on unobstructed extracardiac conduits (ECC).
- Significant obstruction in ECC can lead to complications like protein-losing enteropathy.
- Echocardiography may underestimate the severity of ECC obstruction.
Purpose of the Study:
- To evaluate the feasibility and outcomes of percutaneous transcatheter stenting of ECC in pediatric Fontan patients.
- To assess the impact of stenting on ECC diameter and Fontan pathway hemodynamics.
- To determine the acute clinical benefit and midterm patency of ECC stenting.
Main Methods:
- Retrospective review of a single-institution database for Fontan patients who underwent ECC stenting.
- Analysis of medical records, cardiac catheterization data, and echocardiographic findings.
- Vessel diameters were normalized for body surface area to assess stenosis severity.
Main Results:
- Nineteen pediatric Fontan patients with significant ECC stenosis underwent successful stenting.
- ECC diameter significantly increased post-stenting (p<0.0001).
- 94.7% of patients experienced acute clinical benefit, with good midterm ECC patency.
Conclusions:
- Percutaneous transcatheter ECC stenting is a promising and feasible option for managing Fontan pathway obstruction in children.
- Stenting can improve hemodynamics and potentially postpone the need for surgical intervention.
- The development of ECC stenoses is likely multifactorial.
Objectives:
An unobstructed extracardiac conduit (ECC) is essential for optimal Fontan haemodynamics. We aimed to evaluate the feasibility and results of percutaneous transcatheter stenting of the ECC in paediatric patients with a significant Fontan pathway obstruction.
Methods:
Our institutional database was searched to identify all Fontan patients who had a stent placed in their ECC. Medical records, cardiac catheterisation data and echocardiographic investigations were reviewed. Vessel diameters were normalised to account for differences in body surface area.
Results:
Nineteen Fontan patients (age 6.5±3.2 years; male 78.9%) with a significant stenosis of their Dacron ECC graft were identified. Seven patients presented with protein-losing enteropathy (36.8%). An ECC obstruction was suspected on echocardiography in only 6/19 patients (31.6%). The mean minimum diameter of the ECC was 8.3±2.4 mm. A stenosis of >45% was seen in the majority of patients (n=12, 63.1%). Significant correlations between the severity of the ECC obstruction and Fontan pathway vessel diameters were found (all p<0.05). Stenting was successful in all children. The ECC diameter increased significantly after stenting (p<0.0001). An acute clinical benefit of ECC stenting was observed in 18/19 (94.7%) patients. ECC patency was good during a mean follow-up of 1.8±0.9 years.
Conclusions:
The feasibility and acute results of percutaneous transcatheter ECC stenting are promising and may provide a good alternative to postpone surgery to a later age. The mechanisms contributing to the development of ECC stenoses are likely multifactorial.
