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Multimodal Imaging to Guide Stent Placement in a Patient After Fontan Palliation With Restrictive Interatrial
Daniel S Schwab1, Patcharapong Suntharos1, Nicholas A Szugye1
1Cleveland Clinic Children's, Cleveland, Ohio, USA.
JACC. Case Reports
|June 27, 2025
Summary
Late interatrial communication restriction in single-ventricle patients can be challenging. Advanced imaging and 3D reconstruction aid in planning percutaneous interventions for successful stent placement and improved pulmonary venous flow.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Late interatrial communication restriction is a rare but serious complication in patients with single-ventricle physiology.
- This condition obstructs pulmonary venous return to the systemic ventricle, necessitating intervention.
Observation:
- Percutaneous treatment, such as balloon atrial septoplasty or atrial septum stenting, is the standard approach.
- These procedures are technically demanding and require precise planning.
Findings:
- Preprocedural specialized postprocessing of multiphase acquisition cardiac computed tomography (CT) combined with intraprocedure transesophageal echocardiography (TEE) enabled successful stent placement.
- This multimodal imaging approach facilitated planning, reduced left atrial pressure, and relieved pulmonary venous outflow obstruction.
Implications:
- Multimodality preprocedural imaging and advanced 3D reconstruction are crucial for procedural design in complex congenital heart disease interventions.
- This strategy can improve outcomes for patients with single-ventricle physiology experiencing interatrial communication restriction.
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