Transcatheter fenestration in Fontan failure: Our clinical experience

Area of Science:

• Cardiology
• Pediatric Cardiology
• Interventional Cardiology

Background:

• Fontan failure presents significant challenges in patients with complex congenital heart disease.
• Evaluating interventions for Fontan failure is crucial for improving long-term outcomes.

Purpose of the Study:

• To assess the hemodynamic effects of transcatheter fenestration in patients experiencing Fontan failure.
• To evaluate the clinical outcomes and complication rates associated with this intervention.

Main Methods:

• Retrospective analysis of 10 patients who underwent transcatheter Fontan fenestration between 2014 and 2022.
• Patients were categorized into early-stage (pre-discharge) and late-stage (post-discharge) groups based on the timing of fenestration.
• Comparison of hemodynamic parameters, oxygen saturation, and complication rates between the groups.

Main Results:

• Transcatheter fenestration led to a median decrease of 3.4 mmHg in systemic venous pressure.
• Pleural effusion resolved in 4 patients, and 70% experienced clinical improvement within one month.
• Favorable outcomes were observed in patients with protein-losing enteropathy, with all achieving clinical improvement.

Conclusions:

• Transcatheter Fontan fenestration is a reliable therapeutic option for symptomatic Fontan patients.
• The procedure demonstrates potential for favorable clinical outcomes with low complication rates.
• It plays a significant role in managing high-risk Fontan patients.