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Cardiac catheterization and test occlusion of the interatrial communication after the fenestrated Fontan operation
N D Bridges1, J E Lock, J E Mayer
1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Postoperative cardiac catheterization after a fenestrated Fontan operation provides key data for patient management. Systemic venous pressure response during test occlusion predicts functional status and guides decisions on interatrial communication closure.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- The fenestrated Fontan operation is a palliative procedure for complex congenital heart defects.
- Postoperative cardiac catheterization is crucial for assessing residual lesions and baffle fenestration response.
Purpose of the Study:
- To evaluate if catheterization data after fenestrated Fontan operation influence patient management.
- To determine if catheterization predicts functional status in these patients.
Main Methods:
- Sixty patients with fenestrated Fontan operation underwent postoperative catheterization with test occlusion.
- Catheterization data and clinical follow-up status were analyzed.
Main Results:
- Test occlusion significantly altered systemic venous pressure and oxygen saturation.
- Elevated systemic venous pressure correlated with unfavorable responses and specific complications like pulmonary artery stenosis.
- Most patients achieved excellent functional status (NYHA Class I) at 2-year follow-up, with low systemic venous pressure being a key predictor.
Conclusions:
- Cardiac catheterization with test occlusion offers valuable insights post-fenestrated Fontan operation.
- Identifying and treating conditions causing elevated systemic venous pressure is essential.
- Systemic venous pressure response to test occlusion should inform decisions regarding interatrial communication closure.
Objectives:
Our objective was to determine whether catheterization data obtained after a fenestrated Fontan operation influenced patient management or predicted functional status.
Background:
Cardiac catheterization after a fenestrated Fontan operation is undertaken to identify residual lesions and to observe the patient's response to test occlusion of the baffle fenestration.
Methods:
Sixty patients undergoing both a fenestrated Fontan operation before July 1991 and a postoperative catheterization before March 1992 were included in the study. Catheterization data were collected according to a test occlusion protocol; these data were reviewed, and the patient's clinical status at follow-up was ascertained.
Results:
Test occlusion resulted in a significant increase in systemic venous pressure, arterial oxygen saturation and arteriovenous difference in oxygen content (p < 0.0001). After test occlusion, systemic venous pressure was 40% higher and systemic venous saturation 23% lower among patients with an unfavorable versus a favorable response to test occlusion, although differences between the two groups were subtle or inapparent in the baseline state. Branch pulmonary artery stenosis (identified and balloon dilated in 6 patients) and grade 2 or 3 aortopulmonary collateral vessels (identified and coil embolized in 20) were associated with elevation in systemic venous pressure (p < 0.01). After an average of 2 years of follow-up, there were no deaths, and 50 (83%) of 60 patients were in New York Heart Association functional class I. The only postoperative characteristic significantly associated with being in functional class I at follow-up was a systemic venous pressure < 17 mm Hg.
Conclusions:
Cardiac catheterization with test occlusion of the interatrial communication provides useful information after a fenestrated Fontan operation. Conditions associated with elevated systemic venous pressure should be sought and treated, and the response of systemic venous pressure to test occlusion should be considered when deciding whether to close an interatrial communication.