Fate of the Fontan connection: Mechanisms of stenosis and management

Congenital Heart Disease
D J HaglerNathaniel W Taggart

Abstract

Stenosis of the venous connections and conduits is a well-known late complication of the Fontan procedure. Currently, data on the outcomes of percutaneous intervention for the treatment of extra- or intracardiac conduits and lateral tunnel baffles obstruction are limited. In an attempt to better define the nature and severity of the stenosis and the results of catheter interventional management, we reviewed Fontan patients with obstructed extra- or intracardiac conduits and lateral tunnel baffles. Retrospective review of all Fontan patients who had cardiac catheterization from January 2002 to October 2018 was performed. Hemodynamic and angiographic data that assessed extra- or intracardiac conduit, or lateral tunnel baffle obstruction/stenosis were evaluated. Twenty patients underwent catheter intervention because of conduit stenosis, including calcified homografts, stenotic Gore-Tex conduits and obstructed lateral tunnels. Six other patients had Fontan obstruction but were referred for surgical revision. After stenting, there was a significant reduction in the connection gradient [2.0 mm Hg (IQR 2; 3) vs 0 mm Hg (IQR 0; 1), P < .0001]. Fontan conduit/connection diameter increased [10.5 mm (IQR 9; 12) vs 18 mm (IQR 14.9; 18); P...Continue Reading

References

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Citations

Oct 31, 2019·Heart·Fred H Rodriguez, Wendy M Book
Dec 20, 2019·Journal of the American Heart Association·Shelby KuttyDavid A Danford
Nov 9, 2020·Pediatric Cardiology·John M KellyKan N Hor
Feb 20, 2021·Journal of Cardiovascular Imaging·Parveen Kumar, Mona Bhatia
Oct 17, 2020·Advanced Healthcare Materials·Jacob C ZbindenChristopher K Breuer
Dec 22, 2020·The Journal of Thoracic and Cardiovascular Surgery·Aybala Tongut, Yves d'Udekem
Nov 23, 2020·The Journal of Thoracic and Cardiovascular Surgery·Neil D PatelAndrew L Cheng
Jul 24, 2021·Npj Regenerative Medicine·Erica L SchwarzChristopher K Breuer
Aug 31, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Vibeke Elisabeth Hjortdal

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Methods Mentioned

BETA
homograft
homografts

Software Mentioned

JMP

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