Page 24 - Journal of Structural Heart Disease Volume 5, Issue 1

13 Case Report
Figure 2. Panel A. Angiogram showing Brockenbrough needle being advanced from the right internal jugular vein into the roof of the Fontan baffle, and Panel B. 28 mm covered Cheatham Platinum stent placed between the Glenn and Fontan anastomoses.
Fontan pressure decreased to a mean of 13 mmHg, while the Glenn pressure was noted to be similar to the pre-procedure mean of 11-12 mmHg. The patient was discharged to home the next day. A cardiac CT obtained at 6-week follow-up showed patent Glenn and Fontan anastomoses connected by the covered CP stent (Figure 3B).
Discussion
The prognosis of patients with single ventricle physiology palliated using the Norwood, Glenn and Fontan procedures is influenced by multiple factors such as the anatomical relationship, flow patterns, and the pressures in the Glenn and Fontan circula- tions. These patients are at potential risk for the de- velopment of complications including PAVMs, Fontan failure, ventricular systolic or diastolic dysfunction, protein losing enteropathy, lymphatic abnormalities, plastic bronchitis, FALD, and reduced glomerular fil- tration rate [3, 4]. It is speculated that the risk for de- veloping PAVMs increases when hepatic blood flow carrying hepatic factor; a protective factor to prevent formation of PAVMs, to the lungs is interrupted [5-7]. The risk for developing veno-venous collaterals, Fon-
Video 1. Post-procedure angiogram demonstrates widely pat- ent Glenn and Fontan anastomoses connected by the covered CP stent with unobstructed flow and favorable hemodynam- ics. View supplemental video at https://doi.org/10.12945/j. jshd.2019.017.18.sup.01.
Kaley V. R. et al.
Transcatheter Revision of Fontan Circulation