Page 25 - Journal of Structural Heart Disease Volume 5, Issue 1

Case Report 14
Figure 3. Panel A. Post-procedure angiogram, and Panel B. Follow-up computed tomography scan confirm widely patent Glenn and Fontan anastomoses connected by the 28 mm CP stent.
tan failure, and FALD is increased in patients with ele- vated Fontan pressures, which are known to increase further with activity [8]. As a result these patients may require multiple surgical or transcatheter interven- tions to address these late-onset complications. Sur- gical interventions are not without risk for these pa- tients given the inherent need for re-do sternotomy, and CPB. As such, transcatheter interventions provide a safer alternative for these patients.
The proof of concept for transcatheter Fontan completion was first demonstrated using specially developed occluding stents in an ovine model [9]. Safety and feasibility in human subjects was then demonstrated in 16 patients with single ventricle physiology with successful transcatheter Fontan completion in 2007 [10]. The technique of transcath- eter Fontan completion has been described in which patients underwent a planned modified cavopulmo- nary anastomosis followed by transcatheter Fontan completion [11]. The technique has not been widely accepted. Patients with traditional Glenn and unidi- rectional Fontan palliation with PAVMs have bene- fitted after reconnection of the pulmonary arteries. The feasibility of transcatheter reconnection of the pulmonary arteries in cyanotic patients with PAVMs
has been previously described. In this case series of 6 patients with unidirectional Fontan and PAVMs, ox- ygen saturations were noted to have improved fol- lowing transcatheter reconnection of the pulmonary arteries. The transcatheter approach was noted to be less invasive with decreased morbidity compared to surgical pulmonary artery reconnection or brachial arteriovenous fistula placement [12].
The unique condition of developing PAVMs in the right lung and veno-venous collaterals in left lung in our patient may be explained by the absence of hepatic flow into the right lung and exposure of the left lung to higher Fontan pressures [6]. The liver cir- rhosis may also be attributed to high pressures in the Fontan circuit. Anticipating the potential benefits of connecting both the Glenn and Fontan anastomoses to achieve even distribution of blood into the lungs, transcatheter approach for Fontan completion was selected as an alternative approach to surgical inter- vention.
Transcatheter Fontan completion was performed without preconditioning in this patient due to func- tional decline associated with chronic cyanosis, to avoid re-do sternotomy and CPB and multi-organ complications associated with Fontan failure and
Journal of Structural Heart Disease, February 2019
Volume 5, Issue 1:11-15