Page 23 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
20. Figure 1
20. Figure 2
underwent multiple interventions with a total of 6 sternot- omies at another institution. The last surgical procedure was a failed fenestrated lateral tunnel Fontan palliation at 4-years of age with conversion to Hemi-Fontan circulation 3-weeks later due to severe hypoxemia requiring ECMO support. Evaluation at our center at age 15-years revealed elevated LVEDP with systemic hypertension. Following medical management, LVEDP was 10mmHg with MPAP of 14mmHg. 3D transesophageal echocardiogram and car- diac CT were performed to evaluate suitability for Fontan completion. Due to complex medical/surgical history, a multidisciplinary team recommended transcatheter Fontan completion. A prototype CP Stent was designed based on 3D visualization of cardiac CT on True3DViewer
(EchoPixel, Inc., Santa Clara, CA), and deployed in a flexible 3D-printed model to evaluate stent positioning and fore- shortening (Figure 1 & 2).
A significant ePTFE tear was noted. The ideal deployed stent length was determined to be 82mm mounted on a custom dog-bone shaped BIB catheter: 10mm upper end uncovered for anchoring, and 15mm lower end uncovered to avoid obstructing the hepatic veins flaring to 32mm in diameter; and middle 57mm covered segment (22mm in diameter) with a 4-6 mm fenestration punched into the ePTFE. After obtaining compassionate use authorization for the custom CP Stent from the FDA, IRB and institutional risk and compliance, we brought the patient to the cathe- terization laboratory for intervention.
Intervention: A transseptal needle was inserted into the femoral venous sheath and advanced across the hemi-Fon- tan pouch. Subsequently, a 0.018”V18 wire was snared from the left internal jugular vein (LIJV). Serial balloon dilations of the punctured hemi-Fontan pouch were performed using Advance balloons. The V18 wire was exchanged for a 0.035 Amplatz super stiff wire. The LIJV sheath was exchanged for a Gore 22Fr DrySeal sheath (65cm in length). The CP Stent was prepped and loaded into the long sheath over the Amplatz super stiff wire. The stent was deployed after confirming optimal positioning. Repeat angiograms showed the stent seated in a stable position connecting the hemi-Fontan pouch with the inferior vena cava.
20. Figure 3
Hijazi, Z
22nd Annual PICS/AICS Meeting