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Transcatheter Closure of Ventriculo-Pulmonary Artery Communications in staged Fontan Procedures
  1. Tarak Desai (tarak.desai{at}bch.nhs.uk)
  1. Birmingham Children's Hospital, United Kingdom
    1. John Wright (john.wright{at}bch.nhs.uk)
    1. Birmingham Children's Hospital, United Kingdom
      1. Rami Dhillon (rami.dhillon{at}bch.nhs.uk)
      1. Birmingham Children's Hospital, United Kingdom
        1. Oliver Stumper (oliver.stumper{at}bch.nhs.uk)
        1. Birmingham Children's Hospital, United Kingdom

          Abstract

          Objective To evaluate the use of interventional catheter closure of a ventriclo-pulmonary artery communication in the setting of a cavopulmonary shunt or after the Fontan procedure.

          Design Retrospective analysis of haemodynamic,angiographic and procedural data.

          Setting A single tertiary Paediatric Cardiology centre.

          Patients and Methods Eight patients (Age: 1.5 -18 years, mean 7.8 years ) underwent transcatheter closure of a ventricle-pulmonary artery communication. Indications were cardiac failure or persistent pleural effusions after cavopulmonary shunt (n=2) or after Fontan (n=3) and abolishing the volume load of the single ventricle prior to Fontan completion (n=3).

          Results Devices used were Rashkind Umbrella device (n=1), Amplatzer PDA device (n=7) and Amplatzer ASD device (n=1). One patient required two devices. There were no procedural complications. All 3 patients with prolonged pleural effusions (1 post CP shunt and 2 post Fontan) showed complete resolution of effusions 4-10 days post catheter. Two patients underwent transcatheter occlusion for progressive ventricular dilatation and cardiac failure. The first patient was post Fontan and showed gradual improvement in ventricular function. The second patient after CP shunt died 48 hours post intervention(non procedure related cardiac death). Three patients underwent catheter closure to off-load the systemic ventricle prior to the Fontan procedure. The device was removed in one patient because of an unsatisfactory position. All three patients underwent successful completion of Fontan 6-8 weeks post catheter.

          Conclusions Transcatheter closure of ventricle-pulmonary artery communication is a safe and effective technique in the treatment of selected patients after CP shunt or Fontan procedure. It can also be employed prior to the Fontan completion in order to off-load the systemic ventricle.

          • Fontan
          • anterograde flow
          • catheter closure
          • cavopulmonary shunt
          • congenital heart disease

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