Back ground; Fenestration in Fontan operation allows right to left shunting that may result in cyanosis and increase the risk of thromboembolism. There are several reports using expensive devices to close fenestration. This report describes our experience in 12 patients who underwent transcatheter closure of Fontan fenestration using Cook® detachable coil.
Methods; We retrospectively reviewed 12 patients, whose age at fenestration closure was 5.2 ±2.4 years (range: 2.7~11.7 years, median: 4.4 years). They underwent two kinds of Fontan operation, extracardiac Fontan operation with conduit fenestration in 6 patients (fenestration range; 5-6mm), lateral tunnel with fenestration Fontan operation in 6 patients (fenestration range; 3.5-5.1mm, unknown size in 1 patient).
Results; The closures were done at 34 months of average (range; 9-123 months, median; 18months) after fenestrated Fontan operation. After test occlusion, coils were delivered to straddle the fenestration with established techniques. We used one coil in eight patients and 2 coils in three patients. In one patients, we used a third coils. Aortic oxygen saturations increased by 5.6% (2 to 9%) and mean pressures in the Fontan circuit by 2.0mm (-1 to 6mmHg) on average. Durations of follow-up after fenestration closure were variable from 3 to 74 months (median 11months). In five patients (4 patients with extracardiac Fontan operation, 1 patients in lateral tunnel Fontan operation), immediate complete occlusion was confirmed on angiography and echocardiography, but one patient who had undergone extracardiac Fontan operation had small residual shunt at 6 months after procedure. Seven patients (2 patients with extracardiac Fontan operation, 5 patients with lateral tunnel Fontan operation) had persistent trivial residual shunt. There have been no immediate complications, late coil embolizations, thromboembolic events, or documented hemolysis within a follow-up after coil implantation.
Conclusion; Transcatheter closure of fenestration in Fontan operation using Cook® detachable coil is a safe, feasible technique. But, in lateral tunnel type Fontan operation, it was not completely effective.
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