| Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: medium-term outcomes. | |
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MedLine Citation:
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PMID: 17421018 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study was to review an institutional experience with transcatheter closure of Fontan fenestrations and its impact on clinical care. BACKGROUND: An interatrial fenestration improves postoperative outcomes in high-risk children undergoing a Fontan repair. While technical feasibility has been well defined, the clinical impact of subsequent closure is not well defined. METHODS: Transcatheter closure of a surgically created or additional interatrial communication was attempted in 152 children at a median interval of 13.8 months after surgery. The clinical records were reviewed for demographic and anatomical characteristics, previous surgeries; catheterization data, and status at latest follow-up. RESULTS: Mean oxygen saturation and right atrial pressure increased acutely from 87% +/- 5% to 96% +/- 3% (P < 0.001) and 12 +/- 2 mm Hg to 13 +/- 3 mm Hg (P < 0.001), respectively. Higher systemic venous atrial pressures after occlusion correlated with higher pulmonary artery pressures (P = 0.05) before the Fontan procedure and with higher right (P < 0.001) and left atrial (P = 0.001) and ventricular end-diastolic pressures (P < 0.001) immediately before occlusion. Complications included device malposition in 2 children, 1 child each had an air embolism and post-procedural bleeding, and each self-limiting and 1 child had acute ST elevation in inferior ECG leads because of occlusion of the acute marginal branch which was treated with angioplasty and placement of a stent. At follow-up (median 4.5 years), the mean oxygen saturation was 95% +/- 3%. Residual interatrial leaks were noted echocardiographically in 9%. Two children developed protein-losing enteropathy after fenestration closure. No deaths or strokes were observed in follow-up. CONCLUSIONS: Transcatheter occlusion of Fontan fenestrations is safe with acute and persistent improvements in oxygen saturations. |
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Authors:
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Jaana Pihkala; Satoshi Yazaki; Rohit Mehta; Kyong-Jin Lee; Rajiv Chaturvedi; Brian W McCrindle; Glen Van Arsdell; Lee N Benson |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Volume: 69 ISSN: 1522-1946 ISO Abbreviation: Catheter Cardiovasc Interv Publication Date: 2007 Jun |
Date Detail:
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Created Date: 2007-05-31 Completed Date: 2007-07-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 1007-14 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Balloon Occlusion / instrumentation Child Child, Preschool Coronary Angiography Coronary Circulation* Embolization, Therapeutic / instrumentation Feasibility Studies Female Follow-Up Studies Fontan Procedure* / adverse effects Heart Catheterization / adverse effects, instrumentation* Heart Defects, Congenital / blood, physiopathology, radiography, surgery, therapy* Humans Infant Male Oxygen / blood Prosthesis Design Pulmonary Circulation* Retrospective Studies Stents Time Factors Treatment Outcome Venous Pressure |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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