Percutaneous Interventions in Patients with Fontan Circulation

pp. 228-234

Abstract

Background: Total bypass surgery of the pulmonary ventricle is a palliative procedure with high incidence of complications requiring careful postoperative follow-up. Interventional catheterization plays an essential role in the early detection and possible treatment of complications.

Objective: The aim of this study was to describe the interventional catheterization procedures performed in patients with Fontan circulation.

Methods: Between 1999 and 2014, 85 patients with Fontan surgery underwent 154 interventional catheterization procedures, with mean postoperative follow-up of 7.05 years (±4.8 years).

Results: Different interventional catheterizations were performed: 38 patients underwent closure at the fenestration level and 4 underwent reopening. Forty-four catheterization procedures were done in 37 patients for aortopulmonary collateral vessel embolization; 28 patients required embolization of veno-venous collaterals; in 13 patients, after angioplasty of pul monary branches, 7 stents were implanted at the extracardiac conduit level, and after angioplasty, 3 stents were implanted in 4 patients; antegrade flow was occluded in 4 patients, in 2 patients the atrioventricular valve was closed and 5 patients underwent other procedures. No complications were associated with interventional catheterization procedures. Twenty percent of interventional catheterizations were performed immediately after surgery due to Fontan circulation dysfunction. Short-term mortality was associated with the severe complications characteristic of the disease (p=0.0007). Long-term mortality was 5%.

Conclusions: Patients with Fontan circulation required diverse catheterization procedures, both in the immediate postsurgical period as in the long-term follow-up. The most frequent cause for recatheterization was hemoptysis secondary to aortopulmonary collateral vessel circulation. In no case were there complications associated with the interventional catheterization procedure. Mortality was related with the need for catheterization in the immediate postoperative period to treat severe complications of the Fontan circulation. Interventional catheterization is essential in the management of patients with Fontan circulation.