The Birmingham Children's Hospital, Birmingham, United Kingdom.
Catheter Cardiovasc Interv. 2010 Nov 15;76(6):860-4. doi: 10.1002/ccd.22661.
To develop an effective catheter technique to reduce the size of a Diabolo stent fenestration in the failing Fontan circulation.
Diabolo stent fenestration is employed by many centers in the treatment of the failing Fontan patient. With subsequent recovery, exercise tolerance may be impaired by significant desaturation secondary to the right to left shunt across the fenestration. Complete fenestration closure carries the risk of recurrence of the initial symptoms and, hence, reduction of the size of fenestration should be the preferred technique.
Twenty-eight patients with failing Fontan circulations (16 early and 12 late) underwent Diabolo stent fenestration for relief of symptoms. Five of these patients remained very limited by severe desaturation even at rest, after complete recovery from symptoms. Further cardiac catheterization with crimping/reduction of the size of the waist of the stent was carried out using a technique whereby a snare catheter was placed over the waist of the stent aided by an arterio-venous guidewire loop and a balloon catheter placed within the stent.
All 5 patients had successful stent reduction with improvement in saturations, whilst still maintaining a small residual fenestration. No complications were encountered.
This novel technique of reduction of a diabolo stent fenestration, in a failing Fontan circulation, offers the advantages of avoidance of implanting further devices in the circulation and the ability to redilate the stent should symptoms recur.
开发一种有效的导管技术，以缩小 Diabolo 支架开窗在衰竭 Fontan 循环中的大小。
许多中心在治疗衰竭 Fontan 患者时采用 Diabolo 支架开窗。随着后续的恢复，运动耐量可能会因开窗处的右向左分流导致显著的氧饱和度下降而受损。完全关闭开窗会增加最初症状复发的风险，因此，缩小开窗的大小应该是首选技术。
28 例衰竭 Fontan 循环患者（16 例早期和 12 例晚期）接受 Diabolo 支架开窗术缓解症状。其中 5 例患者即使在症状完全缓解后，在休息时仍因严重的氧饱和度下降而受到严重限制。进一步的心脏导管检查采用一种技术，即用圈套器套住支架腰部并用动静脉导丝环辅助，将球囊导管置于支架内，来缩小/减少支架腰部的尺寸。
所有 5 例患者的支架缩小均成功，氧饱和度提高，同时仍保持较小的残余开窗。未发生任何并发症。
这种在衰竭 Fontan 循环中缩小 Diabolo 支架开窗的新技术具有避免在循环中植入更多设备的优势，并且如果症状再次出现，能够重新扩张支架。
