Sommer R J, Recto M, Golinko R J, Griepp R B
Department of Pediatries, Mount Sinai Medical Center, New York, NY 10029, USA.
Circulation. 1996 Aug 1;94(3):249-52. doi: 10.1161/01.cir.94.3.249.
Fenestration of the Fontan circulation that results in a residual right-to-left shunt has improved operative survival rates among high-risk patients. Late closure of the fenestration by use of a transcatheter umbrella device has achieved separation of the systemic and pulmonary venous circulations, "completing" the Fontan pathway. Because use of umbrella devices is restricted, many institutions continue to perform only nonfenestrated Fontan procedures.
Five children 3.5 to 8.3 years old (mean, 5.1 years) underwent cardiac catheterization 0.5 to 24 months (mean, 10 months) after operation for the purpose of occluding a persistently patent Fontan fenestration. Once candidacy was determined, an 8-mm x 10-cm Gianturco coil was delivered to straddle the fenestration with established techniques for coil occlusion of patent ductus arteriosus. Complete occlusion occurred in 4 of 5 patients, in 2 of the 4 before they left the catheterization laboratory. One patient had a residual angiographic shunt but had complete closure within 24 hours by echocardiography. In 1 patient who had a residual shunt at 24 hours, the fenestration was completely closed at 1 month after coil placement. One patient had residual shunting at 2 months but saturations have increased 15% to 17% since coil placement. No embolizations (early or late), clinical hemolysis, thromboembolic events, or hemodynamic deterioration occurred among patients during 1- to 14-month follow-up periods.
A persistently patent fenestration after Fontan operation may be closed with a Gianturco coil. This universally available alternative to umbrella devices may make the fenestrated Fontan a more appealing option to centers that had not previously considered its use.
Fontan循环开窗导致残余右向左分流，提高了高危患者的手术生存率。使用经导管伞形装置延迟关闭开窗已实现体循环和肺静脉循环分离，“完成”了Fontan通路。由于伞形装置的使用受限，许多机构仍仅进行非开窗Fontan手术。
5名年龄在3.5至8.3岁（平均5.1岁）的儿童在Fontan手术后0.5至24个月（平均10个月）接受了心导管检查，目的是封堵持续存在的Fontan开窗。一旦确定符合条件，使用用于动脉导管未闭线圈封堵的既定技术，将一个8毫米×10厘米的Gianturco线圈输送至横跨开窗处。5名患者中有4名实现了完全封堵，其中4名中的2名在离开心导管实验室前即完成封堵。1名患者血管造影显示有残余分流，但超声心动图显示在24小时内实现了完全封堵。1名在24小时时有残余分流的患者，在放置线圈后1个月开窗完全关闭。1名患者在2个月时有残余分流，但自放置线圈后血氧饱和度提高了15%至17%。在1至14个月的随访期内，患者未发生栓塞（早期或晚期）、临床溶血、血栓栓塞事件或血流动力学恶化。
Fontan手术后持续存在的开窗可用Gianturco线圈关闭。这种普遍可用的伞形装置替代方法可能会使开窗Fontan手术对以前未考虑使用该方法的中心更具吸引力。
