Gamillscheg A, Beitzke A, Stein J I, Rupitz M, Zobel G, Rigler B
Department of Paediatric Cardiology, Children's Hospital, University of Graz, Austria.
Heart. 1998 Jul;80(1):49-53. doi: 10.1136/hrt.80.1.49.
To assess the use of detachable coils as an alternative method to occlude interatrial communications after Fontan operations.
Descriptive clinical study of selected patients after Fontan operation with interatrial communications inappropriate for transcatheter umbrella occlusion.
Tertiary paediatric cardiac referral centre.
Seven patients after Fontan operation with residual interatrial communications of various types producing a right to left shunt.
Transcatheter placement of detachable coils with a diameter of 3 or 5 mm within the interatrial communication.
A total of 14 coils were successfully placed within persistent patent fenestrations of the interatrial baffle, residual leaks at the suture line between the patch material and the right atrial wall, and unusual venous interatrial communications. The mean (SD) aortic oxygen saturation increased from 88 (1.1)% (range 86-89%) to 92 (1.3)% (range, 89-93%; p < 0.001) and the mean (SD) right atrial pressure rose from 9.7 (2) mm Hg (range, 6-11) to 10.6 (2.4) mm Hg (range, 6-13; p < 0.05) after coil implantation. In five patients, complete obliteration of the interatrial shunt was shown by angiography after coil implantation. At a mean (SD) follow up of 10 (4) months (range, 3-15) a residual interatrial shunt was detected by Doppler colour echocardiography in only one patient, and oxygen saturations ranged from 90% to 95% (mean, 92%). There were no late coil embolisations, thromboembolic events, or haemolysis in any patient.
Detachable coils can be used successfully to occlude residual interatrial communications after the Fontan procedure. In selected cases, in whom intended transcatheter umbrella occlusion of residual interatrial leaks is not possible, the use of detachable coils might offer a safe alternative method to eliminate interatrial right to left shunting after the Fontan procedure.
评估使用可脱卸线圈作为封堵Fontan手术后房间隔交通的替代方法。
对Fontan手术后房间隔交通不适合经导管伞封堵的选定患者进行描述性临床研究。
三级儿科心脏转诊中心。
7例Fontan手术后患者，存在各种类型的残余房间隔交通，导致右向左分流。
经导管在房间隔交通内放置直径为3或5mm的可脱卸线圈。
总共14个线圈成功放置在房间隔挡板的持续未闭卵圆孔、补片材料与右心房壁之间缝线处的残余漏口以及不寻常的静脉性房间隔交通处。植入线圈后，平均（标准差）主动脉血氧饱和度从88（1.1）%（范围86 - 89%）升至92（1.3）%（范围89 - 93%；p < 0.001），平均（标准差）右心房压力从9.7（2）mmHg（范围6 - 11）升至10.6（2.4）mmHg（范围6 - 13；p < 0.05）。5例患者植入线圈后血管造影显示房间隔分流完全消失。平均（标准差）随访10（4）个月（范围3 - 15），仅1例患者经彩色多普勒超声心动图检测到残余房间隔分流，血氧饱和度范围为90%至95%（平均92%）。所有患者均未发生晚期线圈栓塞、血栓栓塞事件或溶血。
可脱卸线圈可成功用于封堵Fontan手术后的残余房间隔交通。在某些选定病例中，若无法进行预期的经导管伞封堵残余房间隔漏口，使用可脱卸线圈可能为消除Fontan手术后房间隔右向左分流提供一种安全的替代方法。
