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Ingenuity in the Catheterization Laboratory

Ingenuity in the Catheterization Laboratory Fontan fenestrations are needed in most patients undergoing the Fontan operation. The advantages of such fenestrations that act as a pop‐off include: augmenting the cardiac output, reduction of pleural effusions, and therefore, shortening the intensive care unit stay. Obviously, the risks of such fenestrations are the cyanosis and the small chance of paradoxical emboli. Fenestrations created in the lateral tunnel or the extra cardiac conduit between the tunnel and the left atrium can be constructed by a tube graft or simply a punch hole between the tunnel and the left atrium. It is very difficult to gauge the exact size needed to have an effective fenestration. Traditionally, a 3‐ to 4‐mm fenestration has been adequate to maintain good cardiac output and yet, with acceptable systemic oxygen saturation (usually over 80%). Premature closure of the fenestration due to various reasons (including clot formation or simply the small size of the fenestration) may constitute a medical emergency. Patients may present with low cardiac output state with good oxygen saturation. To recanalize such fenestrations there are options: balloon angioplasty alone; stent implantation or the use of a custom made fenestrated Amplatzer ASD device. Balloon angioplasty may not be effective and may result in re‐occlusion. The custom made device is not readily available and is not approved by the regulatory agency (FDA). Therefore, the best option is stent placement. In this issue of the journal, Torres et al. reported on stent implantation to re‐establish right to left shunt. However, I believe due to technical factors, the authors over inflated the inner balloon and possibly the outer balloon resulting in a larger fenestration than needed. This of course resulted in significant dilemma. The authors are to be commended on their ingenuity and novel ideal of using a snare to crimp the stent back to a known outer diameter and avoid surgical exploration in these high‐risk patients. This new technique proved useful and easy to apply. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Interventional Cardiology Wiley

Ingenuity in the Catheterization Laboratory

Journal of Interventional Cardiology , Volume 18 (2) – Apr 1, 2005

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Publisher
Wiley
Copyright
Copyright © 2005 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0896-4327
eISSN
1540-8183
DOI
10.1111/j.1540-8183.2005.41001.x
pmid
15882159
Publisher site
See Article on Publisher Site

Abstract

Fontan fenestrations are needed in most patients undergoing the Fontan operation. The advantages of such fenestrations that act as a pop‐off include: augmenting the cardiac output, reduction of pleural effusions, and therefore, shortening the intensive care unit stay. Obviously, the risks of such fenestrations are the cyanosis and the small chance of paradoxical emboli. Fenestrations created in the lateral tunnel or the extra cardiac conduit between the tunnel and the left atrium can be constructed by a tube graft or simply a punch hole between the tunnel and the left atrium. It is very difficult to gauge the exact size needed to have an effective fenestration. Traditionally, a 3‐ to 4‐mm fenestration has been adequate to maintain good cardiac output and yet, with acceptable systemic oxygen saturation (usually over 80%). Premature closure of the fenestration due to various reasons (including clot formation or simply the small size of the fenestration) may constitute a medical emergency. Patients may present with low cardiac output state with good oxygen saturation. To recanalize such fenestrations there are options: balloon angioplasty alone; stent implantation or the use of a custom made fenestrated Amplatzer ASD device. Balloon angioplasty may not be effective and may result in re‐occlusion. The custom made device is not readily available and is not approved by the regulatory agency (FDA). Therefore, the best option is stent placement. In this issue of the journal, Torres et al. reported on stent implantation to re‐establish right to left shunt. However, I believe due to technical factors, the authors over inflated the inner balloon and possibly the outer balloon resulting in a larger fenestration than needed. This of course resulted in significant dilemma. The authors are to be commended on their ingenuity and novel ideal of using a snare to crimp the stent back to a known outer diameter and avoid surgical exploration in these high‐risk patients. This new technique proved useful and easy to apply.

Journal

Journal of Interventional CardiologyWiley

Published: Apr 1, 2005

There are no references for this article.