Access the full text.
Sign up today, get DeepDyve free for 14 days.
References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.
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 of Interventional Cardiology – Wiley
Published: Apr 1, 2005
You can share this free article with as many people as you like with the url below! We hope you enjoy this feature!
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.