Transcatheter fenestration dilation and/or creation in postoperative Fontan patients

In modified Fontan procedures, a surgically created intra-atrial communication or baffle fenestration (BF) has been shown to increase cardiac index, reduce right venous pressures, and decrease perioperative and postoperative morbidity(1-8) at the expense of systemic desaturation. Subsequent BF closure can be performed in most patients.(1,9) When BF closure occurs spontaneously, it may lead to hemodynamic deterioration associated with elevated right-sided pressures and high systemic oxygen saturation, low cardiac output, progressive edema and effusions. Therapeutic options for these severely ill patients are few and of high risk (Fontan takedown or heart transplantation).(10) We report the results of a transcatheter palliative approach for symptomatic postoperative Fontan patients with total or virtual BF occlusion.