@Article{chd.12757,
AUTHOR = {Donald J. Hagler, William R. Miranda, Brielle J. Haggerty, Jason H. Anderson, Jonathan N. Johnson, Frank Cetta, Sameh M. Said, Nathaniel W. Taggart},
TITLE = {Fate of the Fontan connection: Mechanisms of stenosis and management},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {4},
PAGES = {571--581},
URL = {http://www.techscience.com/schd/v14n4/39262},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Stenosis of the venous connections and conduits is a well‐known late
complication of the Fontan procedure. Currently, data on the outcomes of percuta‐
neous intervention for the treatment of extra‐ or intracardiac conduits and lateral
tunnel baffles obstruction are limited. In an attempt to better define the nature and
severity of the stenosis and the results of catheter interventional management, we
reviewed Fontan patients with obstructed extra‐ or intracardiac conduits and lateral
tunnel baffles.<br/>
<b>Methods:</b> Retrospective review of all Fontan patients who had cardiac catheteriza‐
tion from January 2002 to October 2018 was performed. Hemodynamic and angio‐
graphic data that assessed extra‐ or intracardiac conduit, or lateral tunnel baffle
obstruction/stenosis were evaluated.<br/>
<b>Results:</b> Twenty patients underwent catheter intervention because of conduit steno‐
sis, including calcified homografts, stenotic Gore‐Tex conduits and obstructed lateral
tunnels. Six other patients had Fontan obstruction but were referred for surgical revi‐
sion. After stenting, there was a significant reduction in the connection gradient [2.0
mm Hg (IQR 2; 3) vs 0 mm Hg (IQR 0; 1), P < .0001]. Fontan conduit/connection di‐
ameter increased [10.5 mm (IQR 9; 12) vs 18 mm (IQR 14.9; 18); P < .0001] and New
York Heart Association class [III (IQR II; III) vs I (IQR II; III); P = .03) with stent
placement.<br/>
<b>Conclusions:</b> We demonstrated the hemodynamics and angiographic subtypes of
conduit stenosis in patients after Fontan, We showed that calcified homografts, sten‐
otic Gore‐Tex conduits and lateral tunnels pathways can be safely and effectively
stented to eliminate obstruction. Percutaneous stenting is associated with a decrease
in connection gradients and improvement in functional capacity.},
DOI = {10.1111/chd.12757}
}