921-72 Catheter Management of Stenotic Fontan Baffles & Conduits

Abstract

Fontan conduit or baffle stenosis may lead to elevated right sided pressures, poor exercise tolerance, chronic effussions and/or atrial arrhythmias (AA). Since these findings may also occur independently post Fontan, we report a group of 14 patients who underwent balloon dilation (BD) and/or stent placement (SP) of stenotic Fontan conduits or baffles. From 1/87 to 6/94, 18 procedures (10/18 SP; 8/18 BD) were performed in 14 patients (pts) with Fontan baffle or conduit stenosis, aged 1.3 to 39.4 years (21.6 ± 11.8 y). Diagnoses were tricuspid atresia (12/14), single ventricle (1/14) and ma laligned complete atrioventricular canal (1/14). The previous Fontan procedures included a right atrium (RA) to pulmonary artery (PA) conduit in 11, atriopulmonary anastomosis (APA) in 2 and a lateral tunnel (LT) Fontan in 1. All pts had decreased cardiac index (CI) and poor exercise tolerance; 7/14 had AA; 1/14 had chronic effussions. At catheterization, 4 pts underwent BD only. Ten pts had 13 iliac stents (30 mm) placed (12 in conduits and 1 in a stenotic APA). The balloonlvessel ratio was 3.0 ± 1.2. There was no mortality with the procedure. One pt died 1.6 y later following conversion to a LT Fontan. Complications were AA requiring cardioversion (3/14), migration of a stent to the RA (1/14) which was retrieved in the cath lab and misplacement of a stent in the proximal left PA. Following BD and/or SP: 1) mean vessel diameter increased from 7.4 mm ± 3.6 mm to 11.7 ± 4.4 (p < 0.01); 2) the mean gradient at stenotic baffle or conduit changed from 7.9 ± 6 mmHg to 2.6 mmHG ± 3.39 (p < 0.005); 3) the mixed venous saturation changed from 51% ± 11 to 59% ± 12 (p < 0.01); 4) mean RA pressures changed from 20 ± 6 mmHg to 16.6 ± 4 (p < 0.01); 5) CI changed from 1.8 ± 0.6 I/min/m2 to 2.5 ± 1.1 I/min/m2 (p < 0.06). At follow up (1.3 ± 1.1 y) 4 pts had no symptomatic improvement and underwent conduit change (1), conversion to a LT (2) and Fontan take-down (1). Eight pts had symptomatic improvement, with 2/14 lost to follow-up. BD and/or stent placement of stenotic Fontan baffles or conduits improves hemodynamics and often provides short term symptomatic benefit.