An investigation on the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations

Abstract

Objective To investigate the therapeutic effect of the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations. Methods Retrospective analysis of 6 Fontan surgical patients, 4 males and 2 females, who received surgical treatment in the cardiothoracic surgery of Shanghai Children's Medical Center from May 2016 to August 2018; Age(5.7±2.9) years; (19.8±5.5) kg weight. All 6 patients were treated with primary pulmonary artery banding operation and secondary bilateral Glenn operation(BDG) and re-PAB. Before Fontan surgery, cardiac catheterization was performed in the department of cardiology to close the antegrade pulmonary blood flow. Results These six patients received interventional therapy in the department of cardiology.The mean pulmonary artery pressure(Pp) before occlusion was(17.0±0.8) mmHg(1 mmHg=0.133 kPa), the ventricular diastolic pressure(VEDP) was (11.2±0.9) mmHg, and the mean pulmonary artery pressure after occlusion was effectively decreased to(14.2±0.7) mmHg and VEDP to(9.7±0.7) mmHg. Fontan surgery was performed 6 to 12 months after the occlusion. No death was found after the operation, and all the clinical indicators were normal after the operation. Follow-up was conducted for 2-24 months, and the cardiac function and the function of each organ recovered well. Conclusion For some patients with high risk Fontan before operation, this method can safely and effectively reduce the average pulmonary artery pressure and reduce the ventricular and pulmonary vascular load, which is of positive help for the successful Fontan operation. Key words: High-risk fontan operation; Antegrade pulmonary blood flow; Transcatheter closure