Transcatheter closure of fenestrations and excluded hepatic veins after Fontan: Versatility of the Amplatzer device

作     者：Moore, JW Murdison, KA Baffa, GM Kashow, K Murphy, JD 

作者机构：DuPont Hosp Children Nemours Cardiac Ctr Wilmington DE USA 

出 版 物：《AMERICAN HEART JOURNAL》 (美国心脏杂志)

年 卷 期：2000年第140卷第3期

页      面：534-540页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：冠状动脉血栓形成/预防和控制 Fontan手术/仪器和设备 心脏导管插入术/仪器和设备 心脏导管插入术/方法 心脏缺损 先天性/外科学 肝静脉/外科学 手术后并发症/预防和控制 假体植入 支架 青少年 儿童 儿童 学龄前 女(雌)性 人类 婴儿 男(雄)性 

摘      要：Background The aim of this study was to evaluate the Amplatzer septal occluder (ASO) for transcatheter closure of fenestrations and excluded hepatic veins in patients after modified Fontan operations. Residual right-to-left shunts have improved surgical results of the Fontan operation. Shunt closure may eventually be desirable to eliminate hypoxemia and reduce risk of embolic complications. Methods and Results Ten patients with hypoxemia caused by residual shunts after Fontan procedures were evaluated for closure. After favorable results of test occlusion, all shunts were closed with the use of the ASO, Eight ASOs were used to close fenestrations in 7 patients with 6F transvenous sheaths, Three ASOs were used to close excluded hepatic veins in 3 patients with 6F venous sheaths and transbaffle punctures. Fluoroscopy and transesophageal echocardiography were used to guide device placement. Device placement in all patients was successful. All shunts were closed by angiography after device placement. While breathing room air, systemic oxygen saturation rose from 87.9% +/- 3.0% to 96.3% +/- 0.9% (P .001) in the patients. There were no complications of the implant procedures and none noted in outpatient follow-up. Conclusions This experience suggests that the ASO is safe and effective for closing surgical shunts after Fontan procedures. The ASO design allows closure of excluded hepatic veins and has advantages over other devices in closure of fenestrations.