RESUMEN
Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male [oxygen saturation in the room air was 65%] who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure [Glenn shunt and left pulmonary artery [LPA] stenting]. After the procedure, oxygen saturation rose to 83%. At six months follow-up of the patient, exercise capacity and cyanosis had improved significantly, with o[2] saturation having reached near 85% by pulse oximetry
RESUMEN
Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Fenestration closure was performed at a mean age of 8 yr [6-12 yr] and average of 15 months after the Fontan operation. Aortic O[2] saturation increased by an average of 17.6% [9-26%]. During more than a two-year period of follow-up [mean: 27 months], two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O[2] saturation and well-being and confers acceptable growth and development in children