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Revista Uruguaya de Cardiología

On-line version ISSN 1688-0420


CHIESA, PEDRO et al. Cierre percutáneo de la fenestración en cirugía de Fontan-Kreutzer. Rev.Urug.Cardiol. [online]. 2005, vol.20, n.1, pp.32-39. ISSN 1688-0420.

Cavopulmonary tunnel fenestration is involved in the Fontan-Kreutzer surgical technique. In the long-term, spontaneous closure might not take place, leading to a shunt to the systemic atrium, therefore causing arterial oxygen desaturation. We present the experience of the Institute of Pediatric Cardiology in percutaneous closure of permeable fenestration, with four patients who underwent this procedure, using the ASD Amplatzer occluder device. All patients had congenital heart disase with univentricular physiology, underwent total cavopulmonary anastomosis and showed signs of arterial oxygen desaturation in the medium-term follow-up. Color Doppler echocardiography revealed in all cases the existence of a fenestration with a significant right to left shunt. Cardiac catheterization lead to the confirmation of this as the cause of the arterial oxygen desaturation, as other causes of hypoxemia were discarded. Using the percutaneous closure of the atrial septal defects approach, we then occluded the fenestration through the implantation of an ASD Amplatzer occluder device, which was followed by a remarkable increase in arterial oxygen saturation and no changes for the cavopulmonary systemic pressure, No complications were observed. The patients were discharged home 18 hours after the procedure was performed. In conclusion, percutaneous closure of surgical fenestrations is suggested when such fenestration represents the prime cause of oxygen desaturation in postoperative Fontan-Kreutzer patients. This procedure has shown to be practical, effective, represents a brief in-hospital stay and reduced psycho-physical aggression for the patient.


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