Universität zu Köln

ten Cate, Floris E. A. Udink, Trieschmann, Uwe, Germund, Ingo, Hannes, Tobias, Emmel, Mathias, Bennink, Gerardus and Sreeram, Narayanswami (2017). Stenting the Fontan pathway in paediatric patients with obstructed extracardiac conduits. Heart, 103 (14). S. 1111 - 1117. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-201X

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Abstract

Objectives An unobstructed extracardiac conduit (ECC) is essential for optimal Fontan haemodynamics. We aimed to evaluate the feasibility and results of percutaneous transcatheter stenting of the ECC in paediatric patients with a significant Fontan pathway obstruction. Methods Our institutional database was searched to identify all Fontan patients who had a stent placed in their ECC. Medical records, cardiac catheterisation data and echocardiographic investigations were reviewed. Vessel diameters were normalised to account for differences in body surface area. Results Nineteen Fontan patients (age 6.5+/-3.2 years; male 78.9%) with a significant stenosis of their Dacron ECC graft were identified. Seven patients presented with protein-losing enteropathy (36.8%). An ECC obstruction was suspected on echocardiography in only 6/19 patients (31.6%). The mean minimum diameter of the ECC was 8.3+/-2.4 mm. A stenosis of >45% was seen in the majority of patients (n=12, 63.1%). Significant correlations between the severity of the ECC obstruction and Fontan pathway vessel diameters were found (all p<0.05). Stenting was successful in all children. The ECC diameter increased significantly after stenting (p<0.0001). An acute clinical benefit of ECC stenting was observed in 18/19 (94.7%) patients. ECC patency was good during a mean follow-up of 1.8+/-0.9 years. Conclusions The feasibility and acute results of percutaneous transcatheter ECC stenting are promising and may provide a good alternative to postpone surgery to a later age. The mechanisms contributing to the development of ECC stenoses are likely multifactorial.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code ten Cate, Floris E. A. Udink UNSPECIFIED UNSPECIFIED UNSPECIFIED Trieschmann, Uwe UNSPECIFIED UNSPECIFIED UNSPECIFIED Germund, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Hannes, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Emmel, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED Bennink, Gerardus UNSPECIFIED UNSPECIFIED UNSPECIFIED Sreeram, Narayanswami UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-226291
DOI:	10.1136/heartjnl-2016-310511
Journal or Publication Title:	Heart
Volume:	103
Number:	14
Page Range:	S. 1111 - 1117
Date:	2017
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-201X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TOTAL CAVOPULMONARY CONNECTION; PROTEIN-LOSING ENTEROPATHY; MIDTERM FOLLOW-UP; GORE-TEX GRAFT; OPERATION; HEMODYNAMICS; STENOSIS; IMPLANTATION; EXPERIENCE; DYNAMICS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22629