TRANSCATHETER COIL OCCLUSION OF RESIDUAL INTERATRIAL COMMUNICATIONS AFTER FONTAN PROCEDURE

Objective-To assess the use of detachable coils as an alternative meth od to occlude interatrial communications after Fontan operations. Desi gn-Descriptive clinical study of selected patients after Fontan operat ion with interatrial communications inappropriate for transcatheter um brella occlusion. Setting-Tertiary paediatric cardiac referral centre. Patients-Seven patients after Fontan operation with residual interatr ial communications of various types producing a right to left shunt. I nterventions-Transcatheter placement of detachable coils with a diamet er of 3 or 5 mm within the interatrial communication. Results-A total of 14 coils were successfully placed within persistent patent fenestra tions of the interatrial baffle, residual leaks at the suture line bet ween the patch material and the right atrial wall, and unusual venous interatrial communications. The mean (SD) aortic oxygen saturation inc reased from 88 (1.1)% (range, 86-89%) to 92 (1.3)% (range, 89-93%; p < 0.001) and the mean (SD) right atrial pressure rose from 9.7 (2) mm H g (range, 6-11) to 10.6 (2.4) mm Hg (range, 6-13; p < 0.05) after coil implantation. In five patients, complete obliteration of the interatr ial shunt was shown by angiography after coil implantation. At a mean (SD) follow up of 10 (4) months (range, 3-15) a residual interatrial s hunt was detected by Doppler colour echocardiography in only one patie nt, and oxygen saturations ranged from 90% to 95% (mean, 92%). There w ere no late coil embolisations, thromboembolic events, or haemolysis i n any patient. Conclusions-Detachable coils can be used successfully t o occlude residual interatrial communications after the Fontan procedu re. In selected cases, in whom intended transcatheter umbrella occlusi on of residual interatrial leaks is not possible, the use of detachabl e coils might offer a safe alternative method to eliminate interatrial right to left shunting after the Fontan procedure.