CATHETER THERAPY FOR FONTAN BAFFLE OBSTRUCTION AND LEAK, USING AN ENDOVASCULAR COVERED STENT

A 6 1/2-year-old (weight 20 kg) patient was found to have significant cavo-atrial obstruction and significant right-to-left shunt via multip le large fenestrations in the baffle, with oxygen saturation of 81% 3 1/2 yr after a fenestrated Fontan operation. In one session, this pati ent had undergone placement of a Palmaz stent at the cavo-atrial narro wing in order to increase anterograde venous return into the pulmonary artery, This was unsuccessful in improving the oxygen saturation beca use of the large leak in the baffle. Therefore, at a second catheteriz ation session, two telescoping dacron-covered experimental vascular se lf-expanding stents were placed from the right atrial origin (distal t o the hepatic veins) into the pulmonary artery connection delineated b y the Palmaz stent, with complete reconstruction of the baffle and imp rovement in oxygen saturation to 95%. (C) 1998 Wiley-Liss, Inc.