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J Thorac Cardiovasc Surg 2008;136:793-795
© 2008 The American Association for Thoracic Surgery

Brief Communication

Novel use of an aortic endograft in the closure of a Fontan circuit leak

Sanjeev Pradhan, MDa, Bart E. Muhs, MD, PhDa, John T. Fahey, MDb, Jeremy D. Asnes, MDb,*

a Section of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut
b Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut

Received for publication October 30, 2007; accepted for publication February 1, 2008.

* Address for reprints: Jeremy D. Asnes, MD, Section of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064. (Email: Jeremy.Asnes@yale.edu).

The first 20% of the full text of this article appears below.

Unintended residual interatrial communications or baffle leaks after the lateral tunnel Fontan operation have been well described.1Go Such unintended communications have the potential to result in hypoxemia, cyanosis, exercise intolerance, and paradoxical embolization.2Go Surgical eradication of these leaks has the attendant risks of reoperative sternotomy and cardiopulmonary bypass. Therefore, transcatheter approaches are now commonly used. No ideal device exists for this task. Gianturco coils (Cook Medical, Bloomington, Ind), Amplatzer septal occluders (AGA Medical, Plymouth, Minn), and CardioSEAL VSD occluders (NMT Medical, Boston, Mass) have been used with varying degrees of success. These devices often prove ineffective because of their inability to conform to the complex atrial anatomy. Balloon-expandable covered stents have been used to exclude leaks and intentional fenestrations with good success.3Go However, balloon-expandable covered stents of sufficient size are not available in the United States. We describe the novel use of a commercially available adult-size, self-expanding aortic stent graft to seal a large, symptomatic Fontan baffle leak.

Clinical Summary

A 15-year-old male with dextrocardia, bilateral superior vena cavae, common atrium, and unbalanced atrioventricular canal . . . [Full Text of this Article]






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