OBJECTIVE: To assess the efficacy and safety of the Amplatzer septal device for occlusion of Fontan fenestrations percutaneously.

BACKGROUND: Fenestration improves postoperative outcomes in children undergoing Fontan repair. Many of these fenestrations close spontaneously; ultimately persistent fenestrations cause desaturation and a potential cause of paradoxical embolism.

METHODS: This is a retrospective review of 26 consecutive patients who underwent transcatheter closure of Fontan fenestration in a tertiary cardiology centre in Kuwait. The median age was 9.2 years (range, 1.5 to 18.3). After assessment of hemodynamic suitability for fenestration closure, an appropriate balloon wedge catheter sizing of fenestration was obtained. Occlusion was accomplished using a 4-7 mm single Amplatzer septal device in 12 patients and 8-13 mm devices in the other thirteen patients while two devices were deployed in one patient. The median fluoroscopic and procedure times were 22 and 143.5 minutes.

RESULTS: There was one immediate complication. A 100% occlusion rate of the fenestration was achieved in both types of Fontan circulation. Mean ±SD arterial oxygen saturation increased from 84.7±4.7% to 95.2±1.7% (paired t test p<0.001) 10 minutes after deployment of the occluder, while the mean Fontan circuit pressure increased but within the acceptable range (12.9±3.2 vs. 14.6±2.6 mmHg, p<0.001). No complications or device failures were seen during follow up.

CONCLUSION: The Amplatzer septal occluder device is safe, and effective to close Fontan fenestration in the lateral tunnel and extracardiac conduit types. However, outpatients follow up with serial trasthoracic echocardiographic monitoring for systemic venous congestion or thrombosis is warranted.