Percutaneous closure of fistula between pulmonary trunk and Fontan circulation

Abstract

CASE PRESENTATION Fontan procedure is a complex surgery with more risks compared to other cardiac surgeries. Also, complications have been associated with it because of its physiology being the most common of all elevated blood pressure in the cavopulmonary connection, low cardiac output syndrome, hypoxemia, and arrhythmias; others like plastic bronchitis, protein-losing enteropathy, ascites, pleural effusion, portal hypertension, and hepatic fibrosis can also occur. Similarly, connections between the pulmonary and the systemic circuits can be established triggering higher pressures of Fontan circulation. This is the case of a 17-year-old male patient diagnosed at birth with tricuspid atresia with restrictive interventricular communication (IVC), large vessel malapposition, and severe mixed pulmonary stenosis (PS). The patient’s corresponding informed consents—that remain on file—were obtained to conduct this study. At the age of 7 the patient was treated with a single-stage fenestrated Fontan procedure with independent anastomoses of the superior vena cava and, on the other hand, right atrial roof with right pulmonary branch, ventricular septal defect enlargement, and pulmonary artery trunk ligation (video 1 of the supplementary data). Lesion was solved with continuous suture during surgery in the left circumflex coronary artery. Disease progression was good, and the patient remained asymptomatic for the next 7 years with...