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(Circulation. 1996;94:247-248.)
© 1996 American Heart Association, Inc.

Articles

Should Fontan FenestrationsBe Closed With Coils?

John W. Moore, MD

the Division of Cardiology, Children's Heart Institute, Children's Hospital, San Diego, Calif.

Correspondence to John W.M. Moore, MD, Director, Cardiology, Children's Heart Institute, Children's Hospital–San Diego, San Diego, 3020 Children's Way, MC5004, San Diego, CA 92123-4282.

Key Words: Fontan procedure • catheterization • Editorials

	Introduction

 
In this issue of Circulation, Sommer et al¹ describe yet another use for Gianturco coils: closure of fenestrations placed in Fontan circuits. In 5 patients, they implanted coils with 8-mm helical diameters straddling 4-mm fenestrations. In 3 patients, there was immediate angiographic and echocardiographic closure, and in a fourth, echocardiographic closure was noted after 4 weeks. A small residual shunt persisted in the fifth patient. Among the 4 who had complete closure, oxygen saturation increased an average of 9% and tissue oxygen delivery decreased 12%. Sommer et al suggest that coil occlusion of fenestrations may be preferable both to no intervention and to occlusion with experimental septal occluders. They note that most pediatric centers have expertise with coils and therefore conclude that transcatheter closure of fenestrations should now be widely available.

Certainly, Sommer et al have demonstrated that coil occlusion of small fenestrations may be technically feasible. What they have not elucidated, however, are the more important issues: should closure of such fenestrations be performed at all, and if so, is it safe to use Gianturco coils for this purpose?

As background, it is worthwhile to note that a considerable percentage of small fenestrations close spontaneously. In Sommer's series, 4 of 14 patients had spontaneous closure. It is also interesting to discover the occasional patient who after closure of a fenestration with a septal occluder has required repeated placement of a fenestration (J.E. Locke, unpublished data, 1996). Thus, it may be prudent to pause and consider whether patients who require . . . [Full Text of this Article]

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