Fontan circuit fenestration occlusion with Occlutech patent ductus arteriosus occluder

  • Zongezile Masonwabe Makrexeni Walter sisulu university
  • Lungile Pepeta Nelson Mandela University


We present a case of Fontan fenestration closure using an Occlutech patent ductus arteriosus occluder. The patient was diagnosed with tricuspid atresia, pulmonary atresia and secundum ASD at birth. He had a bilateral modified Blalock-Taussig shunt to promote growth of hypoplastic branch pulmonary arteries. He had a bidirectional Glenn Shunt at 11 years of age, and a total cavo-pulmonary connection (TCPC) with a fenestration at 19 years of age. He presented a year later with severe exercise intolerance and cyanosis. Cardiac catheterisation showed hypoxemia, normal pulmonary pressures, patent Fontan circuit and branch pulmonary arteries, and a Fontan circuit-to-right atrium fenestration with right to left shunting. A short shank Occlutech PDA occluder with a waist of 8mm, a pulmonary end of 10mm, an aortic disk of 16mm, and a length of 7mm, was selected to close the fenestration through the transvenous approach. The fenestration achieved complete immediate occlusion with this device.


Bridges ND, Lock JE, Castaneda, AR. Baffle fenestration with subsequent Transcatheter closure. Modification of the Fontan operation for patients at increased risk. Circul 1980; 82:1681-1689.

Driscoll, DJ. Long term results of the Fontan operation. Paediatr Cardiol 2007; 28: 438-442.

Rueda F, Squitieri C, Ballerini, L. Closure of the fenestration in the extra cardiac Fontan with the Amplatzer duct occlude device. Catheter Cardivasc Interv 2001; 54: 88-92.

Boshoff DE, Brown SC, Degiovanni J, Stumper O, Wright J, Mertens L, Gewillig, M. Percutaneous management of a Fontan fenestration: In search for the ideal restriction-occlusion device. Cather Cardiovasc Interv 2010; 75: 60-65.

Monagle P, Cochrane A, McCrindle B, Benson L, Williams W, Andrew, M. Thrombo-embolic complications after a Fontan procedure- the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg 1998; 115: 493-498.

Kreutzer J, Graziano JN, Stapleton G, Rome, JJ. Late catheter intervention in hypoplastic left heart syndrome. Cardiol Young 2011; 21(suppl 2): 65-76.

Pihkala J, Yazaki S, Mehta R, Lee KJ, Chaturvedi R, McCridle BW, Arsdell V, Benson GLN. Feasibility and clinical impact of catheter closure of interatrial communication after a fenestrated Fontan procedure: Medium term outcomes. Catheter Cardiovasc Interv 2007; 69: 1007-1014.

Momenah TS, Eltayb H, Oakley RE, Qethamy HA, Faraidi YA. Effects of transcatheter closure of Fontan fenestration on exercise tolerance. Pediatri Cardiol 2008; 29: 585-588.

Goff DA, Blume ED, Gauvreau K, Mayer JE, Lock JE, Jenkins KJ. Clinical outcome of fenestrated Fontan patients after closure: The first 10 years. Circulation 2000; 102: 2094-2099.

Mays WA, Border WL, Knecht SK, Gerdes YM, Pfriem H, Claytor RP, Knilans TK, Hirsch R, Mone SM, and Beekman HR. Exercise capacity improves after transcatheter closure of the Fontan fenestration in children. Congenit Hear Dis 2008; 3: 254-261.

McCrossan MD, Walsh KP. Fontan Fenestration Closure with Amplatzer Duct Occluder 2 Device. Catheter and Cardiovasc Interv 2015; 85: 837-841.

De wolff D, Dessy H, Haas N. Use of a new low profile Occlutech PLD device for closure of Fontan fenestration. Catheter Cardiovasc Interv 2016; 87(6): E243-E247

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