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Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery

Published online by Cambridge University Press:  24 April 2023

Asra Khan Open the ORCID record for Asra Khan [Opens in a new window] ,
Athar M. Qureshi Open the ORCID record for Athar M. Qureshi [Opens in a new window] ,
Manish Bansal ,
Gary Stapleton ,
Melissa K. Webb ,
Wilson Lam ,
Lindsay Eilers Open the ORCID record for Lindsay Eilers [Opens in a new window] ,
Harinder R. Singh  and
Srinath T. Gowda
Asra Khan*
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Athar M. Qureshi
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Manish Bansal
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Gary Stapleton
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Melissa K. Webb
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Wilson Lam
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Lindsay Eilers
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
Harinder R. Singh
Affiliation:
The Children’s Hospital of San Antonio, 333 N. Santa Rosa Street, San Antonio, TX 78207, USA
Srinath T. Gowda
Affiliation:
Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA
*
Author for correspondence: Asra Khan MD, Pediatric Interventional Cardiology, Assistant Professor, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA. Tel: 8328265682. E-mail: asrak@bcm.edu
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Abstract

Background:

Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy.

Objectives:

We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures.

Methods:

A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021.

Results:

A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3–36 years) and 55 (14–88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10–50 W) and required 1–5 attempts for 2–5 seconds. There were no vascular or neurological complications.

Conclusions:

Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.

Keywords

Fontan baffle punctureFontan fenestrationradiofrequencysurgical electrocautery tip
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 12 , December 2023 , pp. 2621 - 2627
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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