Daniel S. Schwab MD, Patcharapong Suntharos MD, Nicholas A. Szugye MD, MSc
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Multimodal Imaging to Guide Stent Placement in a Patient After Fontan Palliation With Restrictive Interatrial Communication
Objective
Late interatrial communication restriction is a rare complication in patients with single-ventricle physiology, obstructing pulmonary venous flow to the systemic ventricle. It is commonly treated percutaneously with balloon atrial septoplasty or atrial septum stenting, a technically challenging task.
Key Steps
Preprocedural specialized postprocessing of multiphase acquisition cardiac computed tomography and intraprocedure transesophageal echocardiography allowed for planning and successful stent placement, reducing left atrial pressure and relieving pulmonary venous outflow obstruction.
Potential Pitfalls
Aside from the increased preprocedural time and possible need for additional anesthesia, there are no pitfalls anticipated with this procedure.
Take-Home Message
Multimodality preprocedural imaging and advanced three-dimensional reconstruction can provide a procedural design when planning percutaneous intervention in patients with complex congenital heart disease.