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A stepwise approach to conduit puncture for electrophysiological procedures in patients with Fontan circulation

 Jae-Sun Uhm  ;  Nam Kyun Kim  ;  Hee Tae Yu  ;  Pil-Sung Yang  ;  Jung Ok Kim  ;  Tae-Hoon Kim  ;  Mi Kyoung Song  ;  Sang-Yun Lee  ;  Boyoung Joung  ;  Hui-Nam Pak  ;  Jae Young Choi  ;  Jo Won Jung  ;  Moon-Hyoung Lee 
 Europace, Vol.20(6) : 1043-1049, 2018 
Journal Title
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Aims: In patients with Fontan circulation, the conduit may be punctured for electrophysiological procedures. We evaluated the feasibility and safety of a stepwise approach to conduit puncture in adults who have undergone Fontan operation. Methods and results: We included 13 consecutive patients with lateral tunnel or extracardiac conduit Fontan circulation [median age (interquartile range), 24.0 (16.0-25.0) years; seven men] who had undergone electrophysiological procedures. We performed a stepwise approach to conduit puncture: 1st, Brockenbrough needle; 2nd, Brockenbrough needle with snare; 3rd, extra-steep Brockenbrough needle with/without snare; 4th radiofrequency transseptal needle with/without snare; 5th, wiring through the puncture; 6th, conduit dilation with angioplasty balloon; 7th, non-compliant or cutting balloon; and 8th, Inoue dilator. In 12 patients, conduit puncture was successful. In two, one, and two patients with a lateral tunnel made of the pericardium or right atrial wall, conduit puncture was performed by steps 1st, 2nd, and 4th, respectively. In one, three, two, and one patient with the Goretex lateral tunnel or extracardiac conduit, conduit puncture was performed by steps 1st, 6th, 7th, and 8th, respectively. Puncture time was significantly longer in patients with Goretex conduits than with pericardial conduits [62.0 (50.0-120.0) and 11.5 (10.0-14.8) min, respectively; P < 0.001]. A snare was necessary in patients with angles </= 35 degrees between the conduit wall and vertical line. Conclusion: A stepwise conduit puncture approach is feasible and safe in patients with lateral tunnel and extracardiac conduit Fontan circulation. Goretex conduit puncture was more difficult than pericardial conduit puncture.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김남균(Kim, Nam Kyun)
김태훈(Kim, Tae-Hoon) ORCID logo https://orcid.org/0000-0003-4200-3456
김태훈(Kim, Tae Hoon)
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
양필성(Yang, Pil Sung)
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
유희태(Yu, Hee Tae) ORCID logo https://orcid.org/0000-0002-6835-4759
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
정조원(Jung, Jo Won)
최재영(Choi, Jae Young) ORCID logo https://orcid.org/0000-0002-1247-6669
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