Catheter therapy for fontan baffle obstruction and leak, using an endovascular covered stent.

A 6 1/2-year-old (weight 20 kg) patient was found to have significant cavo-atrial obstruction and significant right-to-left shunt via multiple large fenestrations in the baffle, with oxygen saturation of 81% 3 1/2 yr after a fenestrated Fontan operation. In one session, this patient had undergone placement of a Palmaz stent at the cavo-atrial narrowing in order to increase anterograde venous return into the pulmonary artery. This was unsuccessful in improving the oxygen saturation because of the large leak in the baffle. Therefore, at a second catheterization session, two telescoping dacron-covered experimental vascular self-expanding stents were placed from the right atrial origin (distal to the hepatic veins) into the pulmonary artery connection delineated by the Palmaz stent, with complete reconstruction of the baffle and improvement in oxygen saturation to 95%.