PDF(Pubmed)
Abstract：
UNASSIGNED: In patients with a total cavopulmonary connection in Fontan circulation, the access to the common atrium (CA) during a catheter ablation can be challenging, even in the presence of fenestration in an intra-atrial lateral tunnel (IALT). In our department, the fenestration is typically marked with metal clips (MCs). To the best of our knowledge, there is no previous report of balloonoplasty of clipped fenestration.
UNASSIGNED: A 19-year-old male with hypoplastic left heart syndrome (HLHS) was scheduled for catheter ablation of recurrent atrial tachycardia. He was diagnosed with HLHS prenatally and underwent a stepwise surgical palliation. Fontan circulation was completed with the creation of a fenestrated IALT. The fenestration was marked by four MCs. During the ablation procedure, the passage of the steerable sheath with mapping catheter to the CA was prevented by a small fenestration size and rigidness of the edges of the fenestration caused by the MCs. Multiple attempts to dilate the fenestration using a peripheric angioplasty balloon failed. Only angioplasty with the \'balloon-against-dilator\' technique was finally successful. Activation map showed a counterclockwise atrial flutter in the CA; successful ablation was performed.
UNASSIGNED: We present a case of challenging access to the CA through a clipped fenestration in a polytetrafluoroethylene baffle for atrial tachycardia ablation. Even though a tunnel fenestration in Fontan patients facilitates access to the CA, the passage of a steerable introducer with a mapping catheter may be challenging due to diameter mismatch and the rigidity of its edges caused by MCs. The balloon-against-dilator technique might be helpful when conventional balloon angioplasty fails.
UNASSIGNED: A 19-year-old male with hypoplastic left heart syndrome (HLHS) was scheduled for catheter ablation of recurrent atrial tachycardia. He was diagnosed with HLHS prenatally and underwent a stepwise surgical palliation. Fontan circulation was completed with the creation of a fenestrated IALT. The fenestration was marked by four MCs. During the ablation procedure, the passage of the steerable sheath with mapping catheter to the CA was prevented by a small fenestration size and rigidness of the edges of the fenestration caused by the MCs. Multiple attempts to dilate the fenestration using a peripheric angioplasty balloon failed. Only angioplasty with the \'balloon-against-dilator\' technique was finally successful. Activation map showed a counterclockwise atrial flutter in the CA; successful ablation was performed.
UNASSIGNED: We present a case of challenging access to the CA through a clipped fenestration in a polytetrafluoroethylene baffle for atrial tachycardia ablation. Even though a tunnel fenestration in Fontan patients facilitates access to the CA, the passage of a steerable introducer with a mapping catheter may be challenging due to diameter mismatch and the rigidity of its edges caused by MCs. The balloon-against-dilator technique might be helpful when conventional balloon angioplasty fails.
摘要：
■在Fontan循环中具有全腔肺连接的患者中，在导管消融期间进入公共心房（CA）可能具有挑战性，即使在心房内外侧隧道（IALT）中存在开窗。在我们部门,开窗通常用金属夹(MC)标记。据我们所知,以前没有关于开窗夹闭球囊成形术的报道。
■一名患有左心发育不良综合征（HLHS）的19岁男性被安排为复发性房性心动过速的导管消融。他在产前被诊断出患有HLHS，并接受了逐步的手术缓解。Fontan循环是通过创建开窗的IALT完成的。开窗由四个MC标记。在消融过程中,带标测导管的可操纵鞘管通过CA的小的开窗尺寸和由MC引起的开窗边缘的刚性阻止。使用外周血管成形术球囊扩张开窗的多次尝试失败。只有“球囊对扩张器”技术的血管成形术最终成功。激活图显示CA出现逆时针房扑;成功进行了消融。
■我们提出了一种具有挑战性的情况，该情况是通过聚四氟乙烯挡板中的开窗夹住的房性心动过速消融进入CA。即使Fontan患者的隧道开窗术有助于进入CA，具有标测导管的可操纵导引器的通过可能由于MC引起的直径不匹配和其边缘的刚性而具有挑战性。当常规球囊血管成形术失败时，球囊对扩张器技术可能会有所帮助。
■一名患有左心发育不良综合征（HLHS）的19岁男性被安排为复发性房性心动过速的导管消融。他在产前被诊断出患有HLHS，并接受了逐步的手术缓解。Fontan循环是通过创建开窗的IALT完成的。开窗由四个MC标记。在消融过程中,带标测导管的可操纵鞘管通过CA的小的开窗尺寸和由MC引起的开窗边缘的刚性阻止。使用外周血管成形术球囊扩张开窗的多次尝试失败。只有“球囊对扩张器”技术的血管成形术最终成功。激活图显示CA出现逆时针房扑;成功进行了消融。
■我们提出了一种具有挑战性的情况，该情况是通过聚四氟乙烯挡板中的开窗夹住的房性心动过速消融进入CA。即使Fontan患者的隧道开窗术有助于进入CA，具有标测导管的可操纵导引器的通过可能由于MC引起的直径不匹配和其边缘的刚性而具有挑战性。当常规球囊血管成形术失败时，球囊对扩张器技术可能会有所帮助。
