Access to the native atria following conduit total cavopulmonary anastomosis.

OBJECTIVES: We describe the use of trans-thoracic and trans-conduit puncture to access the atria and perform interventional procedures in patients who have undergone conduit total cavopulmonary anastomosis.

BACKGROUND: Catheter access to the atria following intra or extra-cardiac Fontan is desirable when there is a need for trans-atrial interventions.

METHODS: Between 2009 and 2014, 5 patients ages 7 to 28 years underwent this approach; three trans-thoracic and 2 trans-conduit punctures. Various therapeutic aims were achieved. Included are: placement of pacing wire in the left atrial appendage, access to re-canalized left superior vena cava via the coronary sinus for device occlusion eliminating cyanosis, access with subsequent device closure of a dormant pulmonary valve thought to be the nidus of an embolic event, and access to the atria for ablation of an atrial tachycardia.

RESULTS: Entry to the atria was successful in all five patients with either trans-thoracic access or trans-conduit puncture with subsequent intended intervention performed successfully.

CONCLUSIONS: Trans-conduit puncture and trans-thoracic access may allow therapeutic procedures which mitigate the need for further open heart surgery. © 2017 Wiley Periodicals, Inc.