Access to the native atria following conduit total cavopulmonary anastomosis.

ObjectivesWe 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. BackgroundCatheter access to the atria following intra or extra-cardiac Fontan is desirable when there is a need for trans-atrial interventions. MethodsBetween 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. ResultsEntry to the atria was successful in all five patients with either trans-thoracic access or trans-conduit puncture with subsequent intended intervention performed successfully. ConclusionsTrans-conduit puncture and trans-thoracic access may allow therapeutic procedures which mitigate the need for further open heart surgery. (c) 2017 Wiley Periodicals, Inc.