Venous Interventions

Session: Educational Exhibit Presentations - Station 11: Venous Interventions

Central Venous Catheter Placement in Adults with Fontan Circulation: Review of the Anatomy and Physiology Pertinent for an Interventional Radiologist

Monday, March 6, 2023

5:35 PM – 5:40 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

GM

Gabrielle Matarazzo, PA-C

Physician Assistant
University of Rochester

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

LM

Lindsay Marchetti, PA-C

Physician Assistant
University of Rochester
DB

Devang Butani, MD

Physician
University of Rochester
CA

Cantos J. Andrew, MD

Attending Physician / IR Residency Program Director
University of Rochester/Strong Memorial Hospital

Disclosure(s):

Gabrielle Matarazzo, PA-C: No financial relationships to disclose

Learning Objectives: 1. Review the various congenital heart defects and associated corrective surgeries
2. Understand the physiologic differences and implications on central venous catheter placement
3. Impact on the above with regards to procedure planning and access site

Background:

Congenital heart disease (CHD) affects 40,000 births per year in the US and nearly 25% of these are critical enough to require surgery or intervention¹. Originally developed in 1971 for patients with tricuspid atresia², the Fontan procedure is now the most common operation performed for patients with any type of single ventricle including hypoplastic left heart syndrome, atrioventricular canal defects and pulmonary atresia with intact ventricular septum³. Not only has the breadth of pathologies treatable with Fontan procedures expanded, the long-term survival has also steadily improved to a predicted 30-year survival rate². As of 2010 it was estimated that over 1.4 million adults are living with CHD in the US alone¹.

As patients’ age and Fontan circulation becomes a more common variant it’s critical that Interventional Radiologists familiarize themselves with the three most common Fontan connections (classic atriopulmonary Fontan connection, intra-atrial conduit and extracardiac Fontan). To date there has been little published on the placement of tunneled central venous catheter (TCVC) and peripherally inserted central catheters (PICC) in patients with Fontan anatomy and what does exist relates to pediatric and neonatal patients^4,5.

Clinical Findings/Procedure Details:

This exhibit will review the role and challenges of central venous catheter placement in patients with congenital heart diseases (CHD) who underwent subsequent Fontan procedures. This will start by reviewing single ventricle CHD, the three most common Fontan connections and the associated changes to circulatory patterns. The challenges in work up and management of any complication following venous catheter placement in this patient population will be reviewed. Finally, through a case series, we will outline techniques for safe and efficient placement of central venous catheters in this patient population.

Conclusion and/or Teaching Points: 1. Patients status post Fontan procedures for congenital heart defects have non physiologic blood flow.
2. Work up and management of these patients can be difficult and pose clinical and procedural challenges
3. Understanding all this is important for successful central venous catheter placement