274: Is valvulation of Fontan circulation of clinical value?

ObjectivesFontan circulations conduct to complications such as heart dysfunction, arrhythmia, exsudative entheropathy. The circulation largely depends on breathing and gravity. A part of the caval flow comes back in the abdominal compartment. We propose to study the insertion of valve in the system in patients with refractory dysfunction. We hypothesized that the valve will reduce the effects of the respiration and gravity improving the net flow in the lungs, the exercise capacity and the enteropathy. The Melody valve is the valve of choice because it is fine and harvested from the bovine jugular vein.MethodsAll patients who received a valve in a Fontan circulation were eligible.Resultsfour patients were included. All had a Fontan circulation with clinical and hemodynamic alterations: 2 patients had refractory exsudative entheropathy, one a dyfunction of the systemic ventricle and edema, and the last one severe venous insufficiency of the legs. A Melody valve was successfully inserted in all patients; three in the pathway, one after the iliac bifurcation. There was no significant modification of the pressures after valvulation. No acute complication was recorded. There was an improvement of the doppler through the proclive and breathing. However, these were not associated with significant clinical improvement. No thrombosis of the valve accured during the short follow-up (1 to 6 months).Conclusionsthe valvulation of the Fontan circuit is easily performed. We noticed an improvement of the hemodynamic and flow. However, no clinical improvement was recorded as a result. A longer follow-up is needed to appreciate the risks as well as the interest of this procedure