Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T20:48:20.354Z Has data issue: false hasContentIssue false
  • English
  • Français

Characterization and treatment of systemic venous to pulmonary venous collaterals seen after the Fontan operation

Published online by Cambridge University Press:  24 May 2005

Hisashi Sugiyama ,
Shi-Joon Yoo ,
William Williams  and
Lee N. Benson
Hisashi Sugiyama
Affiliation:
Department of Pediatrics and Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada
Shi-Joon Yoo
Affiliation:
Department of Pediatrics and Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada
William Williams
Affiliation:
Division of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada
Lee N. Benson
Affiliation:
Department of Pediatrics and Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To determine the anatomical characteristics of systemic venous collaterals formed after the Fontan operation, and the efficacy of a transcatheter strategy for management. Methods: We reviewed retrospectively the data from cardiac catherization of 50 persistently cyanotic patients after the Fontan operation. Results: A total of 54 transcatheter interventions were performed, at a mean age of 6.3 ± 3.5 years, a mean interval of 2.7 ± 2.9 years from completion of the Fontan circulation. Of 38 patients who had fenestration of the baffle at the time of surgery, 25 had patency of the fenestration, and 24 had the fenestration occluded with a device at the time of interventional treatment for associated venous collaterals. We identified a total of 68 systemic venous collateral channels, of which 36 (53%) were supracardiac, 12 (18%) cardiac, and 20 (29%) infracardiac in origin. The most common site of origin was the brachiocephalic vein (44%), followed by the left phrenic vein (25%). A longer time from surgery, at 3.3 ± 3.4 years, was associated with the identification of collaterals having a diameter larger than 4 mm (p < 0.01). The mean pulmonary arterial pressure was higher in those with larger compared to those with smaller collaterals (13.3 ± 2.8 versus 11.1 ± 2.0 mmHg, p < 0.01). Coils were used for occlusion of 61 vessels, and a Rashkind™ occluder for the remaining 7. After exclusion of the patients undergoing simultaneous closure of their fenestration, systemic saturation of oxygen increased from 89 ± 6% to 95 ± 3% (p < 0.01). Conclusion: Venous collateral channels are common in patients suffering progressive cyanosis in the setting of the Fontan circulation. The collaterals increase in size with time, and are associated with higher pulmonary arterial pressures. Transcatheter treatment is feasible, and results in resolution of cyanosis. Only continuing follow-up will show whether further collateralization occurs in time.

Keywords

Venous collateral channelscavopulmonary connectionscyanosiscoil embolizationRashkind™ Occluderinterventional catheterization
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 5 , October 2003 , pp. 424 - 430
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

de Leval MR. The Fontan circulation: what have we learned? What to expect? Pediatr Cardiol 1998; 19: 316–320.Google Scholar
Fernandez-Martorell P, Skansky MS, Lucas VW, et al. Accessory hepatic vein to pulmonary venous atrium as a cause of cyanosis after the Fontan operation. Am J Cardiol 1996; 77: 1386–1387.Google Scholar
Hayes AM, Burrows P, Benson LN. An usual cause of cyanosis after the modified Fontan procedure-closure of venous communications between the coronary sinus and left atrium by transcatheter techniques. Cardiol Young 1994; 4: 172–174.Google Scholar
Yoshimura N, Yamaguchi M, Oshima Y, Tei T, Ogawa K. Intrahepatic venous shunting to an accessory hepatic vein after Fontan type operation. Ann Thorac Surg 1996; 67: 1494–1496.Google Scholar
Weber HS. Incidence and predictors for the development of significant supradiaphragmatic decompressing venous collateral channels following creation of Fontan physiology. Cardiol Young 2001; 11: 289–294.Google Scholar
Ro PS, Weinberg PM, Delrosario J, Rome JJ. Predicting the identify of decompressing veins after cavopulmonary anastomosis. Am J Cardiol 2001; 88: 1317–1320.Google Scholar
Magee AG, McCrindle BW, Mawson J, Benson LN, Williams WG, Freedom RM. Sustemic venous collateral development after the bidirectional cavopulmonary anastomosis. J Am Coll Cardiol 1998; 32: 502–508.Google Scholar
Filippini LHPM, Oveaert C, Nykanen DG, Freedom RM. Reopening of persistent left superior caval vein after bidirectional cavopulmonary connection. Heart 1998; 79: 509–512.Google Scholar
McElhinney DB, Reddy VM, Hanley FL, Moore P. Systemic venous collaterals causing desaturation after bidirectional cavopulmonary anastomosis: evaluation and management. J Am Coll Cardiol 1997; 30: 817–824.Google Scholar
Gatzoulis MA, Shinebourne EA, Redington AN, Rigby ML, Ho SY, Shore D. Increasing cyanosis early after cavopulmonary connection caused by abnormal systemic venous channels. Br Heart J 1995; 73: 182–186.Google Scholar
Ovaert C, Filippini LH, Benson LN, Freedom RM. You didn't see them, but now you do!: use of balloon occlusion angiography in the identification of systemic venous anomalies before and after cavopulmonary procedures. Cardiol Young 1999; 9: 357–363.Google Scholar
Nasah EN, Moore GW, Hutchins GM. Pathogenesis of persistent left superior vena cava with a coronary sinus connection. Pediatr Pathol 1991; 11: 261–269.Google Scholar
Campbell M, Deuchar DC. The left-sided superior vena cava. Br Heart J 1954; 16: 423–439.Google Scholar
Buirski G, Jordan SC, Joffe HS, Wilde P. Superior vena caval abnormalities: their occurrence rate, associated cardiac abnormalities and angiographic classification in a pediatric population with congenital heart disease. Clin Radiol 1986; 37: 131–138.Google Scholar
Trivedi KR, Freedom RM, Yoo SJ, McCrindle BW, Benson LN. Physiological impact and transcatheter treatment of the persisting left superior caval vein. Cardiol Young 2002; 12: 218–223.Google Scholar
Kanter KR, Vincent RN, Raviele AA. Importance of acquired systemic-to-pulmonary collaterals in the Fontan operation. Ann Thorac Surg 1999; 68: 969–975.Google Scholar
McElhinney DB, Reddy VM, Tworetzky W, Petrossian E, Hanley FL, Moore P. Incidence and implications of systemic to pulmonary collaterals after bidirectional cavopulmonary anastomosis. Ann Thorac Surg 2000; 69: 1222–1228.Google Scholar