Document Detail

Characterization and treatment of systemic venous to pulmonary venous collaterals seen after the Fontan operation.
MedLine Citation:
PMID:  14694936     Owner:  NLM     Status:  MEDLINE    
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.
Hisashi Sugiyama; Shi-Joon Yoo; William Williams; Lee N Benson
Related Documents :
3344686 - Surgical risk factors in total anomalous pulmonary venous connection.
17643666 - Superior sternal cleft repair using autologous rib grafts in an infant with complex con...
2979986 - Surgical treatment of partial anomalous pulmonary venous connection of the left lung (i...
15951886 - Intralobar pulmonary sequestration presenting as a large multicystic mass.
15216276 - Combined replacement of the ascending aorta and the aortic valve in 42 consecutive pati...
12296656 - Distal anterior inferior cerebellar artery aneurysms. report of four cases.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiology in the young     Volume:  13     ISSN:  1047-9511     ISO Abbreviation:  Cardiol Young     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-12-25     Completed Date:  2004-04-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  424-30     Citation Subset:  IM    
Department of Pediatrics and Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Child, Preschool
Collateral Circulation
Fontan Procedure*
Heart Catheterization
Pulmonary Veins / physiopathology*
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Recommendations for the use of palivizumab as prophylaxis against respiratory syncytial virus in inf...
Next Document:  Subclinical rheumatic valvitis: a long-term follow-up.