Acute Effects of Embolizing Systemic-to-Pulmonary Arterial Collaterals on Blood Flow in Patients With Superior Cavopulmonary Connections

Abstract

2 ) (P=0.03). Conclusions-We report on the acute efficacy of SPC embolization, demonstrating a significant decrease in SPC flow and Q P :Q S and increase in Q SVC and Q S . Further studies are needed to assess the durability of the procedure and the effect on Fontan and longer-term outcomes. (Circ Cardiovasc Interv. 2013;6:101-106.)

Life-threatening airway bleeding after palliation of single ventricle congenital heart disease

“…Subsequent occlusion of SPCs which supply the affected lung segment, either in a single catheterisation or over the course of multiple procedures, is effective in achieving cessation of airway bleeding. Recently, our approach to SPC occlusion has tended to shift towards the use of embolisation particles, both for their acute efficacy and long-term durability in collateral obstruction 23. Importantly, as we have gained experience with this management strategy, we have learnt that bronchoscopy is best used to identify culprit lung segments but not to provide complete airway clearance in the acute setting.…”

Relationship of cerebral blood flow to aortic-to-pulmonary collateral/shunt flow in single ventricles

“…Presumably, APC flow may also divert variable amounts of blood from other organs, including the coronaries. Interventions on APCs pharmacologically15 and via catheter5 can decrease APC flow, which may potentially be useful in affecting the patient's neurodevelopmental outcome.…”

“…It also suggests, however, that manipulating APC flow via catheter5 or pharmacology15 may mitigate these effects. CBF is related to intelligence in adults13 22 and cognitive function in children 14 23.…”

“…We hypothesise that APC flow will negatively impact CBF, and speculate that it may represent a risk factor for poor neurodevelopmental outcome. Because APCs may be embolised in the catheterisation laboratory5 or manipulated pharmacologically,15 patients at risk can potentially undergo early intervention making the relationship of APCs to CBF important to identify and characterise for clinical outcome.…”

Coronary Artery Bypass Grafting in Single-Ventricle Patients Palliated with Fontan Procedure: Future Consideration

“…The incidence of LIMA versus RIMA coiling is poorly described in the literature. A Pubmed search revealed many articles investigating pre-Fontan coiling of APCs without clear specification of the vessel(s) being coiled [3,4,15]. A study designed to evaluate this incidence would be a great start.…”