Aortopulmonary Collaterals in Single-Ventricle Congenital Heart Disease

Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection

“…The additional pulmonary blood flow provided can relieve systemic hypoxaemia prior to TCPC 5 6. However, SPC flow may result in important volume overloading of the single ventricle, compete with and limit blood flow via the pulmonary arteries (PAs), and increase pulmonary arterial pressure and vascular resistance.…”

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

“…While some CHD centres routinely embolise SPCs during pre-SCPA or pre-Fontan elective cardiac catheterisation, based either on quantitative assessment of SPC shunt burden, qualitative impression or standard protocol, other centres are as likely to avoid intervention on SPCs at all 17 18. SPCs that are in close association with the bronchial tree may dilate, erode into the airway and rupture, leading to life-threatening hemoptysis 8. This may occur as an unprovoked natural consequence of increasing SPC burden, or in temporal relationship to an acute or chronic airway insult, such as with a lower respiratory tract infection or non-infectious inflammatory process like gastroesophogeal reflux or environmental allergy 19 20…”

Quantification of Systemic-to-Pulmonary Artery Collateral Flow

“…[1][2][3]11 The recent development of a cardiac MR technique to measure SPC flow noninvasively has overcome the drawbacks of previous methods to quantify collateral flow in patients with FSV. 12 First described in a case report by Grosse-Wartmann et al in 2007, 13 this method was subsequently refined and systematically evaluated in small cohorts by the same group and by Whitehead et al 14,15 Using phase contrast cine cardiac MR flow measurements in the aorta, superior and inferior venae cavae, branch pulmonary arteries, and pulmonary veins, SPC flow can be calculated in 2 different ways: (1) SPC flowϭsum of pulmonary vein flowϪsum of branch pulmonary artery flow; and (2) SPC flowϭascending aorta flowϪsum of caval flow (Figure). The results of both methods are then compared with each other for consistency as a measure of internal control.…”