Importance of acquired systemic-to-pulmonary collaterals in the Fontan operation

Aortopulmonary Collaterals in Single-Ventricle Congenital Heart Disease

“…Several centers have reported that higher APC flow was associated with an increased incidence of pleural effusions, elevated pulmonary artery pressure, and mortality. [2][3][4] In contrast, other groups have found that APC flow was not significantly related to postoperative venous pressures, duration of pleural effusions, or resource utilization. 6,7 McElhinney et al 8 found that those patients with significant APCs were, in fact, less likely to have prolonged pleural effusions.…”

“…APCs are also commonly found in patients with singleventricle heart disease, and their extent may fluctuate with successive surgical procedures. [1][2][3][4] The impact and assessment of APCs in patients with a functionally single ventricle is the focus of the discussion that follows.…”

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

“…However, the impact of SPCs on clinical outcomes is far from clear. Whereas some past reports have correlated SPCs with increased morbidity after Fontan, [1][2][3][4][5] other studies have found no such associations. [6][7][8][9] Currently, there is a wide variation in the practice of transcatheter embolization of SPCs before Fontan surgery.…”

“…Typical parameters and positions for the PC-MRI imaging are described elsewhere. 2,15 After the embolization procedure, patients underwent repeat SPC quantification by PC-MRI. A single MRI attending with expertise in collateral flow quantification reviewed and analyzed all PC-MRI data.…”

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

“…APCs are present in up to 80 % of singleventricle patients undergoing pre-Fontan catheterization. Pre-Fontan coil occlusion of these vessels decreases singleventricle volume load and improves outcome after Fontan procedure [8,9,14,16]. These collateral vessels are usually branches of the right and left subclavian arteries including the left internal mammary artery (LIMA) and the right internal mammary artery (RIMA).…”