Incidence and Impact of Systemic Venous Collateral Development after Glenn and Fontan Procedures*

Heinemann, Melina; Breuer, Johannes; Steger, Volker; Steil, E; Sieverding, Ludger; Ziemer, Gerhard

doi:10.1055/s-2001-14339

Cited by 71 publications

(38 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In terms of anatomic factors, heterotaxia syndrome is the only predictor for venous collaterals (53% in heterotaxia vs 22% in non heterotaxia, P < 0.01) [6] . The present patient had polysplenia.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic venous collaterals, which originate from a highpressure systemic vein and drain into a low-pressure pulmonary vein or functional left atrium, may develop after the Fontan operation in single-ventricle patients [1][2][3][4][5][6] . Weber reported that significant systemic venous collaterals were detected in 7 of 40 patients (18%) after the Fontan operation [2] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

Sonomura

Ikoma²,

Kawai³

et al. 2012

WJR

View full text Add to dashboard Cite

Embolization of collateral veins is often treated with rigid coils (Gianturco and interlocking detachable coils type). However, when dealing with tortuous and dilated collateral veins, there is a high risk for technical failure and coil migration due to inflexibility of the coils. To safely and successfully solve this problem, Guglielmi detachable coils (G�C) can be used for embolization. Their flexibility allows for easy navigation in tortuous veins, low risk of unintended coil release or coil migration, and safe deployment. A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure. The symptoms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein, forming a right-to-left shunt. The collateral, which had a large diameter and high flow, and therefore a high risk of coil migration, was successfully embolized with 8 G�C. There were no complications such as coil migration or cerebral infarction. Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%, and increased her ability to exercise. The embolization procedure using flexible G�C was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

Sonomura

Ikoma²,

Kawai³

et al. 2012

WJR

View full text Add to dashboard Cite

show abstract

“…Bedard and colleagues estimated an event rate of 3.1% in a 10-year follow-up of 65 survivors after the fontan procedure (19), and Trieddman and colleagues reported that angiographically diagnosed aortopulmonary chest wall collateral vessels were present in 37% of catheterizations performed in patients who had undergone a Fontan or a bidirectional Glenn procedure (20). Veno-venous collateral channels are also a well described phenomenon after a bidirectional Glenn and most often are a reflection of elevated pulmonary arterial pressure and resistance (19,(21)(22)(23)(24). It is therefore likely that hemoptysis due to aorto-pulmonary arterial …”

Section: Brief Communicationmentioning

confidence: 99%

A Case of Tracheal Varices in an Adolescent Patient with Cyanotic Heart Disease

et al. 2013

View full text Add to dashboard Cite

Tracheal varices and bronchial varices are infrequently reported in adults as a complication of an underlying vascular obstruction, including portal hypertension, pulmonary arterial hypertension, or pulmonary venous hypertension. Tracheal varices and bronchial varices have been reported in adults with failing Fontan physiology, but this occurrence is rare in children. We report the unusual presentation of tracheal-bronchial varices due to veno-venous collaterals in an adolescent patient with Glenn physiology for doubleinlet left ventricle and portal hypertension secondary to cardiac cirrhosis. We document complete resolution of these varices after heart and liver transplantation.

show abstract

“…Clinically significant cyanosis may occur in these patients, depending on the quantity of this shunt, and interventional closure can be indicated. 1 With connection to the paravertebral veins, the vessels are often located extremely posterior, making retrograde access from the pulmonary veins by either transseptal or direct hybrid access via the left atrium and placement of a sheath or closure device extremely difficult. CT visualization of the azygous or hemiazygous veins and their collateral vessels makes CT-guided access through the paravertebral veins technically possible.…”

mentioning

confidence: 99%

“…1,2 The collateral pathways may also include connections to the pulmonary veins via the bronchial vein system with development of a significant right-to-left shunt. 3 Because the azygous vein is typically ligated at its junction with the superior vena cava at the time of a bidirection Glenn procedure, it can be difficult to access and close venous collaterals causing right to-left shunting when they originate from the cervical vertebral venous system and drain through the posterior azygous.…”

mentioning

confidence: 99%

Paravertebral Venous Access for Closure of a Collateral in a Pediatric Patient After Fontan Operation

Schubert

Podrabský

Berger

et al. 2010

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

e report on a 16-year-old female patient with tricuspid atresia, ventricular and atrial septal defect, hypoplastic right ventricle, and pulmonary stenosis. A modified BlalockTaussig shunt was placed within the first month of life, followed by a modified bilateral bidirectional Glenn anastomosis at 3 years and a total cavopulmonary anastomosis (TCPC) at 5 years of age. The azygous vein was ligated at the time of the Glenn procedure. The patient presented with new cyanosis (arterial oxygen saturations were 86% at rest and 76% at exercise) and a decrease in exercise capacity 11 years after TCPC. By cardiac catheterization, a significant right-to-left shunt across a collateral vessel could be detected, originating from the vertebral venous plexus and draining via the azygous system with a single opening to the pulmonary vein ( Figure 1A and 1B). Repeated attempts were made at transcatheter closure through the small and tortuous feeding vessels connected to the jugular veins but were unsuccessful. Therefore, a combined surgical and transcatheter approach (hybrid procedure) was performed: After a median sternotomy, the left atrium was punctured and a long sheath was inserted into the pulmonary vein, which drained the collateral vessel. Because of the large diameter of the collateral, its distant orifice, and its tortuosity, however, it was not possible to advance an introducer sheath or a closure device into the collateral vessel. Therefore, a multidisciplinary interventional approach was applied. With the patient in prone position and under deep conscious sedation, a CT scan was performed (Siemens Somatom Definition AS, application of 80 mL Accupaque 350; flow, 2.5 mL/s; delay, 50 seconds; slice thickness, 5 mm, Erlangen, Germany) and identified a 4-mm paravertebral vein at the level of the 4th to 5th thoracic vertebra as a small feeding vessel. Under real-time CT guidance, this vessel was punctured using a 4F Micropuncture introducer set (Cook Medical Inc, Bloomington, Ind), and a 4F sheath (Cook Medical Inc) was placed by means of the Seldinger technique (Figure 2). The patient was then transferred to the catheterization laboratory. The sheath was exchanged for a 7F sheath and the collateral vessels were embolized with the placement of 8 mm and 12 mm Amplatzer vascular plugs (AGA Medical, Golden Valley, Minn) far from the entrance to the pulmonary vein ( Figure 1C). Because of the position of the sheath and devices, a postclosure venogram could not be performed, but an increase in the arterial saturation to 96% confirmed closure of the collateral vein. Finally, the puncture site was closed by means of Angio Seal 8F (St Jude Medical GmbH, Eschborn, Germany).The vertebral-azygous-hemiazygous pathway may show significantly enlarged collateral vessels in patients after corrective surgery of congenital heart disease, especially in those with modified Glenn or TCPC/Fontan operations or with obstructions or thrombosis of the superior caval vena. 1,2 The collateral pathways may also include connections to the pulmonary vei...

show abstract

Incidence and Impact of Systemic Venous Collateral Development after Glenn and Fontan Procedures*

Cited by 71 publications

References 9 publications

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report

A Case of Tracheal Varices in an Adolescent Patient with Cyanotic Heart Disease

Paravertebral Venous Access for Closure of a Collateral in a Pediatric Patient After Fontan Operation

Contact Info

Product

Resources

About