Post-Glenn Shunt Systemic Desaturation—Is Venovenous Collateral the Culprit?

Ponnana, Hemanth Harish; Jyotsna, Maddury; Kumar, Manoj

doi:10.1055/s-0040-1713582

Cited by 2 publications

(6 citation statements)

References 10 publications

(9 reference statements)

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“…Nepalese Heart Journal 2020; Vol 17 (2), [13][14][15][16][17][18][19] preoperative right ventricular dysfunction. Importantly, all these 8 patients survived the procedure.…”

Section: Resultsmentioning

confidence: 99%

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In Hospital Outcomes after Bidirectional Cavopulmonary Anastomosis: 18 Year Experience from a Single Center

et al. 2020

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Background: Bidirectional cavopulmonary shunt (BCPS) is used for the interim palliation of a variety of cyanotic cardiac lesions. It is a standard palliative step for patients with functionally univentricular hearts in hope of achieving Fontan completion. At our center, first case of BCPS was performed on February 7, 2002. Here, we share our experience with BCPS over last 18 years. Methods: This is a retrospective analysis of all patients undergoing BCPS from February 2002 to July 2019. Patients who underwent BCPS as a part of one-and-half ventricular repair for Ebstein’s anomaly were excluded. Baseline, intraoperative, and postoperative variables were collected from hospital records. Results: A total of 326 patients with mean age of 5.7±5.8 years (median 3.5 years; range: 1.5 months-32 years) underwent BCPS over last 18 years. Majority (61%) were males. Double outlet right ventricle (DORV) was the most common primary cardiac lesion (30%) followed by tricuspid atresia (23%). Mean ICU stay was 3.9±4.8 days, with hospital stay of 7.8±5.9 days. In-hospital mortality was 15%. Patients who died had low body weight (11.8±10.7 kg vs 16.0±11.6 kg; p=0.019), and longer cardiopulmonary bypass time (101±64 min vs 76±42 min; p=0.001). Oxygen saturation improved significantly at the time of discharge (79.2±9.5% vs 68.6±13.7%; p=0.000). Conclusion: This is the first report of its kind to analyze the outcomes of BCPS in our center. We have discussed the evolution of BCPS surgery in our center and presented our outcomes. Our in-hospital mortality remains high, and we need to strive towards reducing the mortality.

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“…Nepalese Heart Journal 2020; Vol 17 (2), [13][14][15][16][17][18][19] preoperative right ventricular dysfunction. Importantly, all these 8 patients survived the procedure.…”

Section: Resultsmentioning

confidence: 99%

“…Even after ligation of azygos vein, there have been reports of veno-venous collaterals between SVC and IVC leading to systemic desaturation. 19 At the time of BCPS, we always takedown the previously created m-BT or central shunts. All the patent shunts (8/11) were taken down at the time of BCPS.…”

Section: Resultsmentioning

confidence: 99%

In Hospital Outcomes after Bidirectional Cavopulmonary Anastomosis: 18 Year Experience from a Single Center

et al. 2020

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“…Despite that no specific oxygen saturation is mentioned in the literature to identify patients after PCPC who developed veno-venous collaterals, there should be a high suspicion for their development in patients presenting with desaturation ( 9 ). The pressure difference between the upper and lower half of the body after PCPC predisposes to the development of veno-venous collaterals between SVC and IVC ( 9 ), and represents a “run-off” from the higher pressure superior caval venous system to the lower pressure atria, hepatic veins/and IVC ( 7 ). Extensive veno-venous collaterals lead to desaturation and cyanosis because the blood is bypassing the lung ( 9 ).…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

“…The pressure difference between the upper and lower half of the body after PCPC predisposes to the development of veno-venous collaterals between SVC and IVC ( 9 ), and represents a “run-off” from the higher pressure superior caval venous system to the lower pressure atria, hepatic veins/and IVC ( 7 ). Extensive veno-venous collaterals lead to desaturation and cyanosis because the blood is bypassing the lung ( 9 ). This mandates closure to improve oxygen saturation and, hence, the functional status of the patients ( 7 ).…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

“…This mandates closure to improve oxygen saturation and, hence, the functional status of the patients ( 7 ). It is obvious that not every patient who presents with desaturation has venous collaterals ( 9 ), because pulmonary arterio-venous fistula (PAVF) is also an important cause for desaturation, and is considered a classical late complication of PCPC (Glenn) operation, which leads to the absence of hepatic factor in the pulmonary blood flow. The condition can be ameliorated by completion to a TCPC circuit ( 10 ), or redirection of hepatic blood flow into the pulmonary arteries ( 11 ).…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

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Catheter interventional closure of veno-venous collaterals in cyanotic patients after partial cavopulmonary shunts in pediatric patients: clinical practice review

Abdelaziz¹,

Tanase²,

Ewert³

et al. 2023

Cardiovasc Diagn Ther

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The development of veno-venous collaterals is an important and treatable cause of cyanosis in patients who had undergone partial cavo-pulmonary connection (PCPC) operations. Nevertheless, the literature on this complicated therapeutic option is sparse. Patients can present cyanosis either immediately after the operation (<30 days), which delays or hinders discharge from the intensive care unit or cyanosis may occur late: (>30 days and/or in another hospital admission), after the operation. Hence, transcatheter closure of veno-venous collaterals is the treatment of choice. Four patients were selected who showed cyanosis at variable durations after PCPC; the morphology of the collaterals and their hemodynamic effect was described and the strategy for closure of such abnormal vessels is suggested. Veno-venous collaterals described in our series were seen originating mainly or mostly from innominate vein angles. The drainage sites were either above the diaphragm into a cardiac structure: the coronary sinus (CS) and/or atria; or below the diaphragm into the inferior vena cava (IVC) or hepatic veins through the paravertebral venous system and/or the azygous system. It is stated in the literature that several types of devices and coils can be used to close the collaterals such as the Amplatzer vascular plugs (AVPs), Amplatzer duct occluder II (ADOII), non-detachable and detachable coils. In this clinical review, the technical details that determine device type and size are explained. The recent generations of hydrogel-coated coils were also used in this series of patients to close the difficult types of collaterals with better results. All described vessels were closed successfully, without any complications. The patients had a significant rise in their transcutaneous oxygen saturations and hence, a clear clinical benefit.

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Post-Glenn Shunt Systemic Desaturation—Is Venovenous Collateral the Culprit?

Cited by 2 publications

References 10 publications

In Hospital Outcomes after Bidirectional Cavopulmonary Anastomosis: 18 Year Experience from a Single Center

In Hospital Outcomes after Bidirectional Cavopulmonary Anastomosis: 18 Year Experience from a Single Center

Catheter interventional closure of veno-venous collaterals in cyanotic patients after partial cavopulmonary shunts in pediatric patients: clinical practice review

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