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High incidence of abdominal venovenous collaterals after Kawashima operation
Muhammed Riyas K Rahmath1, Faraz Masud, Ahmad Sallehuddin
1Division of Pediatric Cardiac Surgery, CT Surgery, CCS, Hamad General Hospital, Doha, Qatar.
Insights
Systemic venous collaterals (SVCs) are common after the Kawashima procedure for single-ventricle palliation. Early evaluation and surgical intervention for these abdominal SVCs are recommended, particularly in patients with declining oxygen saturation.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Palliation
Background:
- Single-ventricle palliation aims to redirect blood flow in complex congenital heart defects.
- The Kawashima procedure is a surgical stage used in specific single-ventricle anatomies.
- Systemic venous collaterals (SVCs) can develop post-operatively, impacting patient outcomes.
Observation:
- This study retrospectively reviewed six patients who underwent the Kawashima procedure.
- A median follow-up of 53.4 months revealed a significant decline in systemic arterial oxygen saturation (Spo2) in most patients.
- Sixteen venous collaterals were identified, with 70% located below the diaphragm.
Findings:
- All patients evaluated post-Kawashima operation developed abdominal SVCs.
- A notable decrease in Spo2 was observed in patients with SVCs.
- SVCs were present in 100% of patients followed after the Kawashima procedure.
Implications:
- Thorough evaluation for SVCs is crucial in the ongoing care of post-Kawashima patients.
- Early surgical rerouting of hepatic veins to pulmonary arteries may be beneficial.
- Identifying and managing SVCs can potentially improve oxygenation and long-term outcomes.
Introduction:
Systemic venous collaterals have been found at different stages of single-ventricle palliation, specifically after Kawashima operation. In this study, we present the incidence, clinical features, associated risk factors, and management of such venovenous collaterals (VVCs) after Kawashima procedure.
Materials And Methods:
A retrospective review of all the patients who underwent Kawashima procedure prior to December 2011 at Hamad General Hospital, Qatar, was performed. Data were collected and reviewed from medical records.
Results:
The study group involved a total of six patients with Kawashima procedure. The median age of patients was 112.7 months (range 46-336 months), and median age at the time of Kawashima operation was 31.7 months (range 15-187 months). Mean systemic arterial oxygen saturation (Spo 2) after Kawashima operation was 94.5% ± 1.5%. In five patients, during a median follow-up of 53.4 months (range 16.9-147.9 months), the Spo 2 declined to a mean of 78.8% ± 8.2%. A total of 16 venous collaterals were observed in the study group, and majority (70%) of these collaterals were subdiaphragmatic.
Conclusion:
In our study, abdominal VVCs were observed in 100% of the patients who were followed after Kawashima operation. We therefore recommend that thorough evaluation for such VVCs should be part of the ongoing evaluation of patients after Kawashima operation, especially in those with low Spo 2. We also recommend early surgical rerouting of hepatic veins to pulmonary arteries in all post-Kawashima patients.
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