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Collaterals in congenital heart disease: when and how to treat?

Alexander Van De Bruaene1, Werner Budts1

  • 1Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.

Cardiovascular Diagnosis and Therapy
|August 16, 2023
PubMed

Insights

Collateral circulation in adults with congenital heart disease and heart failure can impact hemodynamics and oxygen levels. This article offers a practical guide for assessing these collaterals to aid clinical decisions.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Congenital Heart Disease

Background:

  • Collateral circulation is common in patients with congenital heart defects, potentially affecting hemodynamics and causing systemic arterial desaturation.
  • Therapeutic management of collaterals in adult congenital heart disease patients with heart failure is under-reported.
  • Systemic venous anomalies, including collaterals, occur in 20-40% of patients post-Glenn or Fontan procedure.

Purpose of the Study:

  • To provide a pragmatic approach for assessing collateral circulation in adult congenital heart disease patients experiencing heart failure.
  • To offer a practical tool for clinical decision-making regarding the management of these collaterals.
  • To highlight key types of collateral circulation: systemic venous-to-venous, systemic venous-to-pulmonary venous, and pulmonary arteriovenous malformations.

Main Methods:

  • Review and synthesis of existing literature on collateral circulation in congenital heart disease and heart failure.
  • Focus on hemodynamic principles and clinical implications of different collateral types.
  • Discussion of potential etiological factors for collateral formation, including angiogenesis and embryological remnants.

Main Results:

  • Collateral circulation can significantly alter cardiovascular hemodynamics and lead to systemic arterial desaturation.
  • Potential causes of collateral formation include reduced effective pulmonary blood flow, increased oxygen demand, and pressure gradients between caval and atrial systems.
  • Systemic venous anomalies are frequent, particularly after Glenn or Fontan procedures.

Conclusions:

  • A systematic assessment of collateral circulation, considering hemodynamics and clinical impact, is crucial for managing heart failure in adults with congenital heart disease.
  • Understanding the types and causes of collateral formation can guide therapeutic strategies.
  • Further research is needed to elucidate the precise mechanisms of collateral development (angiogenesis vs. embryological channels).

Keywords:
CollateralFontanGlennclosuresingle ventricle

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