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Prevalence and risk factors for aortopulmonary collateral vessels after Fontan and bidirectional Glenn procedures

J K Triedman1, N D Bridges, J E Mayer

  • 1Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.

Journal of the American College of Cardiology
|July 1, 1993
PubMed

Insights

Aortopulmonary collateral vessels are common after bidirectional Glenn and Fontan procedures, affecting 36% of patients. These vessels, often missed by aortograms, can impact pulmonary blood flow and oxygen saturation.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Interventional Cardiology

Background:

  • Aortopulmonary collateral vessels (APCVs) are frequently observed post-bidirectional Glenn or Fontan procedures.
  • These vessels can create pulmonary blood flow competitive with anterograde cavopulmonary flow.

Purpose of the Study:

  • To determine the prevalence of APCVs in patients who have undergone bidirectional Glenn or Fontan procedures.
  • To identify risk factors associated with the development of APCVs.

Main Methods:

  • Retrospective review of 196 patients undergoing catheterization after bidirectional Glenn or Fontan procedures between 1988 and 1992.
  • Analysis of clinical, hemodynamic, and angiographic data.

Main Results:

  • APCVs were diagnosed in 36% of patients; more common after bidirectional Glenn (65%) than Fontan (30%) procedures.
  • A history of Blalock-Taussig shunt increased the likelihood of APCVs (50% vs. 24%).
  • Internal mammary arteries and thyrocervical trunks were common origins; aortograms often failed to visualize APCVs.

Conclusions:

  • APCVs are prevalent following bidirectional Glenn and Fontan procedures.
  • Aortograms have limitations in diagnosing APCVs, which can cause left-to-right shunting indicated by increased pulmonary artery oxygen saturation.
  • The clinical significance and indications for APCV closure remain unknown.
Abstract

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