Systemic venous collateral channels causing desaturation after bidirectional cavopulmonary anastomosis: evaluation...

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Interventional Radiology

Background:

• Systemic venous collateral channels are a known complication after cavopulmonary anastomosis.
• These collaterals can lead to significant systemic desaturation.
• Previous reports on this specific issue are limited.

Purpose of the Study:

• To determine the frequency and anatomical characteristics of collateral channels.
• To identify factors associated with their development after bidirectional cavopulmonary anastomosis.
• To evaluate the effectiveness of treatment for these collateral channels.

Main Methods:

• Retrospective analysis of 54 patients undergoing bidirectional cavopulmonary anastomosis.
• Review of preoperative and postoperative angiograms to identify and measure collateral channels.
• Recording of collateral origin, drainage, and patient clinical data.

Main Results:

• 31 collateral channels were found in 18 patients (33%).
• Collaterals often originated from the brachiocephalic vein and drained below the diaphragm.
• Patients with collaterals had higher transpulmonary pressure gradients and lower arterial oxygen saturation.
• Coil embolization improved arterial oxygen saturation by a median of 16%.

Conclusions:

• Systemic venous collateral channels are common after bidirectional cavopulmonary anastomosis.
• These collaterals are associated with poorer oxygenation.
• Coil embolization is an effective treatment, with indications tailored to individual cases.