Spontaneous closure of arterio-venous pulmonary fistulas by redirection of hepatic venous blood 9 years after Glenn anastomosis in a 12-year-old girl

Gendera, Katarzyna; Eicken, Andreas; Ewert, Peter

doi:10.1017/s1047951119000465

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…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 ). Therefore, if a patient is severely cyanotic after PCPC veno-venous collaterals have to be excluded or closed.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

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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Section: Discussion and Recommendationsmentioning

confidence: 99%

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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Batlivala

McGovern²,

Goldstein³

2022

Annals of Pediatric Cardiology

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Congenital portosystemic venous connections are rare vascular anomalies that connect the portal and systemic venous circulations. These vascular lesions can lead to complex and varied physiologic manifestations in single-ventricle patients as they progress through the various stages of palliation in the Fontan pathway. Specifically, these connections may be unmasked after a superior cavopulmonary anastomosis operation, but then “re-masked” after Fontan completion. We describe the complex physiology with an illustrative case report and present a novel method to unmask these pathologic connections after Fontan completion to facilitate transcatheter occlusion and resolve downstream symptoms.

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Spontaneous closure of arterio-venous pulmonary fistulas by redirection of hepatic venous blood 9 years after Glenn anastomosis in a 12-year-old girl

Cited by 2 publications

References 10 publications

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

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

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