Transition of Aortopulmonary Collateral Arteries before and after the Fontan Procedure

Abstract

Background:In patients with a functional single-ventricle, coil embolization is commonly performed to avoid complications after the Fontan procedure. The position for coil embolization should be determined after considering the postoperative changes in the aortopulmonary collateral arteries (APCAs). Methods:The study involved 163 patients who underwent the Fontan procedure between 2009 and 2015. The amount of APCA was assessed using a 3-point scale based on the aortogram in the cardiac catheterization. The total score for the five sites (bilateral internal thoracic artery, bilateral subclavian artery, and descending aorta) was calculated and compared in patients with and without coil embolization and before and after the Fontan procedure. Results: The mean scores for the APCAs ranged from 6.1±1.5 to 4.5±1.8 points in patients with coil embolization ( ) and from 4.4±1.7 to 3.6±1.7 points in those without coil embolization (−), indicating a significant decrease. The scores of 35 patients at ≥5 years after the Fontan procedure had decreased as compared to those at 6 months postoperatively (mean 4.2±2.0 to 1.3±1.2 points). The APCA flow of 30 patients measured using a magnetic resonance imaging similarly decreased after the Fontan procedure (mean 1.4±0.6 to 0.8±0.6 L/min). When APCA scores before the Fontan procedure were ≤5 points, there were no significant differences between the coil embolization ( ) and coil embolization (−) groups as to the incidence of prolonged pleural effusion. Conclusion: After the Fontan procedure, the APCA tended to decrease with or without coil embolization. Routine coil embolization is not necessary, which is indicated only when APCA scores are ≥6 points.

The Impact of the Pulmonary Artery Index and Aortopulmonary Collateral Artery Coil Embolization on Intractable Pleural Effusions After a Fontan Surgery

“…However, we routinely provided home oxygen therapy soon after the bidirectional Glenn operation based on the clinical implication that oxygen might have favorable effects on the bidirectional Glenn circulation by suppressing the sympathetic tone and lowering pulmonary vascular resistance. 9) Protocol of the APC coil embolization: We evaluated the amount of APC based on an aortogram 10) and instantly discussed the necessity for coil embolization in each case. Although there are no definite criteria for performing coil embolization, we typically perform it in cases where APCs are so significant that there are apparent overloads to the main ventricles.…”

“…A previous report from our institute demonstrated that significant APC either does not emerge or its amount declines after the Fontan operation. 10) From this report, we considered that routine APC coil embolization was not necessary. Considering that APC can resolve after a Fontan opera-RISK FACTORS AND EFFECT OF APC COIL EMBOLIZATION tion, the main purpose of embolization is to achieve a favorable Fontan circulation.…”

“…Once an acceptable Fontan circulation (without fenestration) is established, relatively lower CVP can be maintained without embolization thereafter. 10) Limitations: A limitation is that this study was a retrospective single-center study. Further, there also were no definite criteria regarding the pleural drainage and hospital discharge in our institute.…”