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Systemic venous collaterals between Glenn and Fontan: prevalence, therapy, and impact on outcomes

Published online by Cambridge University Press:  30 January 2025

Michelle Bao Hoa Nguyen Cong Open the ORCID record for Michelle Bao Hoa Nguyen Cong [Opens in a new window] ,
Thibault Schaeffer ,
Takuya Osawa ,
Jonas Palm Open the ORCID record for Jonas Palm [Opens in a new window] ,
Carolin Niedermaier ,
Nicole Piber ,
Muneaki Matsubara ,
Paul Philipp Heinisch ,
Stanimir Georgiev  and
Alfred Hager
...Show all authors
Michelle Bao Hoa Nguyen Cong
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Thibault Schaeffer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Takuya Osawa
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Jonas Palm
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Carolin Niedermaier
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Nicole Piber
Affiliation:
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
Muneaki Matsubara
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Paul Philipp Heinisch
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Stanimir Georgiev
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Alfred Hager
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Peter Ewert
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Jürgen Hörer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
Masamichi Ono*
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany
*
Corresponding author: M Ono; Email: ono@dhm.mhn.de
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Abstract

Objective:

This study aimed to evaluate veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection.

Methods:

Patients who underwent staged total cavopulmonary connection between 1995 and 2022 were reviewed. Veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection were depicted using angiograms. The prevalence of veno-venous collaterals, the risks for the development of veno-venous collaterals, and the impact of veno-venous collaterals on outcomes were analysed.

Results:

In total, 586 patients were included. Veno-venous collaterals were found in 72 (12.3%) patients. Majority of veno-venous collaterals originated from the superior caval vein and drained into the inferior caval vein. Before bidirectional cavopulmonary shunt, mean pulmonary artery pressure (16.3 vs. 14.5 mmHg, p = 0.018), and trans-pulmonary gradient (9.5 vs. 8.0 mmHg, p = 0.030) were higher in patients with veno-venous collaterals compared to those without. Veno-venous collaterals intervention was performed in 32 (5.5%) patients, in a median of 29 (16–152) days after bidirectional cavopulmonary shunt. Before total cavopulmonary connection, pulmonary artery pressure (10.3 vs. 9.4 mmHg, p = 0.015) and ventricular end-diastolic pressure (8.4 vs. 7.6 mmHg, p = 0.035) were higher, and arterial oxygen saturation (SaO2, 80.6 vs. 82.6 %, p = 0.018) was lower in patients with veno-venous collaterals compared to those without. More palliations before total cavopulmonary connection (p < 0.001, odds ratio: 1.689) were an independent risk for the development of veno-venous collaterals. Veno-venous collaterals did not affect survival after total cavopulmonary connection (92.8 vs. 92.7% at 10 years, p = 0.600).

Conclusions:

The prevalence of veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection was 12%. Veno-venous collaterals may be induced by the elevated pulmonary artery pressure and trans-pulmonary gradient, and also by more previous palliations. However, they had no impact on clinical outcomes following total cavopulmonary connection.

Keywords

Fontansingle ventricleveno-venous collateralsbidirectional cavopulmonary shunttotal cavopulmonary connection
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 8
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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