Pediatric Cardiology and Cardiac Surgery
Vol.26 No.4 2010 (300-307)
Takanari Fujii,1,3) Yoshiki Mori,1,4) Kanta Kishi,1) Hiromi Kurosawa2) and Toshio Nakanishi1)
Departments of 1)Pediatric Cardiology and 2)Cardiovascular Surgery, Tokyo Women’s Medical University, 3)Department of Pediatrics, Showa University School of Medicine, Tokyo, and 4)Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
Background: It is known that systemic venous collaterals develop and that they can lead to unanticipated cyanosis after the Fontan procedures. However, these collaterals after the Fontan procedures remain unknown in detail. The aim of this study was to determine the incidence, clinical course and factors associated with venous collaterals after the Fontan procedures.
Methods: We reviewed angiograms and clinical data in 171 Fontan patients who underwent cardiac catheterization. Venous collaterals with <95% systemic desaturation were defined as significant. Anatomic and hemodynamic variables as the predictive factors were compared between the groups with or without decompressing venous collaterals. Results: Fifty-four venous collaterals were identified in 36 patients (21%). In 19 patients (53%), the collaterals were detected within 1 year after the Fontan procedures. The follow-up catheterizations (n=25) showed that the arterial oxygen saturation at rest (90±4%) did not change during follow-up periods (5.3±3.3 years), although the size of vessels increased in 13 cases. The morphology of ventricle, hemodynamic variables including pulmonary artery pressure, resistance, Nakata index before the Fontan procedures and transpulmonary pressure after the procedures were similar between the groups. The only anatomic factor of heterotaxia syndrome was a predictor for venous collaterals (53% in heterotaxia vs. 22% in non heterotaxia, p<0.001). Conclusions: Systemic venous collaterals are not rare in Fontan patients. They do not hemodynamically deteriorate at rest, but increase in size with time. These collaterals are more common in the heterotaxia syndrome.