Durable Benefit of Particle Occlusion of Systemic to Pulmonary Collaterals in Select Patients After Superior Cavopulmonary Connection.
Systemic to pulmonary arterial collaterals (SPC) are commonly found in patients undergoing staged operative palliation for single ventricle heart disease. Occlusion of SPC as part of pre-Fontan catheterization has been shown to improve hemodynamics acutely. Anecdotally, the effect of this intervention appears to be transient, and to our knowledge there is no data supporting its durability in these patients. Between 1/1/2016 and 5/1/2017, 24 children underwent Glenn operations at our institution. Of these, 3 patients had signs and symptoms deteriorating clinical status suggestive of volume overload in the period between their Glenn operation and Fontan completion, prompting heart catheterization. SPC were occluded with a combination of polyvinyl alcohol embolization particles, and in some cases coils or vascular plugs. Clinical course and data from echocardiograms and serial catheterizations are presented. SPC occlusion was performed over 6 procedures in 3 subjects with technical success in each case. Hemodynamic evaluation was repeated in 2/3 patients with improvement in collateral burden and hemodynamics in both cases. One patient previously thought to be unsuitable for Fontan completion improved sufficiently to undergo late Fontan completion, which was ultimately successful. In all patients, there was improvement in clinical status. In patients with severe SPC collateral durable benefit was seen, suggesting that in certain cases intervention on SPC remote from Fontan completion may have clinical benefit.
["O'Byrne|Michael L|ML|", 'Schidlow|David N|DN|']
D000792:Angiography D006328:Cardiac Catheterization D002675:Child, Preschool D003097:Collateral Circulation D004452:Echocardiography D004621:Embolization, Therapeutic D018729:Fontan Procedure D006352:Heart Ventricles D006439:Hemodynamics D006801:Humans D018636:Hypoplastic Left Heart Syndrome D007223:Infant D008297:Male D010166:Palliative Care D011651:Pulmonary Artery
Hypoplastic left heart syndrome Pediatric cardiology Pulmonary atresia intact ventricular septum Transcatheter intervention Vascular embolization