Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis

Ronald William Day

doi:doi:10.11648/j.ijcts.20220802.12

| Peer-Reviewed

Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis

Ronald William Day

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 8, Issue 2)

Received: 20 February 2022 Accepted: 26 March 2022 Published: 31 March 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 8, Issue 2)
DOI	10.11648/j.ijcts.20220802.12
Page(s)	17-23
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

CT Angiography, Heart Catheterization, Hypoxemia, Superior Cavopulmonary Anastomosis, Systemic Venous Collaterals

References

[1]	Gatzoulis MA, Shinebourne EA, Redington AN, Rigby ML, Ho SY, Shore DF. Increasing cyanosis early after the cavopulmonary connection caused by abnormal systemic venous channels. Br Heart J 1995; 73: 182-6.
[2]	McElhinney DB, Reddy VM, Hanley FL, Moore P. Systemic venous collateral channels causing desaturation after bidirectional cavopulmonary anastomosis: evaluation and management. J Am Coll Cardiol 1997; 30: 817-24.
[3]	Magee AG, McCrindle BW, Mawson J, Benson LN, Williams WG, Freedom RM. Systemic venous collateral development after the bidirectional cavopulmonary anastomosis. Prevalence and predictors. J Am Coll Cardiol 1998; 32: 502-8.
[4]	Karur S, Mahima J, Nanjappa MC. Systemic venous collateral channel causing desaturation after bidirectional cavopulmonary anastomosis: percutaneous closure. Cardiol Young 2011; 21: 107-9.
[5]	Zampi JD, Hirsch-Romano JC, Armstrong AK. Early cyanosis after stage II palliation for single ventricle physiology: etiologies and outcomes. World J Pediatr Congenit Heart Surg 2013; 4: 367-72.
[6]	Greenberg JW, Pribble CM, Singareddy A, Ta NA, Sescleifer AM, Fiore AC, Huddleston CB. The failed bidirectional Glenn shunt: Risk factors for poor outcomes and the role for early reoperation. World J Pediatr Congenit Heart Surg 2021; 12: 760-4.
[7]	Lawrence KM, Ittenbach RF, Hunt ML, Kaplinski M, Ravishankar C, Rychik J, Steven JM, Fuller SM, Nicolson SC, Gaynor JW, Spray TL, Mascio CE. Attrition between the superior cavopulmonary connection and the Fontan procedure in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2021; 162: 385-393.
[8]	Day RW, Etheridge SP, Veasy LG, Jenson CB, Hillman ND, Di Russo GB, Thorne JK, Doty DB, McGough EC, Hawkins JA. Single ventricle palliation: Greater risk of complications with the Fontan procedure than with the bidirectional Glenn procedure alone. Int J Cardiol 2006; 106: 201-10.
[9]	Adatia I, Atz AM, Wessel DL. Inhaled nitric oxide does not improve systemic oxygenation after the bidirectional superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2005; 21: 217-9.
[10]	Frank BS, Khailova L, Silveira L, Mitchell MD, Morgan GJ, DiMaria MV, Davidson JA. Increased circulating endothelin 1 is associated with postoperative hypoxemia in infants with single-ventricle heart disease undergoing superior cavopulmonary anastomosis. J Am Heart Assoc 2022; 4: e024007 (Online ahead of print).
[11]	Pearl JM, Nelson DP, Raake JL, Manning PB, Schwartz SM, Koons L, Shanley TP, Wong HR, Duffy JY. Inhaled nitric oxide increases endothelin 1 levels: a potential cause for rebound pulmonary hypertension. Crit Care Med 2002; 30: 89-93.

Cite This Article

Plain Text BibTeX RIS

APA Style

Ronald William Day. (2022). Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. International Journal of Cardiovascular and Thoracic Surgery, 8(2), 17-23. https://doi.org/10.11648/j.ijcts.20220802.12

Copy | Download

ACS Style

Ronald William Day. Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. Int. J. Cardiovasc. Thorac. Surg. 2022, 8(2), 17-23. doi: 10.11648/j.ijcts.20220802.12

Copy | Download

AMA Style

Ronald William Day. Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. Int J Cardiovasc Thorac Surg. 2022;8(2):17-23. doi: 10.11648/j.ijcts.20220802.12

Copy | Download

@article{10.11648/j.ijcts.20220802.12,
  author = {Ronald William Day},
  title = {Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {8},
  number = {2},
  pages = {17-23},
  doi = {10.11648/j.ijcts.20220802.12},
  url = {https://doi.org/10.11648/j.ijcts.20220802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20220802.12},
  abstract = {Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis
AU  - Ronald William Day
Y1  - 2022/03/31
PY  - 2022
N1  - https://doi.org/10.11648/j.ijcts.20220802.12
DO  - 10.11648/j.ijcts.20220802.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 17
EP  - 23
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20220802.12
AB  - Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.
VL  - 8
IS  - 2
ER  -

Copy | Download

Author Information

Ronald William Day

Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, United States

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Ronald William Day. (2022). Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. International Journal of Cardiovascular and Thoracic Surgery, 8(2), 17-23. https://doi.org/10.11648/j.ijcts.20220802.12

Copy | Download

ACS Style

Ronald William Day. Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. Int. J. Cardiovasc. Thorac. Surg. 2022, 8(2), 17-23. doi: 10.11648/j.ijcts.20220802.12

Copy | Download

AMA Style

Ronald William Day. Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis. Int J Cardiovasc Thorac Surg. 2022;8(2):17-23. doi: 10.11648/j.ijcts.20220802.12

Copy | Download

@article{10.11648/j.ijcts.20220802.12,
  author = {Ronald William Day},
  title = {Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {8},
  number = {2},
  pages = {17-23},
  doi = {10.11648/j.ijcts.20220802.12},
  url = {https://doi.org/10.11648/j.ijcts.20220802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20220802.12},
  abstract = {Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Identifying Posterior Venous Collaterals Associated with Inordinate Hypoxemia After the Superior Cavopulmonary Anastomosis
AU  - Ronald William Day
Y1  - 2022/03/31
PY  - 2022
N1  - https://doi.org/10.11648/j.ijcts.20220802.12
DO  - 10.11648/j.ijcts.20220802.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 17
EP  - 23
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20220802.12
AB  - Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.
VL  - 8
IS  - 2
ER  -

Copy | Download