Recanalisation of the left superior caval vein after Fontan procedure: not so rare complication: possibilities of percutaneous closure using various devices

2014 ◽  
Vol 25 (3) ◽  
pp. 485-490
Author(s):  
Jacek Kusa ◽  
Leslaw Szydlowski ◽  
Ewa Nowakowska ◽  
Agnieszka Skierska
Keyword(s):  
Rare Complication ◽  
Fontan Procedure ◽  
Arterial Oxygen Saturation ◽  
Percutaneous Closure ◽  
Arterial Oxygen ◽  
Total Cavopulmonary Connection ◽  
Sudden Increase ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Cavopulmonary Connection

AbstractAim: Evaluation of possibilities of percutaneous closure of recanalised left superior caval vein after total cavopulmonary connection.Methods and Results: We analysed 19 patients after total cavopulmonary connection catheterised because of a sudden increase of desaturation. In four of them, the recanalisation of the left superior caval vein was identified. For this reason, the balloon occlusion tests of the veins were made temporarily. In all cases, the haemodynamic status of patients did not change, and arterial oxygen saturation increased significantly. Thus, using different types of implants, these veins were closed effectively in all patients. During the short-term follow-up, the effectiveness of treatments and constantly maintaining a high level of saturation were confirmed.Conclusions: Meticulous investigation of unclear causes of desaturation in cyanotic patients after Fontan completion is necessary. Almost all causes of desaturation, including recanalised additional left superior caval vein, can be effectively treated percutaneously.

Possible sources of right-to-left shunting in patients following a total cavopulmonary connection

1998 ◽  
Vol 8 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Gernot Buheitel ◽  
Michael Hofbeck ◽  
Ursula Tenbrink ◽  
Georg Leipold ◽  
Jürgen v.d. Emde ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Veins ◽  
Arterial Oxygen ◽  
Total Cavopulmonary Connection ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Arteriovenous Fistulas ◽  
Cavopulmonary Connection

AbstractDespite a good haemodynamic result, many children have amildly decreased arterial oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8±3.5% of the pulmonary blood flow, and the total right-to left shunt accounted for 18.9±5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4±3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterials or leaks accounted for 13.0±5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracafdiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between stystemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.

scholarly journals Use of an Amplatzer ductal occluder to close a persistent left superior caval vein which reopened after a total cavopulmonary anastomosis

2002 ◽  
Vol 12 (1) ◽  
pp. 81-83 ◽  
Author(s):  
Marie-Christine Seghaye ◽  
Uwe Wainwright ◽  
Götz von Bernuth
Keyword(s):  
Total Cavopulmonary Connection ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Large Size ◽  
Cavopulmonary Anastomosis ◽  
Cavopulmonary Connection ◽  
Total Cavopulmonary Anastomosis

A 7-year-old boy developed increasing cyanosis after a total cavopulmonary connection with a 3mm fenestration in the baffle. Catheterisation performed 4 years and 7 months after the operation showed reopening of a left superior caval vein draining into the pulmonary venous atrium. Due to the large size of the left superior caval vein, and the absence of intrinsic stenosis, we chose to use an Amplatzer ductal device to occlude the reopened vein. The procedure was safe and successful.

Outcomes of the Extracardiac Fontan Procedure Using Cardiopulmonary Bypass: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 173 ◽  
Author(s):  
Murat Ugurlucan ◽  
Eylem Yayla Tuncer ◽  
Fusun Guzelmeric ◽  
Eylul Kafali ◽  
Omer Ali Sayin ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Arterial Oxygen Saturation ◽  
Vena Cava ◽  
Arterial Oxygen ◽  
Shunt Operation ◽  
Early Results ◽  
The Mean ◽  
Extracardiac Fontan

<p><strong>Background</strong>: Although the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.</p><p><strong>Methods</strong>: Between September 2011 and April 2013,  9 consecutive patients (3 males and 6 females) underwent extra-cardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon.  The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the infe-rior vena cava and right pulmonary artery.</p><p><strong>Results</strong>: The mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged with-out complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventila-tion within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ±  1.9 days, respectively.</p><p><strong>Conclusions</strong>: The extracardiac Fontan operation per-formed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favor-able postoperative hemodynamics and morbidity rates.</p>

Long-term outcome after percutaneous closure of persistent left superior caval vein draining into the left atrium: a contrast-enhanced CT study

2017 ◽  
Vol 27 (8) ◽  
pp. 1550-1556 ◽  
Author(s):  
Davide Marini ◽  
Matteo Castagno ◽  
Michele Millesimo ◽  
Francesca Ferroni ◽  
Gaetana Ferraro ◽  
...  
Keyword(s):  
Left Atrium ◽  
Percutaneous Closure ◽  
Caval Vein ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Superior Caval Vein ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

AbstractBackgroundData regarding long-term outcome after percutaneous closure of left superior caval vein draining into the left atrium are lacking. The aim of the present study was to report the long-term follow-up by using contrast-enhanced CT.MethodsIn all, three patients underwent percutaneous closure of left superior caval vein draining into the left atrium between 2005 and 2015. All of them were evaluated clinically and underwent contrast-enhanced CT.ResultsIn one patient, the Amplatzer® Septal Occluder was used. In two patients, the Amplatzer® Vascular Plug type-1 was preferred: the device size/LSVC diameter ratio was 1.7 in the child and 1.2 in the adult. There were no early-onset or long-term onset complications. CT was performed 1, 2, and 10 years after the procedure, respectively. Complete occlusion of the vessel was documented in all. After 10 years since the procedure, CT revealed a persistent trivial residual shunt through the accessory hemiazygos vein in one patient, in whom the device was implanted above its drainage into the left superior caval vein. When an Amplatzer® Vascular Plug type-1 is oversized compared with the venous vessel diameter, it immediately assumes a dog-bone shape that disappears early to regain its shape memory and nominal size.ConclusionsPercutaneous occlusion of left superior caval vein draining into the left atrium has excellent early and long-term outcomes. The optimal implantation of the device is below the drainage of the accessory hemiazygos vein, when present. The device might be oversized compared with the left superior caval vein diameter according to the age of the patient.

scholarly journals Midterm Prognosis and Effectiveness of Fontan Procedure with Total Cavopulmonary Connection Performed in Adults

2018 ◽  
Vol 34 (3) ◽  
pp. 143-152
Author(s):  
Taku Ishii ◽  
Tadahiro Yoshikawa ◽  
Satoshi Yazaki ◽  
Takumi Kobayashi ◽  
Kanako Kishiki ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Total Cavopulmonary Connection ◽  
Cavopulmonary Connection

Haemoptysis as a late complication of a Mustard operation treated by balloon dilation of a superior caval venous obstruction

2002 ◽  
Vol 12 (3) ◽  
pp. 298-301
Author(s):  
Ansgar Berg ◽  
Gunnar Norgård ◽  
Gottfried Greve
Keyword(s):  
Rare Complication ◽  
Venous Pressure ◽  
Late Complication ◽  
Balloon Dilation ◽  
Fiberoptic Bronchoscopy ◽  
Physical Work ◽  
Venous Obstruction ◽  
Caval Vein ◽  
Superior Caval Vein ◽  
Mustard Operation

Haemoptysis was the presenting symptom in a 27-year-old male. He had undergone a Mustard operation for connection of complete transposition at the age of 2 years. For 6 months prior to admission, he had complained of dyspnoea without chestpain, and swelling of the fingers during hard physical work. Chest radiography and computer tomographic scans showed normal features of the pulmonary parenchyma, and no sign of cardiomegaly or vascular stasis. Fiberoptic bronchoscopy demonstrated a blood clot in the upper right bronchus, without any associated abnormalities of the bronchial tree. Doppler echocardiography showed obstruction of the superior caval vein, which was verified by cardiac catheterization. Balloon dilation at the site of obstruction increased the diameter of the vein from 0.5 to 1.7 cm, and the mean pressure in the superior caval vein was reduced significantly from 18 to 10 mmHg. The haemoptysis did not recur, and no complaints of dyspnoea or swelling of fingers during physical activity was reported 2 years later. Transthoracic echocardiography undertaken at this time revealed no obstruction of the superior caval vein. We conclude that hemoptysis is a rare complication of increased venous pressure in the upper body of patients with superior caval venous obstruction, which can be treated by balloon dilation or stenting.

Fontan completion in reverse order out of necessity: secondary Glenn after primary extracardiac inferior cavopulmonary artery connection

2016 ◽  
Vol 27 (5) ◽  
pp. 925-928 ◽  
Author(s):  
Jannika Dodge-Khatami ◽  
Avichal Aggarwal ◽  
Mary B. Taylor ◽  
Douglas Maposa ◽  
Jorge D. Salazar ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Upper Body ◽  
Reverse Order ◽  
Venous Anatomy ◽  
Caval Vein ◽  
Single Ventricle Physiology ◽  
Superior Caval Vein ◽  
Good Outcome ◽  
Cavopulmonary Connection

AbstractThe primary extracardiac inferior cavopulmonary connection is an unusual novel palliation for single-ventricle physiology, which we first performed in the setting of unfavourable upper-body systemic venous anatomy for a standard bi-directional Glenn, and in lieu of leaving our patient with shunt-dependent physiology. After an initial 16-month satisfactory follow-up, increasing cyanosis led to the discovery of a veno-venous collateral that was coiled, but, more importantly, to impressive growth of a previously diminutive superior caval vein, which allowed us to perform completion Fontan with a good outcome. Performing the single-ventricle staging in a reverse manner, first from below with a primary inferior cavopulmonary connection, followed by Fontan completion from above with a standard superior caval vein bi-directional Glenn, is also possible when deemed necessary.

Right-to-left shunt through the cardiac veins after the Fontan procedure

2000 ◽  
Vol 10 (4) ◽  
pp. 416-418 ◽  
Author(s):  
Hideki Uemura ◽  
Toshikatsu Yagihara ◽  
Osamu Monta
Keyword(s):  
Coronary Sinus ◽  
Fontan Procedure ◽  
The Other ◽  
Caval Vein ◽  
Postoperative Course ◽  
Superior Caval Vein ◽  
Cardiac Veins

AbstractWe found right-to-left shunts through the cardiac veins postoperatively in 2 patients who had undergone the Fontan procedure. In one of the patients, channels were present through the cardiac veins independent of the coronary sinus. In the other patient, an atretic orifice for the coronary sinus, coupled with a persistent left-sided superior caval vein, complicated the postoperative course.

Investigation of Vessel Growth and its Impact on Hemodynamics in Patients With Lateral Tunnel Total Cavopulmonary Connection

2012 ◽  
Author(s):  
Maria Restrepo ◽  
Lucia Mirabella ◽  
Elaine Tang ◽  
Chris Haggerty ◽  
Mark A. Fogel ◽  
...  
Keyword(s):  
Heart Defects ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Total Cavopulmonary Connection ◽  
Lateral Tunnel ◽  
Vessel Growth ◽  
Original Size ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle heart defects affect 2 per 1000 live births in the US and are lethal if left untreated. The Fontan procedure used to treat these defects consists of a series of palliative surgeries to create the total cavopulmonary connection (TCPC), which bypasses the right heart. In the last stage of this procedure, the inferior vena cava (IVC) is connected to the pulmonary arteries (PA) using one of the two approaches: the extra-cardiac (EC), where a synthetic graft is used as the conduit; and the lateral tunnel (LT) where part of the atrial wall is used along with a synthetic patch to create the conduit. The LT conduit is thought to grow in size in the long term because it is formed partially with biological tissue, as opposed to the EC conduit that retains its original size because it contains only synthetic material. The growth of the LT has not been yet quantified, especially in respect to the growth of other vessels forming the TCPC. Furthermore, the effect of this growth on the hemodynamics has not been elucidated. The objective of this study is to quantify the TCPC vessels growth in LT patients from serial magnetic resonance (MR) images, and to understand its effect on the connection hemodynamics using computational fluid dynamics (CFD).

scholarly journals Cerebral and Limb Tissue Oxygenation During Peripheral Venoarterial Extracorporeal Life Support

2017 ◽  
Vol 35 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Nousjka P. A. Vranken ◽  
Anouk A. M. A. Lindelauf ◽  
Antoine P. Simons ◽  
Marcel J. H. Ariës ◽  
Jos G. Maessen ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Femoral Artery ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Tissue Oxygen Saturation ◽  
Sudden Increase ◽  
Femoral Access ◽  
Tissue Oximetry

Femoral access in extracorporeal life support (ECLS) has been associated with regional variations in arterial oxygen saturation, potentially predisposing the patient to ischemic tissue damage. Current monitoring techniques, however, are limited to intermittent bedside evaluation of capillary refill among other factors. The aim of this study was to assess whether cerebral and limb regional tissue oxygen saturation (rSO2) values reflect changes in various patient-related parameters during venoarterial ECLS (VA-ECLS). This retrospective observational study included adults assisted by femorofemoral VA-ECLS. Bifrontal cerebral and bilateral limb tissue oximetry was performed for the entire duration of support. Hemodynamic data were analyzed parallel to cerebral and limb rSO2. A total of 23 patients were included with a median ECLS duration of 5 [1-20] days. Cardiac arrhythmias were observed in 12 patients, which was associated with a decreased mean rSO2 from 61%±11% to 51%±10% during atrial fibrillation and 67%±9% to 58%±10% during ventricular fibrillation ( P<0.001 for both). A presumably sudden increase in cardiac output due to myocardial recovery (n=8) resulted in a significant decrease in mean cerebral rSO2 from 73%±7% to 54%±6% and from 69%±9% to 53%±8% for the left and right cerebral hemisphere, respectively ( P=0.012 for both hemispheres). Also, right radial artery partial gas pressure for oxygen decreased from 15.6±2.8 to 8.3±1.9 kPa ( P=0.028). No differences were found in cerebral desaturation episodes between patients with and without neurologic complications. In six patients, limb rSO2 increased from on average 29.3±2.7 to 64.0±5.1 following insertion of a distal cannula in the femoral artery ( P=0.027). Likewise, restoration of flow in a clotted distal cannula inserted in the femoral artery was necessary in four cases and resulted in increased limb rSO2 from 31.3±0.8 to 79.5±9.0; P=0.068. Non-invasive tissue oximetry adequately reflects events influencing cerebral and limb perfusion and can aid in monitoring tissue perfusion in patients assisted by ECLS.

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