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. 2024 Oct 16;6(4):296-304.
doi: 10.24875/RECIC.M24000475. eCollection 2024 Oct-Dec.

[Management of collaterals after Glenn procedure and its impact on patients with a single ventricle: a single-center study]

[Article in Spanish]
Yasmin Abdelrazek Ali  1 , Nehad El-Sayed Nour El-Deen  1 , Ghada Samir Elshahed  1
Affiliations

[Management of collaterals after Glenn procedure and its impact on patients with a single ventricle: a single-center study]

[Article in Spanish]
Yasmin Abdelrazek Ali et al. REC Interv Cardiol. .

Abstract
in English, Spanish

Introduction and objectives: The bidirectional Glenn shunt (BDG) is an essential step in the repair of a physiologically single-ventricle heart. BDG increases pulmonary blood flow, allows growth of the pulmonary arteries, and improves SaO2. The procedure also allows unloading of ventricular volume, thereby improving survival. Our aim was to register all patients who developed collaterals following BDG, document the management methods used, and assess their impact.

Methods: We included 56 patients who underwent BDG procedures at a median age of 2.08 (1-3) years. After BDG, peripheral pulmonary stenting was used in 2 patients. Symptomatic hyperviscosity was present in 10 patients (17.86%), who underwent venesection. BDG was unsuccessful in 2 patients. Venovenous collaterals were observed in 41 patients (73.2%), and aortopulmonary collaterals in 37 (66.1%).

Results: Hematocrit levels were significantly higher in patients with venovenous collaterals (50.00 ± 8.76) than in those without (P = .031). Mean pulmonary artery pressure was also significantly higher in patients with venovenous collaterals (15 [12-18] mmHg; P = .025). One patient had undergone successful closure of venovenous collaterals to epicardial veins and abdominal veins 3 years previously. Seven patients underwent transcatheter closure (TCC) of collaterals. Of these, 4 patients underwent TCC of venovenous collaterals to left and right pulmonary veins; 1 patient underwent closure of an aortopulmonary collateral; 1 patient underwent a failed attempt at venovenous collateral closure that was complicated by an ischemic stroke; and 1 patient had localized extravasation upon separation of the cable. A highly statistically significant increase in SaO2 was observed after TCC of venovenous collaterals (69.83 ± 10.91 vs 82.83 ± 9.87; P = .008).

Conclusions: TCC of collaterals is a technically demanding but effective management strategy following BDG to improve patients' SaO2 and quality of life. Awareness of possible complications and their effective management is crucial.

Introducción y objetivos:: La derivación bidireccional de Glenn (DBG) es un paso esencial en la reparación cardiaca fisiológica del ventrículo único. La DBG aumenta el flujo sanguíneo pulmonar, permite el crecimiento de las arterias pulmonares y mejora la saturación arterial de oxígeno. También permite la descarga del volumen ventricular, mejorando así la supervivencia. El objetivo del estudio fue registrar a todos los pacientes tras DBG que desarrollaron canales colaterales, los métodos de abordaje y su impacto.

Métodos:: Se incluyeron 56 pacientes que habían sido tratados con DBG, con una mediana de edad de 2,08 (1-3) años. Se colocó un stent pulmonar periférico tras la DBG a 2 pacientes. De todos ellos, 10 (17,86%) presentaban hiperviscosidad sintomática y se les realizó una flebotomía. La DBG falló en 2 pacientes. Cuarenta y un pacientes (73,2%) tenían colaterales y 37 (66,1%) colaterales aortopulmonares.

Resultados:: Los pacientes con colaterales presentaban valores de hematocrito significativamente mayores (50,00 ± 8,76), desde el punto de vista estadístico, en comparación con los pacientes sin colaterales venosas (p = 0,031). Los pacientes con colaterales presentaban una presión arterial pulmonar media significativamente mayor (15 [12-18] mmHg), desde el punto de vista estadístico (p = 0,025). Se llevó a cabo el cierre percutáneo (CP) de las colaterales en 7 pacientes. Uno de ellos tuvo un cierre satisfactorio de las colaterales venovenosas a las venas epicárdicas y abdominales 3 años antes. Cuatro pacientes se sometieron a CP de colaterales venovenosas a venas pulmonares izquierdas y derechas. Se realizó un cierre de una colateral aortopulmonar a 1 paciente. En 1 paciente se falló en un intento de cierre de colaterales venosas que se complicó con un accidente vascular cerebral. Un paciente presentó extravasación localizada al separar el cable. Se produjo un aumento estadísticamente muy significativo de la saturación de oxígeno tras el CP de las colaterales venovenosas (69,83 ± 10,91 frente a 82,83 ± 9,87; p = 0,008).

Conclusiones:: El CP de las colaterales es técnicamente exigente, pero es un tratamiento eficaz tras la DBG para mejorar la saturación y la calidad de vida del paciente. Es crucial conocer las posibles complicaciones y su tratamiento eficaz.

Keywords: Aortopulmonary collaterals; Coil embolization; Device embolization; Pulmonary vein; Transcatheter closure; Venovenous.

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Conflict of interest statement

CONFLICTO DE INTERESES: Ninguno.

Figures

Figura 1
Figura 1. Aortografía en planos craneales lateral y oblicuo anterior derecho muestra 2 arterias colaterales aortopulmonares mayores, una proveniente de la arteria mamaria interna derecha y la otra de la región posterior del arco aórtico con llenado de las 2 arterias pulmonares. A, B: cierre percutáneo exitoso de las colaterales aortopulmonares. C, D, E: cierre de las colaterales aortopulmonares mediante el uso de 3 coils. F: inyección final tras el cierre de las colaterales aortopulmonares con coils.
Figura 2
Figura 2. Cierre percutáneo exitoso de colaterales venovenosas. A: colaterales venovenosas drenando en las venas pulmonares superiores derecha e izquierda. B: cierre de la región proximal de las colaterales con coils. C, D: resultado tras el cierre percutáneo de las colaterales venovenosas con coils con flujo residual lento hacia las colaterales.
Figura 3
Figura 3. Cierre percutáneo exitoso de una colateral venovenosa. A: derivación de Glenn y colateral venovenosa hacia la vena pulmonar superior izquierda. B: cierre percutáneo de la colateral venovenosa con 2 coils. C: inyección final tras el cierre de la colateral venovenosa con un flujo muy reducido hacia la vena pulmonar superior izquierda.
Figura 4
Figura 4. Angiografía de colateral venovenosa en plano posteroanterior. A: Amplatzer Duct Occluder II bien colocado en la colateral venovenosa. B: extravasación en el origen proximal de la colateral tras separación del cable. C: inyección tras varios minutos que muestra el sellado de la extravasación.
Figure 1
Figure 1. Aortography in lateral and right anterior oblique cranial views showing 2 major aortopulmonary collateral arteries, one from the right internal mammary artery and the other from the posterior part of aortic arch filling both pulmonary arteries. A, B, successful transcatheter closure of aortopulmonary collaterals. C, D, E, closure of aortopulmonary collaterals by 3 coils. F, final injection after aortopulmonary collateral coil closure.
Figure 2
Figure 2. Successful transcatheter closure of venovenous collaterals. A, venovenous collaterals draining into right and left upper pulmonary veins. B, coil closure of the proximal part of the collaterals. C, D, result after transcatheter closure of venovenous collateral by the coil shows residual sluggish flow to collaterals.
Figure 3
Figure 3. Successful transcatheter closure of a venovenous collateral. A, Glenn shunt and venovenous collateral to the left upper pulmonary vein. B, transcatheter closure of the venovenous collateral by 2 coils. C, final injection after closure of the venovenous collateral with significantly diminished flow to the left upper pulmonary vein.
Figure 4
Figure 4. Venovenous collateral angiography in posteroanterior view. A, well-seated Amplatzer Duct Occluder II in venovenous collateral. B, extravasation at the proximal origin of collateral after cable separation. C, injection after several minutes showing sealing of extravasation.
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