Systemic venous collateral development after the bidirectional cavopulmonary anastomosis. Prevalence and predictors.

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  • Additional Information
    • Source:
      Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
    • Subject Terms:
      Anastomosis, Surgical*/adverse effects ; Anastomosis, Surgical*/methods; Collateral Circulation/*physiology ; Pulmonary Artery/*surgery ; Veins/*physiology ; Vena Cava, Superior/*surgery; Adolescent ; Analysis of Variance ; Atrial Function, Right/physiology ; Blood Pressure/physiology ; Cardiac Catheterization ; Child ; Child, Preschool ; Confidence Intervals ; Female ; Forecasting ; Heart Defects, Congenital/surgery ; Humans ; Infant ; Logistic Models ; Male ; Odds Ratio ; Postoperative Complications ; Prevalence ; Pulmonary Artery/physiopathology ; Vena Cava, Superior/physiopathology ; Venous Pressure/physiology
    • Abstract:
      Objectives: To determine the prevalence of systemic venous collaterals after the bidirectional cavopulmonary anastomosis and the factors associated with their development.
      Background: Systemic venous collaterals have been found after cavopulmonary anastomosis. Methods. Cardiac catheterization was performed in 103 patients before and after a bidirectional cavopulmonary anastomosis.
      Results: After surgery, 51 venous collaterals were identified in 32 patients (31%). Collateral development was associated with an abnormal superior vena caval connection (56% incidence vs. 26% with a single right superior vena cava, p = 0.01) and postoperative factors including pulmonary artery distortion (53% incidence vs. 22% without distortion, p = 0.002); increased superior vena caval mean pressure (14 +/- 5 mm Hg versus 11 +/- 4 mm Hg with no collaterals, p = 0.0002); increased pulmonary artery mean pressure (13 +/- 4 mm Hg vs. 11 +/- 4 mm Hg with no collaterals, p = 0.02); lower right atrial mean pressure (5 +/- 2 mm Hg vs. 6 +/- 3 mm Hg with no collaterals, p = 0.04); and increased mean gradient between superior vena cava and right atrium (8 +/- 3 mm Hg vs. 5 +/- 4 mm Hg with no collaterals, p = 0.0002). Using multiple logistic regression, only this last factor was independently associated with collateral development with an odds ratio per 1 mm Hg of 1.33 (95% CI 1.12-1.58, p = 0.001) for their presence.
      Conclusions: Systemic venous collaterals occur frequently after a bidirectional cavopulmonary anastomosis and are found postoperatively when a significant pressure gradient occurs between cava and right atrium.
    • Publication Date:
      Date Created: 19980826 Date Completed: 19980901 Latest Revision: 20190708
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/s0735-1097(98)00246-0
    • Accession Number:
      9708483