Systemic venous collateral development after the bidirectional cavopulmonary anastomosis. Prevalence and predictors.
OBJECTIVE
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.
Department of Pediatrics, The Hospital for Sick Children and the University of Toronto Faculty of Medicine, Canada.
A G
AG
Magee
B W
BW
McCrindle
J
J
Mawson
L N
LN
Benson
W G
WG
Williams
R M
RM
Freedom
D000293:Adolescent; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D016280:Atrial Function, Right / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology*; D016001:Confidence Intervals; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D015995:Prevalence; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D014680:Veins / Q000502:physiology*; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery*; D014690:Venous Pressure / Q000502:physiology