Coil occlusion of systemic venous collaterals in hypoplastic left heart syndrome.
OBJECTIVE
To assess the frequency of systemic venous collaterals to the atria, which may cause desaturation, after stage II reconstructive surgery for hypoplastic left heart syndrome (HLHS) and to determine whether coil occlusion prevents the need for surgical ligation.


METHODS
Prospective interventional study.


METHODS
Tertiary referral centre.


METHODS
27 children with HLHS undergoing cardiac catheterisation between October 1996 and February 2001.


METHODS
19 children were catheterised prestage II, 1 poststage II, and 17 prestage III. Aortic oxygen saturation (SaAo) and pulmonary artery pressure (pPA) were recorded. Angiography was performed into the left internal jugular vein to look for venous collaterals. If present, they were occluded with Cook MReye coils. Angiography was repeated to confirm occlusion, and SaAo and pPA were remeasured.


RESULTS
Collaterals were found in 7 of 27 children: 1 poststage II and 6 prestage III. These were occluded with 1-3 coils without complication. Mean (SE) SaAo before occlusion was 80.2 (2.1)% in those with collaterals compared with 88.7 (1.0)% in those without (p = 0.007). There was no difference in mean pPA between the two groups. After coil occlusion mean SaAo rose to 83.8 (1.8)% (p = 0.007) and mean pPA rose from 12.5 (1.5) to 14.5 (1.8) mm Hg (p = 0.02). None required surgical ligation.


CONCLUSIONS
Angiography should be performed at catheterisation before stage II and III surgery for HLHS to exclude systemic venous collaterals. If present, they may be safely and effectively occluded with coils to improve saturation and prevent the need for subsequent surgical ligation.
Department of Congenital Heart Disease, Guy's and St Thomas' Hospital, London, UK.
R E
RE
Andrews
R M R
RM
Tulloh
D R
DR
Anderson
D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D018729:Fontan Procedure / Q000379:methods; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011446:Prospective Studies