[Interventional therapy of large veno-venous collaterals after univentricular palliation for congenital heart disease using the Starflex- and Amplatzer- PDA occluder].
Arterial hypoxemia is frequently observed after Fontan-like palliation of congenital heart defects. Whereas small systemic-to-pulmonary venous collaterals can easily be occluded by use of metal spirals, large collateral vessels may be therapeutically challenging. We report on two patients with arterial hypoxemia (transcutaneous oxygen saturations 72% and 82%, respectively) after Fontan-like operation. One patient was diagnosed with double inlet left ventricle, malposition of the great arteries and subaortic obstruction; another patient was diagnosed with mitral atresia, double-outlet right ventricle, malposition of the great arteries and hemiazygos continuity. In the first patient, a large venous collateral (measuring 16 mm in diameter) was observed connecting the superior vena cava and the right upper pulmonary vein. In the latter patient, hepatic fistulas drained systemic venous blood into an excluded hepatic vein. There was an associated patent fenestration of the conduit connecting the hepatic veins to the pulmonary artery. After occlusion of the supracardiac venous collateral with a 33 mm Starflex device, arterial oxxgen saturation rose to levels above 95%. The excluded hepatic vein was occluded with of an 10/8 mm Amplatzer PDA occluder and the fenestration was closed with a 17 mm Starflex device. Arterial oxygen saturations rose to 98%.


CONCLUSIONS
Occlusion of large collateral vessels after Fontan-like palliation of congenital heart defects can be effectively performed using the Amplatzer PDA device and the Starflex device. Different occlusion devices are needed to address the morphological differences of the collateral vessels.
Peuster
Matthias
M
Abteilung KinderheilkundeIII, Pädiatrische Kardologie un Pädiatrische Intensivmedizin Zentrum Kinderheilkunde, Georg-August-Universität, Göttingen, Germany.
Reckers
Julia
J
Fink
Christoph
C
D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy*; D019736:Prostheses and Implants