title: Acute effects of embolizing systemic-to-pulmonary arterial collaterals on blood flow in patients with superior cavopulmonary connections: a pilot study.
abstract: BACKGROUND
  The significance and optimal treatment of systemic-to-pulmonary arterial collateral (SPC) vessels in single ventricle patients are poorly understood. The acute efficacy of SPC embolization has not been demonstrated in a quantifiable fashion. We sought to assess the acute efficacy of SPC embolization on blood flow as quantified by phase contrast magnetic resonance imaging and hypothesized that embolization acutely decreases SPC flow and increases systemic blood flow (Q(S)).
  
  
  RESULTS
  Six superior cavopulmonary connection patients underwent SPC flow quantification by phase contrast magnetic resonance imaging, including quantification of superior and inferior caval, total pulmonary artery, total pulmonary vein, ascending and descending aortic flows (Q(SVC), Q(IVC), Q(PA), Q(PV), Q(Ao), and Q(Dao), respectively), both immediately before and after cardiac catheterization with coil and particle embolization of angiographically evident SPC vessels. All studies were performed under a single anesthetic. After embolization, we found a significant decrease in SPC flow of 0.9 (range, 0.6-1.3) L/(min·m(2)) (P=0.03); a median reduction of 47% (range, 32-60). There was a significant decrease in the median Q(P):Q(S) from 1.3 before to 0.8 after embolization (P=0.03), and an increase in Q(S) from a median of 3.4 to 4.4 L/(min·m(2)) (P<0.05), and Q(SVC) from a median of 1.7 to 2.3 L/(min·m(2)) (P=0.03).
  
  
  CONCLUSIONS
  We report on the acute efficacy of SPC embolization, demonstrating a significant decrease in SPC flow and Q(P):Q(S) and increase in Q(SVC) and Q(S). Further studies are needed to assess the durability of the procedure and the effect on Fontan and longer-term outcomes.
authors: Department of Radiology, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. doriy@email.chop..edu
authors: Yoav
authors: Y
authors: Dori
authors: Andrew C
authors: AC
authors: Glatz
authors: Brian D
authors: BD
authors: Hanna
authors: Matthew J
authors: MJ
authors: Gillespie
authors: Matthew A
authors: MA
authors: Harris
authors: Marc S
authors: MS
authors: Keller
authors: Mark A
authors: MA
authors: Fogel
authors: Jonathan J
authors: JJ
authors: Rome
authors: Kevin K
authors: KK
authors: Whitehead
mesh_terms: D001783:Blood Flow Velocity; D001808:Blood Vessels / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D018610:Heart Bypass, Right; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D012039:Regional Blood Flow; D014656:Vascular Surgical Procedures / Q000379:methods*