title: Early cyanosis after stage II palliation for single ventricle physiology: etiologies and outcomes.
abstract: BACKGROUND
  In the early postoperative period after stage II palliation, patients with single ventricle physiology can have cyanosis due to a variety of causes. This cyanosis can be significant and necessitate cardiac catheterization to determine etiology and attempt treatment. Our objective was to determine the etiology of early postoperative cyanosis and outcomes in patients referred to the catheterization laboratory from the cardiac intensive care unit (CICU) after stage II palliation.
  
  
  METHODS
  We performed a retrospective analysis of all patients referred for cardiac catheterization from the CICU for evaluation of early cyanosis after stage II palliation. Etiology for hypoxemia, treatment strategy, and patient outcomes were examined for each patient.
  
  
  RESULTS
  Between January 1, 2006, and December 31, 2011, 244 patients underwent stage II palliation of which 22 required cardiac catheterization during the early postoperative period because of severe cyanosis. The etiologies for cyanosis were venovenous collaterals (n = 12), cavopulmonary pathway thrombosis (n = 3), hemi-Fontan pathway baffle leak (n = 2), and undetermined (n = 5). Overall, transplant-free survival to hospital discharge was 50% and survival to hospital discharge with stage II physiology was 32%. Venovenous collateral occlusion, cavopulmonary anastomosis takedown, and addition of a second source of pulmonary blood flow were not associated with improved outcome.
  
  
  CONCLUSIONS
  Regardless of the etiology or treatment strategy, severe cyanosis in the early postoperative period after stage II palliation imparts high mortality and usually indicates failing stage II physiology. Venovenous collateral occlusion and thrombectomy are usually futile, and those who survive have a low likelihood of having stage II physiology at hospital discharge.
authors: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
authors: Jeffrey D
authors: JD
authors: Zampi
authors: Jennifer C
authors: JC
authors: Hirsch-Romano
authors: Aimee K
authors: AK
authors: Armstrong
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D003490:Cyanosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010166:Palliative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery
keywords: cardiac catheterization/intervention; congenital heart disease; congenital heart surgery; outcomes; postoperative care; univentricular heart