title: Vascular anatomy in children with univentricular hearts regarding transcatheter bidirectional Glenn anastomosis.
abstract: BACKGROUND
  Transcatheter stent-secured Glenn anastomosis, aiming to reduce the invasiveness of palliation in patients with univentricular heart defects, has been reported in large experimental animals. The advent of biodegradable stents and tissue-engineered vascular grafts will make this procedure a reality in human patients. However, the relationship between the superior vena cava (SVC) and the right pulmonary artery (RPA) is different in humans.
  
  
  OBJECTIVE
  To characterise vascular anatomy in children with univentricular hearts, regarding technical aspects and device design for this procedure.
  
  
  METHODS
  Retrospective analysis of 35 thoracic computed tomography angiograms at a mean age of 18.1±22.4 months.
  
  
  RESULTS
  Two types of arrangement between the SVC and the RPA were identified: anatomy convenient for immediate wire passage and stent deployment between the two vessels (60%); and pattern of early RPA branching, requiring the perforation wire to traverse the intervascular space to avoid entrance into the upper RPA branch (40%). In patients with the convenient vascular arrangement, the vessels were nearly perpendicular, having immediate contact, with the posterior SVC aspect partially "wrapping" the adjacent RPA in most patients. In patients with early RPA branching, the mean shortest SVC-to-central RPA distance was 4.3±2.7mm. For the total population, the mean length of proximal SVC that allowed stent deployment without covering the brachiocephalic vein was 15.6±5.1mm.
  
  
  CONCLUSIONS
  A trumpet-shaped covered stent in a craniocaudal orientation reaching from the SVC into the prebranching RPA seems most suitable for achieving bidirectional Glenn anastomosis percutaneously in humans. However, the short length of the proximal SVC and the presence of early RPA branching pose challenges for optimal design of the dedicated device.
authors.affiliation: Cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes, hôpital universitaire Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sizarov
authors.affiliation: Cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes, hôpital universitaire Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France; Service de radiologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France.
authors.forename: Francesca
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes, hôpital universitaire Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France; Université Paris V Descartes, 75006 Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.affiliation: Cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes, hôpital universitaire Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France; Université Paris V Descartes, 75006 Paris, France. Electronic address: younes.boudjemline@aphp.fr.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D062906:Cardiac Catheters; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D018729:Fontan Procedure / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007223:Infant; D010166:Palliative Care; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*
keywords: Anatomie vasculaire; Cardiac computed tomography; Dérivation cavopulmonaire partielle par voie percutanée; Scanner cardiaque; Transcatheter Glenn anastomosis; Vascular anatomy