HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stümper, O. Articles by De Giovanni, J. V. Search for Related Content PubMed PubMed Citation Articles by Stümper, O. Articles by De Giovanni, J. V.

Late systemic desaturation after total cavopulmonary shunt operations.

Heart Unit, Birmingham Children's Hospital.

OBJECTIVES--To assess the medium-term results of total cavopulmonary shunt operations in children with left atrial isomerism, interrupted inferior vena cava, and complex congenital heart defects. BACKGROUND--Creation of a total cavopulmonary shunt provides very good interim palliation for children with interrupted inferior vena cava and complex congenital heart disease; however, longer term results after this operation have not been reported. METHODS--Detailed follow up of six children who underwent creation of a total cavopulmonary shunt at a tertiary referral centre. RESULTS--There were no early or late deaths. Oxygen saturations at discharge ranged from 89% to 92% (mean 90%). At last follow up (mean 4.7 years) saturations at rest ranged from 73% to 81% (mean 77%) (P < 0.05). All patients underwent exercise stress testing. At peak exercise oxygen saturations ranged from 62% to 87% (mean 71.5%) and during recovery from 68% to 85% (mean 78%). Cardiac catheterisation was performed in five patients with saturations of less than 80% at rest or peak exercise. No patient had pulmonary arteriovenous fistula. Systemic venous to hepatic venous collaterals were documented in four patients. These were localised below the diaphragm in three and above the diaphragm in one patient. The collateral vessel was successfully embolised in three of these patients, with a rise in resting oxygen saturations from 6 to 10% (mean 7%). CONCLUSIONS--The development of systemic venous to hepatic venous collaterals is a common complication in patients who undergo a total cavopulmonary shunt operation. This can lead to significant desaturation at rest and during exercise. Detailed angiographic studies of the infradiaphragmatic system veins is required for diagnosis. Transcatheter embolisation of such vessels gives good relief.

This article has been cited by other articles:

				E. Usta, W. Schneider, L. Sieverding, and G. Ziemer Late desaturation due to collateral veins 10 years after total cavopulmonary shunt in left atrial isomerism: surgical closure Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 519 - 521. [Abstract] [Full Text] [PDF]

				C. H Kiesewetter, N. Sheron, J. J Vettukattill, N. Hacking, B. Stedman, H. Millward-Sadler, M. Haw, R. Cope, A. P Salmon, M. C Sivaprakasam, et al. Hepatic changes in the failing Fontan circulation Heart, May 1, 2007; 93(5): 579 - 584. [Abstract] [Full Text] [PDF]

				R Kaulitz and M Hofbeck Current treatment and prognosis in children with functionally univentricular hearts Arch. Dis. Child., July 1, 2005; 90(7): 757 - 762. [Abstract] [Full Text] [PDF]

				H. Ichikawa, N. Fukushima, M. Ono, T. Kita, T. Matsushita, Y. Miyamoto, and H. Matsuda Resolution of pulmonary arteriovenous fistula by redirection of hepatic venous blood Ann. Thorac. Surg., May 1, 2004; 77(5): 1825 - 1827. [Abstract] [Full Text] [PDF]

				R. Kaulitz, G. Ziemer, T. Paul, M. Peuster, H. Bertram, and G. Hausdorf Fontan-type procedures: residual lesions and late interventions Ann. Thorac. Surg., September 1, 2002; 74(3): 778 - 785. [Abstract] [Full Text] [PDF]

				S. J. Kim, E. J. Bae, D. J. Cho, I. S. Park, Y. M. Kim, W.-H. Kim, and S. H. Kim Development of pulmonary arteriovenous fistulas after bidirectional cavopulmonary shunt Ann. Thorac. Surg., December 1, 2000; 70(6): 1918 - 1922. [Abstract] [Full Text] [PDF]

				R.-K. R. Chang, J. C. Alejos, D. Atkinson, R. Jensen, S. Drant, A. Galindo, and H. Laks Bubble contrast echocardiography in detecting pulmonary arteriovenous shunting in children with univentricular heart after cavopulmonary anastomosis J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2052 - 2058. [Abstract] [Full Text] [PDF]

				A. G. Magee, B. W. McCrindle, J. Mawson, L. N. Benson, W. G. Williams, and R. M. Freedom Systemic venous collateral development after the bidirectional cavopulmonary anastomosis: Prevalence and predictors J. Am. Coll. Cardiol., August 1, 1998; 32(2): 502 - 508. [Abstract] [Full Text] [PDF]

				L H P M Filippini, C Ovaert, D G Nykanen, and R M Freedom Reopening of persistent left superior caval vein after bidirectional cavopulmonary connections Heart, May 1, 1998; 79(5): 509 - 512. [Abstract] [Full Text]