Pediatric Cardiology

, Volume 39, Issue 2, pp 245–253 | Cite as

Durable Benefit of Particle Occlusion of Systemic to Pulmonary Collaterals in Select Patients After Superior Cavopulmonary Connection

  • Michael L. O’ByrneEmail author
  • David N. Schidlow
Original Article


Systemic to pulmonary arterial collaterals (SPC) are commonly found in patients undergoing staged operative palliation for single ventricle heart disease. Occlusion of SPC as part of pre-Fontan catheterization has been shown to improve hemodynamics acutely. Anecdotally, the effect of this intervention appears to be transient, and to our knowledge there is no data supporting its durability in these patients. Between 1/1/2016 and 5/1/2017, 24 children underwent Glenn operations at our institution. Of these, 3 patients had signs and symptoms deteriorating clinical status suggestive of volume overload in the period between their Glenn operation and Fontan completion, prompting heart catheterization. SPC were occluded with a combination of polyvinyl alcohol embolization particles, and in some cases coils or vascular plugs. Clinical course and data from echocardiograms and serial catheterizations are presented. SPC occlusion was performed over 6 procedures in 3 subjects with technical success in each case. Hemodynamic evaluation was repeated in 2/3 patients with improvement in collateral burden and hemodynamics in both cases. One patient previously thought to be unsuitable for Fontan completion improved sufficiently to undergo late Fontan completion, which was ultimately successful. In all patients, there was improvement in clinical status. In patients with severe SPC collateral durable benefit was seen, suggesting that in certain cases intervention on SPC remote from Fontan completion may have clinical benefit.


Pediatric cardiology Hypoplastic left heart syndrome Pulmonary atresia intact ventricular septum Transcatheter intervention Vascular embolization 



Dr. O’Byrne receives research support from the National Institute of Health/National Heart Lung and Blood Institute (K23 HL130420-01). The funding agencies had no role in the drafting of the manuscript or influencing its content. This manuscript represents the opinion of the authors alone.

Compliance with Ethical Standards

Conflicts of interest

The authors have no financial conflicts of interest to disclose.


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© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of CardiologyChildren’s National Medical Center and the George Washington University School of Health SciencesWashingtonUSA
  2. 2.Division of Cardiology and Center for Pediatric Clinical EffectivenessThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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