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Aortopulmonary Collaterals in Single Ventricle Physiology: Variation in Understanding Occlusion Practice Among Interventional Cardiologists

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Abstract

Although aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle palliation, there is a lack of understanding of pathophysiology, natural history, and outcomes with no universal guidelines for management and interventional practice. We conducted a study to assess the views held by interventional congenital cardiologists regarding the hemodynamic impact of APCs in patients with single ventricle palliation, and their embolization practice. An electronic survey using the Pediatric Interventional Cardiology Symposium (PICS) mailing list was conducted between February and March 2019 with one reminder sent 2 weeks after initial invitation for participation. Of the 142 interventional cardiologist respondents, 95 (66.9%) reside in North America and 47 (33.1%) worldwide. We elected to exclude the data from interventionalists outside North America in this analysis as it was not representative of worldwide practice. Hypoxemia was considered to be the most common trigger for development of APCs by 56 (58.9%) respondents. After completion of total cavopulmonary connection, 30 (31.6%) respondents reported the APC burden stays the same while 31 (32.6%) feel it decreases. In evaluating the burden of APC flow, only 4 (4.2%) reported measuring oxygen saturation at different pulmonary artery segments, 21 (22.1%) perform segmental aortic angiograms, and 18 (19%) perform selective bilateral subclavian artery angiograms. A majority of respondents, 71 (74.7%), occlude the feeder vessel at different locations, while 10 (10.5%) occlude only the origin of the vessel. Our study demonstrates significant variation in the understanding of the cause and prognosis of APCs in patients with single ventricle palliation. Furthermore, there is variation in the approach for diagnosis and management among interventional cardiologists. Further studies are required to improve understanding of APCs and develop universal management guidelines.

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Funding

This research received no specific Grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, 100 Michigan NE (MC248), Grand Rapids, MI, USA

    Bassel Mohammad Nijres, E. Oliver Aregullin, Yasser Al-Khatib, Bennett P. Samuel & Joseph J. Vettukattil

  2. Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    E. Oliver Aregullin, Yasser Al-Khatib & Joseph J. Vettukattil

  3. Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Ra-id Abdulla

  4. Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA

    Ziyad M. Hijazi

  5. Sidra Cardiac Program, Sidra Medicine, Doha, Qatar

    Ziyad M. Hijazi

Authors
  1. Bassel Mohammad Nijres
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  2. E. Oliver Aregullin
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  3. Yasser Al-Khatib
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  4. Bennett P. Samuel
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  5. Ra-id Abdulla
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  6. Ziyad M. Hijazi
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  7. Joseph J. Vettukattil
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Correspondence to Bassel Mohammad Nijres.

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The authors declare that they have no conflicts of interest related to this study.

Ethical Approval

The study was approved by the Spectrum Health Institutional Review Board.

Informed Consent

Detailed description of the survey was provided to interventional cardiologists and submission of the questionnaire was interpreted as informed consent to participate in the study.

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Mohammad Nijres, B., Aregullin, E.O., Al-Khatib, Y. et al. Aortopulmonary Collaterals in Single Ventricle Physiology: Variation in Understanding Occlusion Practice Among Interventional Cardiologists. Pediatr Cardiol 41, 1608–1616 (2020). https://doi.org/10.1007/s00246-020-02418-8

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  • DOI: https://doi.org/10.1007/s00246-020-02418-8

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