Incidence and impact of systemic venous collateral development after Glennand Fontan procedures

Background: Development of systemic venous collaterals after Glenn or Fonta n procedures can lead to systemic desaturation and reduction in ventricular function, resulting in impaired everyday performance in patients with univ entricular heart disease. Methods: We analyzed 79 patients who had undergon e a Glenn or Fontan procedure between 1995 and 1999 for the incidence and p redilection sites of systemic venous collaterals as well as the therapeutic options. Results: In 16/79 (= 20.2%) patients, 19 veno-venous connections were detected 310 days (1-966 days) postoperatively. Locations were: brachi ocephalic angles/pericardial veins (7), azygos/hemiazygos system (5), Thebe sian veins (2), epidiaphragmatic veins (5). Drainage was to the pulmonary v eins in 5, to the "left" atrium in 9, and to the IVC system in 5 patients. An isolated intervention became necessary because of low saturations in 5/1 6 pts, with improvement in all of them (catheter embolization 4, surgical c losure 1). Conclusions: After Glenn or Fontan operations, the increased cen tral venous pressure may induce recanalization of embryologically preformed and obliterated vessels. Their predilection sites must be carefully evalua ted pre- and postoperatively. During surgical procedures, potential venous channels should be ligated. Interventional or surgical closure of collatera ls may become necessary.