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CLINICAL STUDIES

Systemic venous collateral development after the bidirectional cavopulmonary anastomosis

Prevalence and predictors

Alan G. Magee, MB, BCh, MRCP^* , Brian W. McCrindle, MD, MPH, FACC^* , John Mawson, MB, ChB, Lee N. Benson, MD, FACC^* , William G. Williams, MD^* and Robert M. Freedom, MD, FACC^*

^* Departments of Pediatrics, Surgery and Diagnostic Imaging, The Hospital for Sick Children and the University of Toronto Faculty of Medicine, Toronto, Canada
Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children and the University of Toronto Faculty of Medicine, Toronto, Canada
Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children and the University of Toronto Faculty of Medicine, Toronto, Canada

Manuscript received September 8, 1997; revised manuscript received March 26, 1998, accepted April 17, 1998.

Address for correspondence: Dr. Robert M. Freedom, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada, M5G 1X8

Objectives. To determine the prevalence of systemic venous collaterals after the bidirectional cavopulmonary anastomosis and the factors associated with their development.

Background. Systemic venous collaterals have been found after cavopulmonary anastomosis.

Methods. Cardiac catheterization was performed in 103 patients before and after a bidirectional cavopulmonary anastomosis.

Results. After surgery, 51 venous collaterals were identified in 32 patients (31%). Collateral development was associated with an abnormal superior vena caval connection (56% incidence vs. 26% with a single right superior vena cava, p = 0.01) and postoperative factors including pulmonary artery distortion (53% incidence vs. 22% without distortion, p = 0.002); increased superior vena caval mean pressure (14 ± 5 mm Hg versus 11 ± 4 mm Hg with no collaterals, p = 0.0002); increased pulmonary artery mean pressure (13 ± 4 mm Hg vs. 11 ± 4 mm Hg with no collaterals, p = 0.02); lower right atrial mean pressure (5 ± 2 mm Hg vs. 6 ± 3 mm Hg with no collaterals, p = 0.04); and increased mean gradient between superior vena cava and right atrium (8 ± 3 mm Hg vs. 5 ± 4 mm Hg with no collaterals, p = 0.0002). Using multiple logistic regression, only this last factor was independently associated with collateral development with an odds ratio per 1 mm Hg of 1.33 (95% CI 1.12–1.58, p = 0.001) for their presence.

Conclusions. Systemic venous collaterals occur frequently after a bidirectional cavopulmonary anastomosis and are found postoperatively when a significant pressure gradient occurs between cava and right atrium.

Abbreviations and Acronyms   BCPA = bidirectional cavopulmonary anastomosis   IVC = inferior vena cava (caval)   PA = pulmonary artery   SVC = superior vena cava (caval)

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