El-Khouri Maya, Arabi Mariam, El Rassi Issam, Bulbul Ziad, Sawaya Fadi, Bitar Fadi
Department of Pediatrics and Adolescent Medicine, The American University of Beirut-Medical Center, Beirut, Lebanon.
The Children's Heart Center, The American University of Beirut-Medical Center, Beirut, Lebanon.
Ann Pediatr Cardiol. 2022 Jul-Aug;15(4):415-418. doi: 10.4103/apc.apc_193_21. Epub 2023 Jan 6.
Right-to-left shunt due to abnormal systemic venous drainage to the left heart is among the causes of hypoxemia following Fontan operation. There are conflicting data regarding the closure of the venovenous collaterals (VVCs) post-Fontan, showing decreased survival in older patients. In a child with visceral heterotaxy, we describe a rare fistula draining a right-sided hepatic vein into hepatic venous plexus and a right-sided pulmonary venous atrium. The patient presented with severe hypoxemia post-Fontan and underwent fistula occlusion with AMPLATZER™ Vascular Plug II, successfully improving hemodynamic status with resolution of the hypoxemia. Younger patients with cyanosis due to VVCs may benefit from percutaneous occlusion post-Fontan.
由于体循环静脉异常引流至左心导致的右向左分流是Fontan手术后低氧血症的原因之一。关于Fontan手术后静脉-静脉侧支（VVCs）闭合的数据存在矛盾，显示老年患者生存率降低。在一名患有内脏异位的儿童中，我们描述了一种罕见的瘘管，它将右侧肝静脉引流至肝静脉丛和右侧肺静脉心房。该患者在Fontan手术后出现严重低氧血症，并接受了使用AMPLATZER™血管封堵器II封堵瘘管的治疗，成功改善了血流动力学状态，低氧血症得以缓解。因VVCs导致青紫的年轻患者可能会从Fontan手术后的经皮封堵中获益。
