Baker David W, Uthayakumaran Gajon, Polwart Ngaire, Lee Melissa G Y, Wilson Will, Ayer Julian, Tanous David, D'Udekem Yves, Celermajer David S, O'Donnell Clare, Cordina Rachael
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Cardiol Young. 2024 Oct;34(10):2201-2206. doi: 10.1017/S1047951124025708. Epub 2024 Sep 30.
Venovenous collaterals are abnormal connections between the systemic and pulmonary venous systems. They are commonly seen in the Fontan circulation and may lead to significant hypoxaemia. Transcatheter closure of venovenous collaterals is a potential but controversial treatment as the long-term benefits and outcomes are not well understood.
This retrospective cohort study utilised data from the Australian and New Zealand Fontan Registry. Patients who underwent transcatheter venovenous collateral occlusion for hypoxemia from the year 2000 onwards were included. Atriopulmonary and Kawashima-type Fontan circulations were excluded to reflect a more contemporary Fontan cohort.
Nineteen patients (age 19.3 ± 7.8 years, 53% female) underwent transcatheter venovenous collateral occlusion. Compared to baseline, mean oxygen saturation was improved at latest follow-up (90.5% vs 87.0%; p = 0.003). Nine patients achieved a clinically significant response (defined as an increase of at least 5% to 90% or greater), and this was associated with lower baseline Fontan pressures (12.9 v 15.6 mmHg; p = 0.02). No heart failure hospitalisations, arrhythmia, transplant referrals, or mortality were observed during the median follow-up period of 4 years. Two patients experienced thromboembolic events and five patients underwent re-intervention.
Transcatheter occlusion of venovenous collaterals in Fontan patients with chronic hypoxaemia resulted in a modest increase in oxygenation over a median follow-up of 4 years and longer-term prognosis did not appear to be adversely affected. Lower Fontan pressures at baseline were associated with a greater improvement in oxygenation.
体静脉与肺静脉系统之间的异常连接即为体肺静脉侧支。其在Fontan循环中较为常见，可能导致严重低氧血症。经导管封堵体肺静脉侧支是一种潜在但存在争议的治疗方法，因为其长期益处和结果尚未得到充分了解。
这项回顾性队列研究利用了澳大利亚和新西兰Fontan注册中心的数据。纳入了2000年起因低氧血症接受经导管体肺静脉侧支封堵的患者。排除了心房肺分流和川岛型Fontan循环，以反映更现代的Fontan队列。
19例患者（年龄19.3±7.8岁，53%为女性）接受了经导管体肺静脉侧支封堵。与基线相比，最新随访时平均血氧饱和度有所改善（90.5%对87.0%；p = 0.003）。9例患者获得了临床显著反应（定义为至少增加5%至90%或更高），这与较低的基线Fontan压力相关（12.9对15.6 mmHg；p = 0.02）。在4年的中位随访期内，未观察到心力衰竭住院、心律失常、移植转诊或死亡情况。2例患者发生血栓栓塞事件，5例患者接受了再次干预。
在慢性低氧血症的Fontan患者中，经导管封堵体肺静脉侧支在4年的中位随访期内使氧合有适度增加，且长期预后似乎未受到不利影响。基线Fontan压力较低与氧合改善程度更大相关。
