Interventional treatment for azygos vein steal syndrome after bidirectional Glenn procedure in cyanotic congenital heart disease: a retrospective study.

OBJECTIVES

Patients with cyanotic congenital heart disease (CCHD) may continue to experience hypoxia and worsening cyanosis after undergoing a bidirectional Glenn procedure (BGP). Azygos or hemiazygos vein steal syndrome is a common cause of these complications. This study aimed to evaluate the safety and efficacy of transcatheter closure for azygos or hemiazygos vein steal syndrome following BGP in patients with CCHD.

METHODS

A retrospective analysis was conducted on clinical data from 13 patients with CCHD who underwent transcatheter closure for azygos or hemiazygos vein steal syndrome after BGP at Fuwai Hospital between December 2007 and September 2019.

RESULTS

All azygos or hemiazygos veins were successfully closed. Femoral artery oxygen saturation (SO%) significantly increased after closure compared to before closure (86.94 ± 2.63% 74.98 ± 3.53%,  < 0.001). The mean pulmonary arterial pressure (mPAP) also showed a statistically significant increase after closure but remained within normal ranges (12.08 ± 2.75 mmHg 10.54 ± 3.28 mmHg,  = 0.020). The superior vena cava pressure (SVCP) showed almost no change before and after closure (11.08 ± 3.62 mmHg 12.31 ± 3.25 mmHg,  = 0.059). During an average follow-up period of 25.69 ± 9.60 months, all patients showed significant improvement in cyanosis, and none experienced facial or neck edema. The saturation of pulse oximetry (SpO) was above 90% in all patients.

CONCLUSIONS

Transcatheter closure of azygos or hemiazygos vein steal syndrome in CCHD patients after BGP is a safe and effective intervention. It offers high technical success and favorable short- to mid-term outcomes, while avoiding the physical and psychological trauma associated with repeat thoracotomy.