Key result
Higher SVC-RA mean gradient is linked to ~33% higher systemic venous collateral odds per mmHg.
Why the study?
Systemic venous collaterals have been found after bidirectional cavopulmonary anastomosis, but their prevalence and associated factors were not well defined.
What is the prevalence of systemic venous collaterals after bidirectional cavopulmonary anastomosis and what factors are associated with their development?
Observational (n=103)
What is the prevalence of systemic venous collaterals after bidirectional cavopulmonary anastomosis and what factors are associated with their development?
Odds Ratio: 1.33 (95% CI 1.12–1.58)
p-value: p=0.001
Systemic venous collaterals are common after bidirectional cavopulmonary anastomosis and are strongly associated with an increased pressure gradient between the superior vena cava and right atrium.
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.
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Magee et al. (1998) conducted an observational in Bidirectional cavopulmonary anastomosis (n=103). Increased mean gradient between superior vena cava and right atrium was evaluated on Systemic venous collateral development (OR 1.33, 95% CI 1.12-1.58, p=0.001). An increased mean gradient between the superior vena cava and right atrium was independently associated with systemic venous collateral development (OR 1.33 per 1 mm Hg; 95% CI 1.12-1.58; p=0.001).
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