scholarly journals Transcatheter Occlusion of a Hepatic Vein to left Atrium Fistula: Should we close Venovenous collateral Vessels following Fontan operation?

2021 ◽  
Vol 4 (8) ◽  
pp. 01-04
Author(s):  
Fadi Bitar
Keyword(s):  
Hepatic Vein ◽  
Older Patients ◽  
Fontan Operation ◽  
Venous Plexus ◽  
Vascular Plug ◽  
Severe Hypoxemia ◽  
Transcatheter Occlusion ◽  
Hemodynamic Assessment ◽  
Collateral Vessels ◽  
Visceral Heterotaxy

following the Fontan operation. There are conflicting data regarding the closure of the venovenous collateral (VVC) vessels post-Fontan. The embolization of these VVC in older patients may be associated with decreased survival. We describe a rare fistula draining a right-sided hepatic vein connected to a hepatic venous plexus to a right-sided pulmonary venous atrium in a child with visceral heterotaxy. The patient presented with severe hypoxemia following the Fontan operation. The fistula was successfully occluded by an AMPLATZER™ Vascular Plug II to resolve the hypoxemia and improve the hemodynamic status. Approach to venovenous collaterals in older patients with mild cyanosis after the Fontan operation may differ from that in younger children with severe hypoxemia and intrahepatic VVC. Patients with profound cyanosis due to intrahepatic to atrial connection may benefit from the occlusion of these connections. Percutaneous closure of hepatic to atrial connection with significant hypoxemia following appropriate hemodynamic assessment may be beneficial.

scholarly journals Massive Hematochezia: A Complication of Methamphetamine-Induced Vasculitis Treated by Transcatheter Hemostasis

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Daniel P. Link ◽  
Yung-Wei Chi
Keyword(s):  
Mesenteric Artery ◽  
Distal Colon ◽  
Thromboangiitis Obliterans ◽  
Transcatheter Occlusion ◽  
Rectal Hemorrhage ◽  
Life Threatening ◽  
Collateral Vessels ◽  
Stenotic Lesions ◽  
Methamphetamine User

A long-term, heavy methamphetamine user with life-threatening rectal hemorrhage was treated with transcatheter occlusion of the bleeding arteries. The bleeding blood vessels were vulnerable submucosal arteries, part of the collateral supply to the distal colon. Visceral arteriography demonstrates severe arterial stenotic lesions of the celiac axis, superior mesenteric artery and the inferior mesenteric artery. Collateral vessels were seen with corkscrew morphology similar to that seen with thromboangiitis obliterans.

Accessory hepatic vein to pulmonary venous atrium as a cause of cyanosis after the Fontan operation

1996 ◽  
Vol 77 (15) ◽  
pp. 1386-1387 ◽  
Author(s):  
Patricio Fernandez-Martorell ◽  
Mark S. Sklansky ◽  
Victor W. Lucas ◽  
Iraj A. Kashani ◽  
Mark W. Cocalis ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Fontan Operation ◽  
Accessory Hepatic Vein

Hepatic Vein Incorporation Into the Azygos System in Heterotaxy and Interrupted Inferior Vena Cava

2019 ◽  
Vol 10 (3) ◽  
pp. 330-337
Author(s):  
Christine Montesa ◽  
Tara Karamlou ◽  
Kanishka Ratnayaka ◽  
Stephen G. Pophal ◽  
Justin Ryan ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Fontan Operation ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Extracardiac Conduit ◽  
Complex Patients ◽  
Surgeon Experience

Background: Patients with heterotaxy, single ventricle and interrupted inferior vena cava are at risk of developing significant pulmonary arteriovenous malformations and cyanosis, and inequitable distribution of hepatic factor has been implicated in their development. We describe our experience with a technique for hepatic vein incorporation that reliably provides resolution of cyanosis and presumably equitable hepatic factor distribution. Methods: A retrospective review of a single-surgeon experience was conducted for patients who underwent this modified Fontan operation utilizing an extracardiac conduit from the hepatic veins to the dominant superior cavopulmonary connection. Preoperative characteristics and imaging, operative details, and postoperative course and imaging were abstracted. Results: Median age at operation was 5 years (2-10 years) and median weight was 19.6 kg (11.8-23 kg). Sixty percent (3/5) of patients had Fontan completion without cardiopulmonary bypass, and follow-up was complete at a median of 14 months (range 1-20 months). Systemic saturations increased significantly from 81% ± 1.9% preoperatively to 95% ± 3.5% postoperatively, P = .0008. Median length of stay was 10 days (range: 7-14 days). No deaths occurred. One patient required reoperation for bleeding and one was readmitted for pleural effusion. Postoperative imaging suggested distribution of hepatic factor to all lung segments with improved pulmonary arteriovenous malformation burden. Conclusions: Hepatic vein incorporation for patients with heterotaxy and interrupted inferior vena cava should optimally provide equitable pulmonary distribution of hepatic factor with resolution of cyanosis. The described technique is performed through a conventional approach, is facile, and improves cyanosis in these complex patients.

Liver nodules after the Fontan operation: role of the computerised tomography scan

2021 ◽  
pp. 1-6
Author(s):  
Saviga Sethasathien ◽  
Suchaya Silvilairat ◽  
Rekwan Sittiwangkul ◽  
Krit Makonkawkeyoon ◽  
Yupada Pongprot ◽  
...  
Keyword(s):  
Ct Scan ◽  
Hepatic Vein ◽  
Fontan Operation ◽  
Cross Sectional Study ◽  
Fontan Patient ◽  
Cross Sectional ◽  
Liver Nodules ◽  
Non Invasive ◽  
Abdomen Ct ◽  
Upper Abdomen

Abstract Currently, there is an increasing prevalence of liver nodules in patients following the Fontan operation. The appropriate non-invasive modalities have been applied to assess a diagnosis of Fontan-associated liver disease. The aims of this study were to determine the prevalence and associated factors for the presence of liver nodules using CT scan. A cross-sectional study of 34 patients older than 15 years of age was recruited. Ultrasound upper abdomen, ultrasound liver elastography, and CT scan of the upper abdomen were performed after the Fontan operation. The median age of patients was 20 years (range 14–36 years). The median age at the Fontan operation was 7 years (range 5–17 years) and the duration after the Fontan operation was 12 years (range 4–22 years). The prevalence of liver nodules was 62% as detected by CT scans. Hepatic vein pressure in patients with liver nodules was significantly higher than in those without liver nodules. Hepatic vein pressure above 13 mmHg was a factor associated with liver nodules. There was little agreement between the ultrasound of the upper abdomen and CT scan of the upper abdomen in the evaluation of liver nodules. Hepatic pressure was the only associated factor for the occurrence of liver nodules in patients following the Fontan operation. The prevalence of liver nodules was very high after the Fontan operation. The upper abdomen CT scan should be performed for the surveillance of liver nodules in every Fontan patient over the age of 15 years.

Ligation of the Left Hepatic Vein for Dilated Intrahepatic Collaterals Late After Fontan Operation

2014 ◽  
Vol 29 (4) ◽  
pp. 564-566 ◽  
Author(s):  
Chun Soo Park ◽  
Jeong-Jun Park ◽  
In-Sook Park ◽  
Hyun Woo Goo
Keyword(s):  
Hepatic Vein ◽  
Fontan Operation ◽  
Left Hepatic Vein

Extended applications of the Amplatzer vascular plug IV in infants

2010 ◽  
Vol 21 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Roland Adelmann ◽  
Alfred Windfuhr ◽  
Gerardus Bennink ◽  
Mathias Emmel ◽  
Narayanswami Sreeram
Keyword(s):  
Transcatheter Closure ◽  
Azygos Vein ◽  
Amplatzer Vascular Plug ◽  
Consecutive Series ◽  
Vascular Plug ◽  
Minimum Diameter ◽  
Mechanically Ventilated ◽  
Young Infants ◽  
Collateral Vessels

AbstractObjectiveA variety of devices are available for transcatheter closure of unwanted shunts. We describe our experience with the use of the Amplatzer vascular plug IV in a consecutive series of infants.MethodsA total of eight consecutive infants – all born preterm at gestational ages ranging from 24 to 35 weeks – undergoing transcatheter closure of unwanted shunts – persistently patent arterial duct in five patients, an aorta to right atrium fistula in one, multiple aortopulmonary collateral vessels in one, and an azygos vein to left atrium connection in one – are described. Their age, from birth, ranged between 3 and 11 months, and weight between 2.6 and 11.3 kilograms. All devices were delivered using percutaneous arterial or venous vascular access via a large lumen (0.038 inch) 4-French delivery catheter.ResultsAll lesions could be successfully occluded using one or more devices. Device diameters ranged between 4 and 8 millimetres, and exceeded the minimum diameter of the target vessel by 1 to 2 millimetres. Successful occlusion was confirmed either directly at angiography or on follow-up echocardiography. Of the infants who were mechanically ventilated prior to the procedure, three could be successfully weaned following closure of the shunt. There were no procedure-related complications.ConclusionsThe new vascular plug IV is cheap and efficacious in closing a variety of shunts in young infants, and warrants further extended clinical application.

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