Interventional catheterization after total cavopulmonary connection: Experience in 68 patients

摘要

Background: Total cavopulmonary connection (TCPC) is performed in patients having a single ventricle to allow the passive flow of systemic venous blood to the lungs. Interventional catheterization is needed to treat residual defects or complications. Aims: We discuss our results concerning 68 patients who had had TCPC from January 1995 to December 2010. Methods: Initial and follow-up catheterization data were reviewed retrospectively. Mid-term results were evaluated by means of angiography and/or CT scan. Results: Mean age at TCPC was 5 years (2.5-18); mean interval between TCPC and catheterization was 5.6 years (1.5-15). Sixty-nine catheterizations were performed in 53 patients. Eleven patients (21%) had low venous pressure, did not display a right-to-left shunt, and did not need any intervention. Fifteen patients (28%) had low venous pressure and only needed the closure of the fenestration. The remaining 27 patients (51%) needed the following interventions: embolization of venous vessels prompting right-to-left shunt (n = 15), stenting or reconnection of pulmonary arteries (n = 5), stenting or recanalization of systemic veins (n = 11), other procedures (n = 5). In 3 patients the fenestration could not be closed due to high venous pressure. After the interventions oxygen saturation increased from 90.5%± 4.8% to 94.7%± 3.6% (P = 0.002). Conclusions: Our data show that 49% of patients with TCPC are in good condition late after surgery. However, half of these patients continue to need interventions generally aimed at suppressing stenoses at various levels of TCPC or at occluding vessels prompting right-to-left shunt. This population should enter a multicenter program aimed at identifying patients at risk.