Coil occlusion of systemic venous collaterals in hypoplastic left heart syndrome

Objective: To assess the frequency of systemic venous collaterals to the atria, which may cause desaturation, after stage 11 reconstructive surgery for hypoplastic left heart syndrome (HLHS) and to determine whether coil occlusion prevents the need for surgical ligation. Design: Prospective interventional study. Setting: Tertiary referral centre. Patients: 27 children with HLHS undergoing cardiac catheterisation between October 1996 and February 2001. Interventions: 19 children were catheterised prestage 11, 1 poststage 11, and 17 prestage III. Aortic oxygen saturation (SaAo) and pulmonary artery pressure (pPA) were recorded. Angiography was performed into the left internal jugular vein to look for venous collaterals. If present, they were occluded with Cook MReye coils. Angiography was repeated to confirm occlusion, and SaAo, and pPA were remeasured. Results: Collaterals were found in 7 of 27 children: I poststage 11 and 6 prestage III. These were occluded with 1-3 coils without complication. Mean (SE) SaAo before occlusion was 80.2 (2.1)% in those with collaterals compared with 88.7 (1.0)% in those without (p = 0.007). There was no difference in mean pPA between the two groups. After coil occlusion mean SaAo rose to 83.8 (1.8)% (p = 0.007) and mean pPA rose from 12.5 (1.5) to 14.5 (1.8) mm Hg (p = 0.02). None required surgical ligation. Conclusion: Angiography should be performed at catheterisation before stage 11 and III surgery for HLHS to exclude systemic venous collaterals. If present, they may be safely and effectively occluded with coils to improve saturation and prevent the need for subsequent surgical ligation.