Management of aortopulmonary collaterals in children following cardiac transplantation for complex congenital heart disease

Usha S. Krishnan, Jacqueline M. Lamour, Daphne T. Hsu, Maryanne R. Kichuk, Christine M. Donnelly, Linda J. Addonizio

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Heart transplantation (HTx) is increasingly utilized as therapy for end-stage cyanotic congenital heart disease. This study investigates the presence and impact of aortopulmonary collaterals (APCs) associated with cyanotic heart disease on the early post-operative course of patients undergoing transplantation. High output cardiac failure due to residual aortopulmonary collaterals can affect outcome following heart transplantation. Methods Seven patients with hemodynamically significant APCs post-transplant were identified among 40 patients with cyanotic congenital heart disease undergoing HTx. The peri- and intra-operative courses of these patients were reviewed. All 7 patients required prolonged inotropic support despite normal ventricular function and no allograft rejection; 5 were ventilator-dependent due to significant pulmonary vascular congestion. Selective angiography demonstrated the presence of significant aortopulmonary collaterals at 7 to 19 days post-transplant. Coil embolization of aortopulmonary collaterals was performed in all patients; a mean of 6 (2 to 16) vessels/patient were embolized. Results After embolization, pulmonary edema resolved and heart size normalized in all patients; inotropic support was weaned within 2 to 10 days in 5 patients. One patient developed transient renal failure secondary to excessive contrast load and another had enterococcal sepsis within 24 hours after the procedure. All patients were asymptomatic from 4 to 10 years of follow-up post-HTx. Conclusions Aortopulmonary collaterals should be considered a cause of early donor heart failure in children following HTx for cyanotic congenital heart disease. Early detection and treatment of aortopulmonary collaterals by coil embolization is necessary to improve the post-transplant course in these complex patients.

Original languageEnglish (US)
Pages (from-to)564-569
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume23
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

Fingerprint

Heart Transplantation
Heart Diseases
Transplants
Heart Failure
Ventricular Function
Pulmonary Edema
Mechanical Ventilators
Renal Insufficiency
Allografts
Blood Vessels
Sepsis
Angiography
Transplantation
Tissue Donors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Management of aortopulmonary collaterals in children following cardiac transplantation for complex congenital heart disease. / Krishnan, Usha S.; Lamour, Jacqueline M.; Hsu, Daphne T.; Kichuk, Maryanne R.; Donnelly, Christine M.; Addonizio, Linda J.

In: Journal of Heart and Lung Transplantation, Vol. 23, No. 5, 05.2004, p. 564-569.

Research output: Contribution to journalArticle

@article{f7a22c93ab6a48d4ab3628b092af8b82,
title = "Management of aortopulmonary collaterals in children following cardiac transplantation for complex congenital heart disease",
abstract = "Background Heart transplantation (HTx) is increasingly utilized as therapy for end-stage cyanotic congenital heart disease. This study investigates the presence and impact of aortopulmonary collaterals (APCs) associated with cyanotic heart disease on the early post-operative course of patients undergoing transplantation. High output cardiac failure due to residual aortopulmonary collaterals can affect outcome following heart transplantation. Methods Seven patients with hemodynamically significant APCs post-transplant were identified among 40 patients with cyanotic congenital heart disease undergoing HTx. The peri- and intra-operative courses of these patients were reviewed. All 7 patients required prolonged inotropic support despite normal ventricular function and no allograft rejection; 5 were ventilator-dependent due to significant pulmonary vascular congestion. Selective angiography demonstrated the presence of significant aortopulmonary collaterals at 7 to 19 days post-transplant. Coil embolization of aortopulmonary collaterals was performed in all patients; a mean of 6 (2 to 16) vessels/patient were embolized. Results After embolization, pulmonary edema resolved and heart size normalized in all patients; inotropic support was weaned within 2 to 10 days in 5 patients. One patient developed transient renal failure secondary to excessive contrast load and another had enterococcal sepsis within 24 hours after the procedure. All patients were asymptomatic from 4 to 10 years of follow-up post-HTx. Conclusions Aortopulmonary collaterals should be considered a cause of early donor heart failure in children following HTx for cyanotic congenital heart disease. Early detection and treatment of aortopulmonary collaterals by coil embolization is necessary to improve the post-transplant course in these complex patients.",
author = "Krishnan, {Usha S.} and Lamour, {Jacqueline M.} and Hsu, {Daphne T.} and Kichuk, {Maryanne R.} and Donnelly, {Christine M.} and Addonizio, {Linda J.}",
year = "2004",
month = "5",
doi = "10.1016/S1053-2498(03)00305-X",
language = "English (US)",
volume = "23",
pages = "564--569",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Management of aortopulmonary collaterals in children following cardiac transplantation for complex congenital heart disease

AU - Krishnan, Usha S.

AU - Lamour, Jacqueline M.

AU - Hsu, Daphne T.

AU - Kichuk, Maryanne R.

AU - Donnelly, Christine M.

AU - Addonizio, Linda J.

PY - 2004/5

Y1 - 2004/5

N2 - Background Heart transplantation (HTx) is increasingly utilized as therapy for end-stage cyanotic congenital heart disease. This study investigates the presence and impact of aortopulmonary collaterals (APCs) associated with cyanotic heart disease on the early post-operative course of patients undergoing transplantation. High output cardiac failure due to residual aortopulmonary collaterals can affect outcome following heart transplantation. Methods Seven patients with hemodynamically significant APCs post-transplant were identified among 40 patients with cyanotic congenital heart disease undergoing HTx. The peri- and intra-operative courses of these patients were reviewed. All 7 patients required prolonged inotropic support despite normal ventricular function and no allograft rejection; 5 were ventilator-dependent due to significant pulmonary vascular congestion. Selective angiography demonstrated the presence of significant aortopulmonary collaterals at 7 to 19 days post-transplant. Coil embolization of aortopulmonary collaterals was performed in all patients; a mean of 6 (2 to 16) vessels/patient were embolized. Results After embolization, pulmonary edema resolved and heart size normalized in all patients; inotropic support was weaned within 2 to 10 days in 5 patients. One patient developed transient renal failure secondary to excessive contrast load and another had enterococcal sepsis within 24 hours after the procedure. All patients were asymptomatic from 4 to 10 years of follow-up post-HTx. Conclusions Aortopulmonary collaterals should be considered a cause of early donor heart failure in children following HTx for cyanotic congenital heart disease. Early detection and treatment of aortopulmonary collaterals by coil embolization is necessary to improve the post-transplant course in these complex patients.

AB - Background Heart transplantation (HTx) is increasingly utilized as therapy for end-stage cyanotic congenital heart disease. This study investigates the presence and impact of aortopulmonary collaterals (APCs) associated with cyanotic heart disease on the early post-operative course of patients undergoing transplantation. High output cardiac failure due to residual aortopulmonary collaterals can affect outcome following heart transplantation. Methods Seven patients with hemodynamically significant APCs post-transplant were identified among 40 patients with cyanotic congenital heart disease undergoing HTx. The peri- and intra-operative courses of these patients were reviewed. All 7 patients required prolonged inotropic support despite normal ventricular function and no allograft rejection; 5 were ventilator-dependent due to significant pulmonary vascular congestion. Selective angiography demonstrated the presence of significant aortopulmonary collaterals at 7 to 19 days post-transplant. Coil embolization of aortopulmonary collaterals was performed in all patients; a mean of 6 (2 to 16) vessels/patient were embolized. Results After embolization, pulmonary edema resolved and heart size normalized in all patients; inotropic support was weaned within 2 to 10 days in 5 patients. One patient developed transient renal failure secondary to excessive contrast load and another had enterococcal sepsis within 24 hours after the procedure. All patients were asymptomatic from 4 to 10 years of follow-up post-HTx. Conclusions Aortopulmonary collaterals should be considered a cause of early donor heart failure in children following HTx for cyanotic congenital heart disease. Early detection and treatment of aortopulmonary collaterals by coil embolization is necessary to improve the post-transplant course in these complex patients.

UR - http://www.scopus.com/inward/record.url?scp=2342462124&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342462124&partnerID=8YFLogxK

U2 - 10.1016/S1053-2498(03)00305-X

DO - 10.1016/S1053-2498(03)00305-X

M3 - Article

C2 - 15135372

AN - SCOPUS:2342462124

VL - 23

SP - 564

EP - 569

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 5

ER -