日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: In patients with a functional single-ventricle, coil embolization is commonly performed to avoid complications after the Fontan procedure. The position for coil embolization should be determined after considering the postoperative changes in the aortopulmonary collateral arteries (APCAs).

Methods: The study involved 163 patients who underwent the Fontan procedure between 2009 and 2015. The amount of APCA was assessed using a 3-point scale based on the aortogram in the cardiac catheterization. The total score for the five sites (bilateral internal thoracic artery, bilateral subclavian artery, and descending aorta) was calculated and compared in patients with and without coil embolization and before and after the Fontan procedure.

Results: The mean scores for the APCAs ranged from 6.1±1.5 to 4.5±1.8 points in patients with coil embolization (＋) and from 4.4±1.7 to 3.6±1.7 points in those without coil embolization (−), indicating a significant decrease. The scores of 35 patients at ≥5 years after the Fontan procedure had decreased as compared to those at 6 months postoperatively (mean 4.2±2.0 to 1.3±1.2 points). The APCA flow of 30 patients measured using a magnetic resonance imaging similarly decreased after the Fontan procedure (mean 1.4±0.6 to 0.8±0.6 L/min). When APCA scores before the Fontan procedure were ≤5 points, there were no significant differences between the coil embolization (＋) and coil embolization (−) groups as to the incidence of prolonged pleural effusion.

Conclusion: After the Fontan procedure, the APCA tended to decrease with or without coil embolization. Routine coil embolization is not necessary, which is indicated only when APCA scores are ≥6 points.