Aggressive coil embolization for connected aortopulmonary collateral arteries with large shunts developed after diaphragmatic plication performed after cavopulmonary connection to facilitate fontan circulation

Abstract

We present two patients of univentricular physiology, who underwent diaphragmatic plication following the complication of diaphragmatic paralysis resulting from a bidirectional Glenn procedure. Over several months, complex connections developed between aortopulmonary collateral arteries, resulting in large shunts around the plication sites and an increased central pulmonary artery (PA) pressure to 14-15 mmHg. Most blood flow from these connections was reversed in the lower PAs of the affected side, reaching the contralateral lungs through the central PAs. Selective angiography identified almost all of the feeding arteries and complex connections. Aggressive coil embolization at these sites decreased the PA pressure to approximately 10 mmHg, enabling the Fontan procedure.