Paravertebral Venous Access for Closure of a Collateral in a Pediatric Patient After Fontan Operation

We report on a 16-year-old female patient with tricuspid atresia, ventricular and atrial septal defect, hypoplastic right ventricle, and pulmonary stenosis. A modified Blalock-Taussig shunt was placed within the first month of life, followed by a modified bilateral bidirectional Glenn anastomosis at 3 years and a total cavopulmonary anastomosis (TCPC) at 5 years of age. The azygous vein was ligated at the time of the Glenn procedure. The patient presented with new cyanosis (arterial oxygen saturations were 86% at rest and 76% at exercise) and a decrease in exercise capacity 11 years after TCPC. By cardiac catheterization, a significant right-to-left shunt across a collateral vessel could be detected, originating from the vertebral venous plexus and draining via the azygous system with a single opening to the pulmonary vein ( Figure 1A and Figure 1B). Repeated attempts were made at transcatheter closure through the small and tortuous feeding vessels connected to the jugular veins but were unsuccessful. Therefore, a combined surgical and transcatheter approach (hybrid procedure) was performed: After a median sternotomy, the …