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Determination of the Frequency of Right and Left Internal Mammary Artery Embolization in Single Ventricle Patients: A Two-Center Study

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Abstract

Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to evaluate the frequency and implications of internal mammary artery (IMA) embolization in the single ventricle (SV) population. A retrospective chart review was performed of SV patients who underwent cardiac catheterization before and after Fontan procedure between February 2007 and 2017. Data were collected from two tertiary care centers in the Midwest. Of the 304 SV patients, 62 (20.4%) underwent embolization of one or more IMAs, whereas 242 (79.6%) did not. The rate of embolization of IMA was 40.5% in one center and 14.5% in the second center. Among patients who received IMA embolization, left internal mammary artery (LIMA) embolization was seen in 6 (9.7%) patients. Majority of patients underwent either right internal mammary artery (RIMA) embolization (n = 25; 40.3%) or RIMA and LIMA embolization (n = 27; 43.5%). IMA embolization in SV patients is common. Embolizing IMAs early in life will likely eliminate a valuable graft option for coronary artery bypass grafting should it be required in the future care of these patients. Multi-center, prospective, nation-wide studies are warranted to examine coronary artery disease in the SV population and true frequency of IMA embolization. Delineation of which IMAs were embolized is a necessary in surgical and cardiac intervention national data, such as Society of Thoracic Surgeons (STS) database. All measures should be taken to preserve IMAs patency, if deemed feasible and safe.

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Authors and Affiliations

  1. Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA

    Bassel Mohammad Nijres, Lamya Mubayed, Gregory J. Jutzy, Ra-id Abdulla, Karim A. Diab, Hoang H. Nguyen, Brieann A. Muller, Cyndi R. Sosnowski, Joshua J. Murphy & Sawsan Awad

  2. Department of Pediatrics, Section of Pediatric Cardiology, Spectrum Health Helen DeVos Children’s Hospital, 100 Michigan St NE, Grand Rapids, MI, 49503, USA

    Anas S. Taqatqa, Joseph Vettukattil, Vishal R. Kaley, Darcy N. Marckini & Bennett P. Samuel

  3. Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60612, USA

    Khaled Abdelhady

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  1. Bassel Mohammad Nijres
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Correspondence to Bassel Mohammad Nijres.

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The authors declare that they have no conflicts of interest related to this study.

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This study was agreed to be conducted by Institutional Review Board of the participating centers.

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Informed Consent was waived as this study was a retrospective chart review study.

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Mohammad Nijres, B., Taqatqa, A.S., Mubayed, L. et al. Determination of the Frequency of Right and Left Internal Mammary Artery Embolization in Single Ventricle Patients: A Two-Center Study. Pediatr Cardiol 39, 1657–1662 (2018). https://doi.org/10.1007/s00246-018-1946-0

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