{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:05:54Z","timestamp":1760101554788,"version":"3.44.0"},"reference-count":13,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":34,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951125100723_as1\"><jats:title>Objective:<\/jats:title><jats:p>To highlight veno-venous collaterals and portosystemic shunts as possible causes of cyanosis requiring evaluation or treatment below the diaphragm in patients with single-ventricle physiology during staged palliation.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100723_as3\"><jats:title>Background:<\/jats:title><jats:p>Cyanosis can complicate staged single-ventricle palliation and is often evaluated with imaging isolated to the thorax. As a result, lesions below the diaphragm, such as veno-venous collaterals and portosystemic shunts, may be missed. Identification is important since these lesions can be treated via transcatheter techniques.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100723_as4\"><jats:title>Methods:<\/jats:title><jats:p>This study is a retrospective, single-centre case series of six patients.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100723_as5\"><jats:title>Results and discussion:<\/jats:title><jats:p>Two patients following stage 2 palliation had multiple small veno-venous collaterals connecting to a reconstituted azygos with retrograde flow to below the diaphragm. Accessing veno-venous collaterals closer to their entry points below the diaphragm was more optimal for occlusion. Two patients following stage 3 palliation had veno-venous collaterals originating below the diaphragm and connecting to the pulmonary veins. Both patients required infrarenal inferior vena cava contrast injection to identify the veno-venous collateral. The final two patients had heterotaxy with either stage 2 or 3 palliation and were found to have bilateral pulmonary arteriovenous malformations secondary to a portosystemic shunt diverting hepatic factor away from the lungs. All patients had successful device closure of their veno-venous collaterals or portosystemic shunts.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100723_as6\"><jats:title>Conclusion:<\/jats:title><jats:p>The six patients discussed demonstrate the importance of evaluating below the diaphragm in single-ventricle physiology patients presenting with cyanosis.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951125100723","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T07:24:42Z","timestamp":1754292282000},"page":"1382-1387","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["The importance of evaluating anatomy below the diaphragm in staged single-ventricle patients presenting with cyanosis"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2865-2982","authenticated-orcid":false,"given":"Amanda","family":"Gottschalk","sequence":"first","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia"},{"name":"The Perelman School of Medicine at The University of Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"O\u2019Byrne","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia"},{"name":"The Perelman School of Medicine at The University of Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Tang","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia"},{"name":"The Perelman School of Medicine at The University of Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0030-7013","authenticated-orcid":false,"given":"Ryan","family":"Callahan","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia"},{"name":"The Perelman School of Medicine at The University of Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"S1047951125100723_ref10","first-page":"86","article-title":"Catheter approach to redirect hepatic venous return for treatment of unilateral pulmonary arteriovenous malformations after fontan","volume":"84","author":"Dori","year":"2014","journal-title":"Catheter Cardio Inte"},{"key":"S1047951125100723_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00246-0"},{"key":"S1047951125100723_ref7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.110.958264"},{"key":"S1047951125100723_ref8","first-page":"843","article-title":"Percutaneous management of cyanosis in Fontan patients using Amplatzer occluders","volume":"71","author":"Masura","year":"2008","journal-title":"Catheter Cardio Inte"},{"key":"S1047951125100723_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2010.00478.x"},{"key":"S1047951125100723_ref1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezab298"},{"key":"S1047951125100723_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00223-4"},{"key":"S1047951125100723_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1029"},{"key":"S1047951125100723_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-013-0581-7"},{"key":"S1047951125100723_ref6","doi-asserted-by":"publisher","DOI":"10.34172\/jcvtr.2021.14"},{"key":"S1047951125100723_ref2","first-page":"e2021260","article-title":"The pathophysiology and complications of Fontan circulation","volume":"92","author":"Mazza","year":"2021","journal-title":"Acta Biomedica"},{"key":"S1047951125100723_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.04.065"},{"key":"S1047951125100723_ref9","doi-asserted-by":"publisher","DOI":"10.21037\/cdt-23-69"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951125100723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T01:04:07Z","timestamp":1756775047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951125100723\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":13,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["S1047951125100723"],"URL":"https:\/\/doi.org\/10.1017\/s1047951125100723","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"type":"print","value":"1047-9511"},{"type":"electronic","value":"1467-1107"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. 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