A review of the options for treatment of major aortopulmonary collateral arteries in the setting of tetralogy of Fallot with pulmonary atresia

Boshoff, Derize; Gewillig, Marc

doi:10.1017/s1047951106000606

Cited by 47 publications

(70 citation statements)

References 46 publications

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“…These vessels normally regress concomitant with the formation of the normal pulmonary arterial system in the first weeks of gestation. 19 Tetralogy of Fallot with MAPCA is reported in about 2% of the cases in pediatric population. 20 Aortopulmonary collaterals provide the source of pulmonary blood flow, resulting in heterogeneous flow to different lung segments.…”

Section: Discussionmentioning

confidence: 99%

“…22 Cardiac catheterization is usually essential to obtain all the necessary information. 19 Patients may occasionally present with multiple, large, unobstructed aortopulmonary collateral arteries producing excessive flow of blood to the lungs, and necessitating intervention. Presence of aortopulmonary collaterals in TOF worsens the prognosis and makes surgical reconstruction more challenging.…”

Section: Discussionmentioning

confidence: 99%

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Factors affecting perioperative mortality in tetralogy of Fallot

Saygı

Ergül

Tola

et al. 2015

Pediatrics International

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Poor preoperative oxygenation, presence of coronary anomaly, complete AV block in the early postoperative period, high RV pressure and requirement of ECMO appear to be the most significant factors that affect early mortality in the surgical treatment of TOF. Appropriate preoperative assessment, correct surgical strategies and attentive intensive care monitoring are required in order to reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors affecting perioperative mortality in tetralogy of Fallot

Saygı

Ergül

Tola

et al. 2015

Pediatrics International

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“…These had some similarities on ANGIO-CT to major aortopulmonary collateral arteries (MAPCAs), 14,15 embryonic vascular systemic to pulmonary circulatory connections that usually regress by birth, but can be maintained when the pulmonary circulation fails to develop as in pulmonary atresia. 15,16 However, concurrent tortuous vessels are not usually apparent in such cases. In cases 1-3, ligation of the major vessel resulted in immediate shrinkage of some or all of the tortuous vessels suggesting at least some communication with the major vessel distal to the point of ligation because none of these cases had angiographic or ANGIO-CT evidence of flow into the vessels from the pulmonary artery.…”

Section: Discussionmentioning

confidence: 99%

Identification and Surgical Ligation of Aortopulmonic Vascular Malformation Causing Left Heart Volume Overload in 4 Dogs

Culshaw

Wagner²,

Fuentes

et al. 2013

Veterinary Internal Medicne

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A 7-month-old intact female Cocker Spaniel weighing 7.7 kg was presented for investigation of a heart base murmur. The dog was free from clinical signs. There was a grade IV/VI pansystolic murmur localized over the left heart base. Femoral pulses were of normal volume and character.Routine serum biochemistry and hematology were unremarkable. Echocardiography showed increased left ventricular internal end diastolic diameter (LVIDD) at 4.2 cm (reference range, 2.3-3.4 cm 1 ) and left ventricular internal end systolic diameter (LVIDS) at 2.8 cm (reference range, 1.4-2.4 cm 1 ), and mildly increased left atrial (LA) to aorta (AO) ratio at 1.8 : 1 (reference range, <1.62 ) ( Fig 1A). Spectral Doppler echocardiography showed increased aortic velocity (AV) at 1.8 m/s (reference range, 1.0-1.4 m/s 3 ) and continuous retrograde flow in the main pulmonary artery ranging from 1.8 m/s in systole (Vs) to 1.2 m/s in diastole (VD) (Fig 1B). Color Doppler echocardiography identified the point of entry of the main shunting vessel into the proximal pulmonary artery (Fig 1C). A PDA was suspected, but not fully imaged (Fig 1A).Selective angiography in the proximal descending aorta showed contrast opacifying a network of tortuous vessels in the dorsocaudal thorax (Fig 2A) with subsequent opacification of the left atrium. A diagnosis of a congenital left-to-right systemic to pulmonary artery vascular shunt was made. In view of the size of the vessel, number of tortuous vessels, and the increased left heart dimensions, surgical ligation of the shunting vessel was attempted.A left thoracotomy was performed at the 5th intercostal space. Multiple tortuous vessels over the visceral surface of the lungs corresponded to those seen on angiography ( Fig 3A). The point of entry of the main vessel into the pulmonary artery could not be identified, but an anomalous vessel, thought to be a bronchoesophageal artery, was observed coursing cranially toward the pulmonary artery from the descending aorta. Digital pressure on this vessel abolished the murmur audible on esophageal stethoscope. After ligation of this vessel, the tortuous vessels immediately decreased dramatically in size. Whether the anomalous vessel arose directly from the descending aorta or a dorsal intercostal artery was not determined. Routine closure was performed and the dog recovered uneventfully.Follow-up color Doppler echocardiography 1 month postoperatively showed reduction in LVIDD to 3.2 cm and LVIDS to 2.5 cm, LA : AO to 1.5 : 1 and AV to 1.3 m/s. There was laminar flow within the pulmonary artery and no shunt was identified.The dog continues to do well clinically 28 months later, although further echocardiography has not been performed. Case 2A 6-year-old neutered female Labrador Retriever weighing 26.7 kg was presented for investigation of coughing, inappetence, and a left-sided murmur Case Report

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“…Although two patients desaturated significantly after coiling and became unstable so surgery was performed immediately with uneventful postoperative course. MAPCAs are basically persistence of splanchnic circulation and the word 'Major' because they are not acquired one [10,11]. MAPCAs can develop in other conditions like TOF with pulmonary atresia and in this condition pulmonary circulation is dependent on these collateral [12].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Major Aortopulmonary Collateral Arteries (MAPCAs) Coiling in Tetralogy of Fallot Patients Undergoing for Total Correction

2015

JCCR

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Background: Tetralogy of Fallot (TOF) is characterized by ventricular septal defect, an overriding aorta, varying degrees of pulmonic stenosis, and right ventricular hypertrophy. It may be associated with a number of lesions including development of major aortopulmonary collateral arteries (MAPCAs) in less than 5% of cases. In this study we just focused on the management of MAPCAs.Methodology: TOF patients with significant MAPCAs were selected after cardiac catheterization and planned for transcatheter embolization just before surgery.Results: A total of 45 patients underwent transcatheter closure of MAPCAs just before surgical correction with 100% success rate. The age varied from 3-30 years and 55% (n=25) were female. In majority 60% (n=27) the procedure was carried out under deep sedation with local anaesthesia while 18 (40%) patients had general anaesthesia. There was insignificant residual leak in 2 (4%) patients, transient bradycardia (n=1) and hypercyanotic spell in 4% (n=2). No serious complications or death occurred during this study period. Conclusion:Transcatheter coiling of MAPCAs is safe, easy, and effective procedure and protects the patient from its long term devastating complications.

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A review of the options for treatment of major aortopulmonary collateral arteries in the setting of tetralogy of Fallot with pulmonary atresia

Cited by 47 publications

References 46 publications

Factors affecting perioperative mortality in tetralogy of Fallot

Factors affecting perioperative mortality in tetralogy of Fallot

Identification and Surgical Ligation of Aortopulmonic Vascular Malformation Causing Left Heart Volume Overload in 4 Dogs

Perioperative Major Aortopulmonary Collateral Arteries (MAPCAs) Coiling in Tetralogy of Fallot Patients Undergoing for Total Correction

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