Aortopulmonary Collateral Artery Embolization During Postoperative Extracorporeal Membrane Oxygenation After Arterial Switch Procedure

Abstract

Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.

Pulmonary Hemorrhage After Arterial Switch Operation

“…The development of aortopulmonary collateral arteries was thought to be more frequent when atrial switch techniques were performed later in life because of longstanding systemic hypoxemia [2]. Only a few case reports have described aortopulmonary collateral vessels causing early symptomatic cardiac overload or failure to wean from mechanical ventilation after neonatal arterial switch operation [4,6].…”

“…When they are of significant size, their hemodynamic appearance occurs late after surgical repair [3]. These aortopulmonary collateral arteries can result in pulmonary hypercirculation and may complicate postoperative recovery even after an uneventful surgical repair [2,4]. The cardiopulmonary function derangement could be so severe that it could necessitate extracorporeal membrane oxygenation support [4,5].…”

“…These aortopulmonary collateral arteries can result in pulmonary hypercirculation and may complicate postoperative recovery even after an uneventful surgical repair [2,4]. The cardiopulmonary function derangement could be so severe that it could necessitate extracorporeal membrane oxygenation support [4,5]. This case report describes the relatively rare incidence of persistent pulmonary hemorrhage after cardiopulmonary bypass as the primary presentation of an associated major aortopulmonary collateral artery in a neonate after a simple arterial switch operation.…”

Collateral Damage in a Neonate with Transposition of the Great Arteries

“…Aortopulmonary collateral arteries sometimes complicate the postoperative course of cyanotic congenital heart defects. 1 We describe a neonate in whom postoperative recovery after arterial switch for simple transposition of the great arteries (TGA) was complicated by previously unrecognized aortopulmonary collateral vessels and discuss their management.…”

Percutaneous occlusion of a pulmonary aneurysm causing hemoptysis in a patient with pulmonary atresia and aortopulmonary collaterals

“…APCs may also predispose to pleural effusions [10]. Hemoptysis is also a recognized complication [5, 11].…”