Balloon occlusion scintigraphy of aortopulmonary collaterals

Abstract

We evaluated two children with pulmonary atresia for coil embolization of aortopulmonary collateral vessels after placement of palliative aortopulmonary shunts. To determine vessel distribution and lung perfusion prior to collateral embolization, perfusion scintigraphy with technetium 99m-labeled macroaggregated albumin assessed pulmonary blood flow before and after balloon wedge catheter occlusion of the collaterals. In the first patient we found no perfusion defect during collateral occlusion, and we proceeded with embolization. In the second child, perfusion scintigraphy during occlusion of the collateral vessels demonstrated a filling defect, and embolization was not performed, thus avoiding the creation of a potential perfusion defect in this patient. Assessing the physiologic significance of aortopulmonary collateral vessels by utilizing temporary balloon occlusion of the collateral vessels and concurrent perfusion scintigraphy as an adjunct to selective angiography can provide a significant contribution to the safety and accuracy of coil embolization.

Transcatheter embolization of abnormal intrathoracic vessels using coils in the setting of children with congenital heart disease

“…Recently, pulmonary scintigraphy combined with occlusion using balloons has been recommended as a means of assessing such perfusion prior to embolization. 19 In our experience, selective angiography proved to be a sufficient evaluation prior to intervention. In none of the cases where the pulmonary circulation had been assessed in the follow-up after embolization of aortopulmonary collaterals was a pulmonary perfusion deficit detected.…”

Pediatric Cardiovascular Embolization Therapy

“…Pulmonary infarction may occur if an aortopulmonary collateral vessel is occluded and there is no other source of pulmonary blood flow to that portion of lung. Determination of dual vs nondual blood supply can be made by performing transient balloon occlusion of the collateral followed by pulmonary angiography or pulmonary vascular perfusion scintigraphy in the catheterization laboratory [16]. If dual supply is confirmed, embolization can be performed.…”