Clinical Study to Individual Treatment for Major Aortopulmonary Collaterals of Tetralogy of Fallot

Abstract

Objectives. To build a guideline for the individual treatment of Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) and tentatively establish the occlusion index of MAPCAs. Methods. According to the diameter of the aortopulmonary collaterals (R: mm) and the bodyweight of the children (weight: kg), K= ((∑R2)/Wt) was set as the occlusion index of TOF with MAPCAs. A retrospective study was initially performed in 171 patients who suffered from TOF with MAPCAs and underwent cardiac malformation repair to investigate the intervals of the K value: K≥2, 1<K<2, and K≤1. In order to examine the reliability of the intervals derived from the retrospective study, a prospective study was conducted in the following 209 cases. When K≥2, the collaterals occlusion was performed immediately behind surgical corrections. The postoperative condition changes in patients with 1<K<2 were observed first and managed by extending mechanical ventilation, while taking further treatments as their conditions worsen. As for patients with K≤1, no occlusion was performed. Finally, the circumstances of collaterals occlusion, postoperative ventilator assist time, and ICU resident time were collected and analyzed. Result. The proportion of the patients treated with occlusion and the postoperative ICU resident time (p<0.05) in patients with 1<K<2 in the prospective study did dramatically decrease when compared with those of the retrospective studies. Conclusion. Due to restrictions on medical conditions in China with a large population base, a standard individual treatment of TOF with MAPCAs should be established based on the Aortopulmonary Collaterals Occlusion Index K= ((∑R2)/Wt), which can effectively avoid unnecessary collateral occlusion, minimize trauma, and shorten the length of ICU and hospital stay. When K≥2, the collateral occlusion and surgical correction are recommended to be performed simultaneously. When 1<K<2, whether to occlude collaterals depends on the patients’ postoperative conditions with extending ventilator time. When K≤1, do not deal with collaterals.

A case of rare pulmonary sequestration complicated with congenital heart disease treated by arterial embolization and atrial defect closure: A case report and review of literature

“…Also, hybrid surgery has been performed for patients with large lung disease and multiple or large feeding arteries or aneurysmal abnormal arteries (14-17). Patients with larger feeding arteries may be at high risk for incomplete embolism, which may require reoperation due to recanalization and symptom recurrence as described in our previous work (18)(19)(20)(21). In the present case, the patients feeding artery opening was 4 mm, and the possibility of incomplete embolization was low.…”