Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report

Abstract

IntroductionBronchial arteries originate from the descending aorta at the level of the T5-T6 vertebrae following an intrapulmonary course along the major bronchi. When bronchial arteries take off from a vessel other than the descending aorta, the anatomy is defined as an anomalous origin of the bronchial artery.Case presentationA 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation. Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation. Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt. Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs. The anomalous ectatic bronchial artery was successfully occluded by coil embolization. The improvement of the patient’s hemodynamic status resulted in an uneventful post-operative course.ConclusionA coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries. When clinically indicated, catheter-based therapy with coil embolization can be performed to successfully treat anomalous bronchial arteries by reducing as such the pulmonary overflow.

Major Aortopulmonary Collateral Arteries Requiring Percutaneous Intervention Following the Arterial Switch Operation: A Case Series and Systematic Review

“…Title and abstract screening resulted in the retrieval of 21 articles for full-text review and, finally, nine studies were deemed eligible for our analysis, as summarized in PRISMA chart (Figure S1). All studies were case reports 8-14 of patients requiring CC for hemodynamically significant MAPCAs following ASO for d-TGA, while only one study 1 was a retrospective single-center study reporting on 15 patients. The study origin was Europe in 67% (6/9) of the cases and Asia in the rest (33%, 3/9) (Table 3).…”

“…However, unrepaired MAPCAs that are significant can contribute arterial blood flow to the pulmonary system at systemic pressures. 13,14 Wipf et al 1 found that clinically significant MAPCAs are present more often in d-TGA with decreased O 2 saturations, thus providing some credence to the hypothesis that hypoxemia may trigger these lesions. In addition, they highlight the role of chest wall stress and pleural inflammation associated with mechanical ventilation while in the ICU as a trigger for the formation of collaterals.…”

“…In our review, we found that hemodynamically significant MAPCAs were identified post-repair after the development of airway bleeding, pulmonary congestion, or symptoms of heart failure. 9-14,17 These MAPCAs were more readily detected on CC after ASO, likely due to vasodilation of MAPCA, once the initial neonatal vasoconstriction resolved following the expected transition from fetal circulation in the postnatal period. When treatment is necessary for hemodynamically significant collaterals, coiling is the preferred therapy, and is found to be effective with rapid stabilization of left atrial hypertension and volume overload.…”