Initial Research on Postoperative Management of Tetralogy of Fallot with Major Aortopulmonary Collaterals

Abstract

Objectives: Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCA) is a well-known but always severe congenital heart disease. This study was designed to explore proper management after radical correction of TOF with MAPCA based on a hierarchical approach. Methods: The following data were collected from 39 patients planned to undergo radical correction of TOF: age, weight, number of aortopulmonary collaterals, total lumen diameter and collateral diameter-to-body weight ratio, transcatheter occlusion and cardiac catheterization findings, mechanical ventilation time, and ICU monitoring time. The patients were divided into 4 groups by collateral diameter-to-body weight ratio as follows: <0.200 mm/kg (group 1), 0.200-0.500 mm/kg (group 2), >0.500 mm/kg (group 3), and no MAPCA (group 4). Data analysis was performed using IBM SPSS Statistics software for Mac version 22.0 (SPSS Inc., Chicago, Ill., USA) with logistic regression and Fisher's exact test. Results: Most of the patients recovered well after radical correction; postoperative complications occurred in 12 patients and included bloody sputum, low cardiac output syndrome, and severe pulmonary infection that led to tracheotomy. By prolonging the mechanical ventilation time of the patients with postoperative complications, the conditions in 3 patients were improved. However, in the remaining patients, the condition worsened until transcatheter occlusions were performed. Transcatheter occlusion was performed in all 7 patients in group 3 (100%). Only 2 of the 8 patients in group 2 required transcatheter occlusion (25%), and none of the 9 patients in group 1 required transcatheter occlusion (0%). Only 1 patient (group 3) died after radical correction. The transcatheter occlusion results showed a strong association with the total lumen diameter and the collateral diameter-to-body weight ratio (p < 0.05) but no obvious association with age, weight, or the number of aortopulmonary collaterals (p > 0.05). Conclusions: Postoperative management of patients with TOF and MAPCA has great significance. To reduce the morbidity and mortality, transcatheter coil embolization or surgical ligation should be performed in patients with a collateral diameter-to-body weight ratio of at least 0.500 mm/kg. In patients with values between approximately 0.200 and 0.500 mm/kg, prolongation of mechanical ventilation should have priority over transcatheter occlusion, and for patients with values below 0.200 mm/kg no additional treatment is needed.

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.…”

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

“…In our former study, we proposed to set collateral diameter-to-body weight ratio as the measure of whether further treatment of aortopulmonary collaterals is needed and provided preliminary ideas for the treatment of MAPCAs [11]. In the further study, we found that the collaterals are always multiple and different in diameter.…”

“…The images and statistics data used to support the findings of this study are available from the corresponding author upon request. Part of those is from previously reported studies and datasets, which have been cited at relevant places within the text as Reference [11].…”

Density of aortopulmonary collaterals predicts in-hospital outcome in tetralogy of Fallot with pulmonary stenosis

“…Previous studies showed that the presence of enlarged APCs was associated with prolonged hospital stay [ 1 ] or ventilation [ 3 ]. However, the current literature has yet to correlate the quantitative amount of APCs with early postoperative outcomes.…”

“…Given that APCs appear to be very common in TOF, establishing cut-off point of APC density predicting unfavourable in-hospital outcome is warranted to guide the clinical practice. Some authors suggested that, based on their clinical observation, APC reduction should be performed in patients with an APC diameter-to-body weight ratio of >0.5 mm/kg [ 3 ] or diameter >2 mm [ 11 ]. However, the association between these criteria and postoperative outcome has not been validated.…”