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

Abstract

Background: Dextro transposition of the great arteries (d-TGA) is the most common critical congenital cardiac defect surgically treated in the neonatal period by arterial switch operation (ASO). Major aortopulmonary collaterals (MAPCAs) can be present in this population and may complicate the early postoperative period. Our aim was to review our institutional data and systematically review the available literature to provide further insight on the clinical significance of MAPCAs during the early postoperative course after ASO. Methods: This is a retrospective study of patients with simple d-TGA who underwent ASO between March 1998 and September 2020 at Boston Children's Hospital. The MEDLINE, Embase, and Cochrane databases were searched from inception to June 2020. Results: Of the 671 d-TGA patients who underwent ASO at our center, 13 (1.9%) were diagnosed with MAPCAs. Five were diagnosed before ASO, while eight were diagnosed after ASO. Of these, two patients required catheterization for MAPCAs coiling during the same hospitalization on the 2nd and 11th postoperative days. The systematic review retrieved a total of 34 articles after duplicates were removed. Finally, nine studies reporting on 23 patients were deemed eligible for our analysis. The average time to MAPCAs coiling was 12 days, while the mean hospital stay was 36 days. Conclusions: MAPCAs should be included in the differential diagnosis of ASO complicated by cardiac or respiratory failure, or pulmonary hemorrhage acutely postoperatively. Once managed, recovery of these patients is predictable, and mortality is low. Further studies investigating the diagnostic value of echocardiography and the long-term outcomes of these MAPCAs are necessary.

Pulmonary, aorta, and coronary arteries post-arterial switch in transposition of great arteries: intermediate-term surveillance utilizing conventional echocardiography and cardiac multislice computed tomography

“…MAPCAs from the descending aorta to the pulmonary arteries are uncommon in D-TGA, especially after ASO. The reported prevalence of MAPCAs in D-TGA was 1.9%, with about two-thirds after ASO [48]. Rarely can they cause critical deterioration, pulmonary bleeding, or heart failure, necessitating closure through coil embolization or vascular plug [49][50][51].…”

Major aortopulmonary collateral arteries: clinical, echocardiographic, and radiologic characteristics

“…In another analysis, MAPCAs were referred to as big when they communicated directly with a pulmonary artery and were typically more than 2 mm in diameter. “Little” arteries were those connected indirectly [ 9 ]. However, in our study, all of the MAPCAs’ calibres were taken into account with proper significance, and the average diameter was about 5 mm, which has not been studied yet.…”