Perioperative Major Aortopulmonary Collateral Arteries (MAPCAs) Coiling in Tetralogy of Fallot Patients Undergoing for Total Correction

Abstract

Background: Tetralogy of Fallot (TOF) is characterized by ventricular septal defect, an overriding aorta, varying degrees of pulmonic stenosis, and right ventricular hypertrophy. It may be associated with a number of lesions including development of major aortopulmonary collateral arteries (MAPCAs) in less than 5% of cases. In this study we just focused on the management of MAPCAs.Methodology: TOF patients with significant MAPCAs were selected after cardiac catheterization and planned for transcatheter embolization just before surgery.Results: A total of 45 patients underwent transcatheter closure of MAPCAs just before surgical correction with 100% success rate. The age varied from 3-30 years and 55% (n=25) were female. In majority 60% (n=27) the procedure was carried out under deep sedation with local anaesthesia while 18 (40%) patients had general anaesthesia. There was insignificant residual leak in 2 (4%) patients, transient bradycardia (n=1) and hypercyanotic spell in 4% (n=2). No serious complications or death occurred during this study period. Conclusion:Transcatheter coiling of MAPCAs is safe, easy, and effective procedure and protects the patient from its long term devastating complications.