The major aortopulmonary collateral arteries in pulmonary atresia with ventricular septal defect: chest radiologic findings

Abstract

The chest radiographs and angiograms were retrospectively evaluated in 47 patients with pulmonary atresia (PA) a nd ventricular septal defect (VSD) to determine the characteristic findings of m 에 or aortopulmonary coll a teral arteries (MAPCAs) on the ches t radiographs. Of 47 patients, 23 had MAPCAs and 24 had only PDA for blood supply of whole right and left lung. Chest radiographs enabled identification of 16 of 23 patients with MAPCAs. The most common findin g ofMAPCAs was inappropriately large peripheral pulmonary vascula ture (n = 16, 69.6 % ). The other findin gs were tortuosity of pulmonary vasculature (n = 12 , 52.2 %), focal unevendi stribution of pulmonary vasculature (n = 12 , 52 .2 %), and two descending pulmonary arteries (n = 4, 17.4 % ). When chest radiogra ph s showed two or more findin gs of MAPCAs, MAPCAs could be differentiated from PDA with statistical significance (p<0.005). It is concluded that chest radiographs may help to identify MAPCAs before angiography if two-dimensional echocardiography suggests PA with VSD Index Words: Pulmonary atresia , 564 .1 555 Pulmonary artery , coll aterals, 564. 91 Aorta , angiography, 563. 12 4 Lung, radiograph y, 60. 11 1n th e cases of pulmona r y a tresia (PA) with ventricular septal d efect (VSD) , the lungs are usually supplied by patent du ctu s arteriosus (PDA) , m ajor aortopulmonary collateral arteries (MAPCAs) , and acquired collateral arteries. The angiograms should provide informat ion about the sources of the pulmonary blood supply and the d etail ed a n a tomy of the central pulmonary artery and of th e intrapulmona ry pulmona ry a rtery. Whe n th e MAPCAs are the sources of the pu lm onary blood supply , se lect i ve a ngiogr ap hy should be performed , because this *세 종병원 방사선과 * Depaγtmeη t 01 Radiology, Sejong General Hospital is essential for diagnosis and for d etermining operability and surgical approach. The angiography usually requires laye quantity of contrast materials and is a time-consuming procedure. If the angiographers know the sources of the pulmonary blood supply before cardioangiography , they may take appropriate a n giographic approach to save time . Although two-dimensional ech ocaridography is a good noninvas ive m ean of evaluatin g PA with VSD , it is limited in the e valuation of collateral blood supply. To authors' knowledge , although the