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Doulamis IP, Marathe SP, Oh NA, Saeed MY, Muter A, Del Nido PJ, Nathan M. Major Aortopulmonary Collateral Arteries Requiring Percutaneous Intervention Following the Arterial Switch Operation: A Case Series and Systematic Review. World J Pediatr Congenit Heart Surg 2022; 13:146-154. [PMID: 35238700 DOI: 10.1177/21501351211064140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Ilias P Doulamis
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Supreet P Marathe
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas A Oh
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mossab Y Saeed
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelika Muter
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meena Nathan
- Department of Cardiac Surgery, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Nakamura M, Kanno K, Nishioka M. Coil embolization and a left ventricular assistive device after arterial switch operation. Ann Thorac Surg 2021; 113:e57-e58. [PMID: 33753058 DOI: 10.1016/j.athoracsur.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Abstract
Aortopulmonary collateral arteries are frequently found in patients with transposition of great arteries after catheterization. Although most of them are asymptomatic, it may cause heart failure or pulmonary hemorrhage after an arterial switch operation. Here, we report a case of symptomatic aortopulmonary collateral arteries following arterial switch, which necessitated support with a centrifugal pump and left ventricular assistive device owing to severe mitral regurgitation and left atrial hypertension and emergent coil embolization. Hemodynamics dramatically improved following embolization. Postoperative period was uneventful and the infant was released from the hospital on the 14th day.
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Affiliation(s)
- Makoto Nakamura
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa 901-1193, Japan.
| | - Kazuyoshi Kanno
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa 901-1193, Japan
| | - Masahiko Nishioka
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa 901-1193, Japan
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Maddali MM, Al-Maskari SN, Kandachar PS, Lacour-Gayet F. Pulmonary Hemorrhage After Arterial Switch Operation. Ann Thorac Surg 2018; 105:e113-e115. [PMID: 29455821 DOI: 10.1016/j.athoracsur.2017.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/15/2017] [Indexed: 11/17/2022]
Abstract
Major aortopulmonary collateral arteries can influence the postoperative course of arterial switch operation, with heart failure being the common clinical presentation. A relatively rare presentation of an aortopulmonary collateral artery in the form of persistent postoperative pulmonary hemorrhage was encountered after an uneventful arterial switch operation in a neonate with transposition of the great arteries, intact interventricular septum, and situs inversus totalis. The aortopulmonary collateral artery was coil embolized with a successful outcome.
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Affiliation(s)
- Madan M Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | - Salim N Al-Maskari
- Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman
| | - Pranav S Kandachar
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
| | - Francois Lacour-Gayet
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
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4
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Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Cardiol Young 2017; 27:530-569. [PMID: 28249633 DOI: 10.1017/s1047951117000014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel EV, Vouhé PR. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51:e1-e32. [DOI: 10.1093/ejcts/ezw360] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cantinotti M, Giordano R, Clemente A, Murzi B, Assanta N, Lunardini A, Spadoni I. Major Aortopulmonary Collaterals in Transposition of the Great Arteries: A Cause for Preoperative and Postoperative Hemodynamic Imbalance. Ann Thorac Surg 2016; 102:e33-5. [DOI: 10.1016/j.athoracsur.2015.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/02/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022]
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Abstract
A neonate with transposition of the great arteries and intact ventricular septum presented without pulmonary over-circulation, and subsequently developed pulmonary haemorrhage after corrective surgery. Postoperative CT revealed an aortopulmonary collateral artery arising from the descending aorta, and we performed successful embolisation on postoperative day 9. Aggressive imaging modalities such as angiography and/or CT imaging with contrast can detect unexpected extra-pulmonary blood supply and guide further management.
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Prifti E, Ademaj F, Baboci A, Kajo E, Vanini V. Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report. J Med Case Rep 2015; 9:55. [PMID: 25889771 PMCID: PMC4375850 DOI: 10.1186/s13256-015-0540-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bronchial 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 PRESENTATION A 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. CONCLUSION A 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.
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Affiliation(s)
- Edvin Prifti
- Cardiac Surgery Department, Tirana University Medical Center, Tirana, Albania.
| | - Fadil Ademaj
- Heart Disease Department, Gjakova Hospital, Rr Prizren, Gjakove, Kosovo.
| | - Arben Baboci
- Cardiac Surgery Department, Tirana University Medical Center, Tirana, Albania.
| | - Efrosina Kajo
- Cardiac Surgery Department, Tirana University Medical Center, Tirana, Albania.
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Maddali MM, Chackochan A, Al-Delamie TY, Nasser Al-Maskari S, Thomas E. Collateral damage in a neonate with transposition of the great arteries. J Card Surg 2013; 28:180-2. [PMID: 23488582 DOI: 10.1111/jocs.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Following an arterial switch operation, aortopulmonary collateral arteries causing an over loading of the pulmonary vasculature and necessitating prolonged postoperative mechanical ventilation were coil embolized resulting in a rapid resolution of the problem.
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Veshti A, Vida VL, Padalino MA, Stellin G. The role of aortopulmonary collaterals after an arterial switch operation: a word of caution. Pediatr Cardiol 2009; 30:347-8. [PMID: 18836756 DOI: 10.1007/s00246-008-9310-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 09/13/2008] [Indexed: 11/28/2022]
Abstract
This report describes the case of a neonate with dextro-transposition of the great arteries and an intact ventricular septum who required postoperative extracorporeal membrane oxygenation support for an unexplained postoperative left ventricular dysfunction after an arterial switch operation. After surgery, a large aortopulmonary collateral suspected of causing overload to the left ventricle was diagnosed. Percutaneous embolization of the aortopulmonary collateral caused prompt improvement in patient's conditions and rapid weaning from mechanical ventilation support.
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Affiliation(s)
- Altin Veshti
- Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy
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Irving C, Chaudhari M. Enlarged bronchial collateral artery complicating recovery after arterial switch for simple transposition of the great arteries. Interact Cardiovasc Thorac Surg 2008; 7:1176-7. [DOI: 10.1510/icvts.2008.188003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Santoro G, Carrozza M, Russo MG, Calabrò R. Symptomatic aorto-pulmonary collaterals early after arterial switch operation. Pediatr Cardiol 2008; 29:838-41. [PMID: 18185950 DOI: 10.1007/s00246-007-9183-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 11/22/2007] [Accepted: 11/23/2007] [Indexed: 11/28/2022]
Abstract
Enlarged bronchial arteries and/or systemic-to-pulmonary collaterals have been frequently demonstrated in association with transposition of the great arteries. They are usually clinically silent, although they might be large enough to cause accelerated pulmonary vascular obstructive disease or symptomatic cardiac volume overload after surgical repair. We report on a low-weight neonate with transposition of the great arteries and intact ventricular septum who showed a stormy postoperative course because of multiple aorto-pulmonary collaterals early after a successful arterial switch operation. Percutaneous coil embolization of these anomalous vessels resulted in sudden weaning from mechanical ventilation and hospital discharge in a few weeks.
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Affiliation(s)
- Giuseppe Santoro
- Cardiology and Pediatric Cardiac Surgery, A.O. "Monaldi", 2nd University of Naples, Naples, Italy.
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Pate GE, Carere RG. Percutaneous occlusion of a pulmonary aneurysm causing hemoptysis in a patient with pulmonary atresia and aortopulmonary collaterals. Catheter Cardiovasc Interv 2005; 65:310-2. [PMID: 15895403 DOI: 10.1002/ccd.20371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 28-year-old male was referred for cardiac catheterization because of recurrent severe hemoptysis necessitating resuscitation and subsequently preventing weaning from ventilation. He had a history of pulmonary atresia, ventricular septal defect, overriding aorta with right-sided aortic arch diagnosed at birth. Eisenmenger's syndrome ensued and he was not felt to be suitable for corrective cardiac surgery. He had multiple major aortopulmonary collateral vessels to both lungs with a large aneurysm in an artery to the right lower lobe, which was suspected to be the source of his bleeding. Occlusion of this aneurysm was achieved percutaneously using an Amplatzer septal occluder device. He had no further bleeding and was successfully weaned from ventilation. Six months later, he has recovered to his functional baseline and has not had any further episodes of hemoptysis.
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Affiliation(s)
- Gordon E Pate
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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