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. 2023 Mar 30;75(1):23.
doi: 10.1186/s43044-023-00349-2.

Clinical deterioration following arterial switch surgery due to extensive aortopulmonary collaterals, unusual condition but worth considering: case report

Gaser Abdelmohsen  1   2 , Naif AlKhushi  3 , Abdullah Alassiri  4 , Osman Al-Radi  5
Affiliations

Clinical deterioration following arterial switch surgery due to extensive aortopulmonary collaterals, unusual condition but worth considering: case report

Gaser Abdelmohsen et al. Egypt Heart J. .

Abstract

Background: The occurrence of major aortopulmonary collateral arteries (MAPCAs) is infrequent in patients with D-transposition of great arteries (D-TGA) with intact ventricular septum (IVS). Hemodynamically significant MAPCAs may complicate the postoperative course of these patients after arterial switch operation (ASO).

Case presentation: We present a rare case of neonatal D-TGA-IVS associated with extensive MAPCAs. After the ASO, the patient developed pulmonary hemorrhage, chest wall edema, and deterioration of lung compliance with the need for high-frequency ventilation (HFV). The patient also had a significant capillary leak with skin edema, high chest tube drainage, and high peritoneal drainage. Cardiac catheterization revealed extensive MAPCAs supplying the whole lung segments. After the catheter closure of most of these MAPCAs, the patient had clinical improvement.

Conclusions: Although the occurrence of MAPCAs with D-TGA-IVS is infrequent, clinicians should suspect their presence in cases with unexplained heart failure, pulmonary hemorrhage, or cardiovascular compromise after ASO. Catheter closure of MAPCAs is feasible with an acceptable short-term outcome.

Keywords: Aortopulmonary collaterals; Arterial switch operation; D-TGA; MAPCA; Transposition of great arteries.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Roentgenogram and angiography before and after the closure of MAPCAs: A chest X-ray after ASO showed pulmonary edema with significant skin edema (yellow arrow). B selective angiography showing a large MAPCA supplying the right upper lung lobe (yellow arrow). C selective angiography showing a large MAPCA supplying the left upper lung lobe (yellow arrow) with vascular plug seen closing the MAPCAs of right upper lobe (white asterisk). D selective angiography showing MAPCA supplying the left lower lung zone with vascular plugs seen occluding MAPCAS for upper left and right lungs (white asterisks). E selective angiography showing large MAPCA supplying the right lower lung lobe (yellow arrow). F Successful closure of 3 MAPCAs using three vascular plugs (white asterisks). ASO: arterial switch operation, MAPCAs: Major aortopulmonary collateral arteries
Fig. 2
Fig. 2
Roentgenogram, angiography, and echocardiography after ASO. A aortic angiography showing normal right coronary artery (yellow arrow). B Pulmonary angiography showing patent pulmonary arteries. C Parasternal short axis echocardiographic view showing the Lecompte with patent pulmonary arteries. D chest X-ray is done after successful closure of MAPCAs, showing improvement of pulmonary edema and skin edema. ASO: arterial switch operation, MAPCAs: Major aortopulmonary collateral arteries. RPA right pulmonary artery, LPA left pulmonary artery
See this image and copyright information in PMC

References

    1. Doulamis IP, Marathe SP, Oh NA, et al. 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(2):146–154. doi: 10.1177/21501351211064140. - DOI - PubMed
    1. Maddali MM, Al-Maskari SN, Kandachar PS, Lacour-Gayet F. Pulmonary hemorrhage after arterial switch operation. Ann Thorac Surg. 2018;105(3):e113–e115. doi: 10.1016/j.athoracsur.2017.07.041. - DOI - PubMed
    1. Cantinotti M, Giordano R, Clemente A, et al. Major aortopulmonary collaterals in transposition of the great arteries: a cause for preoperative and postoperative hemodynamic imbalance. Ann Thorac Surg. 2016;102(1):e33–e35. doi: 10.1016/j.athoracsur.2015.11.025. - DOI - PubMed
    1. Leeladharan SP, Jayashankar JP, Kottayil BP, Kappanayil M, Raman K, Balachandran R. Pulmonary hemorrhage due to unrecognized bronchial collateral after arterial switch operation. Ann Thorac Surg. 2018;105(3):e117–e118. doi: 10.1016/j.athoracsur.2017.09.043. - DOI - PubMed
    1. Anderson RH. The significance of systemic-to-pulmonary collateral arteries. Eur J Cardiothorac Surg. 2022 doi: 10.1093/ejcts/ezac523. - DOI - PubMed

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