Coil Occlusion of Aortopulmonary Collateral Arteries Before Arterial Switch Procedure in an Infant With Transposition of the Great Arteries
2008; Lippincott Williams & Wilkins; Volume: 1; Issue: 3 Linguagem: Inglês
10.1161/circimaging.108.792143
ISSN1942-0080
AutoresVictoria Jowett, Graham Derrick, Victor Tsang, Jan Marek,
Tópico(s)Coronary Artery Anomalies
ResumoHomeCirculation: Cardiovascular ImagingVol. 1, No. 3Coil Occlusion of Aortopulmonary Collateral Arteries Before Arterial Switch Procedure in an Infant With Transposition of the Great Arteries Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBCoil Occlusion of Aortopulmonary Collateral Arteries Before Arterial Switch Procedure in an Infant With Transposition of the Great Arteries Victoria Jowett, MBBS, BSc, MRCPCH, Graham Derrick, BMedSci, BM, BS, Victor Tsang, MD and Jan Marek, MD, PhD Victoria JowettVictoria Jowett From the Great Ormond Street Hospital for Children, London, United Kingdom. , Graham DerrickGraham Derrick From the Great Ormond Street Hospital for Children, London, United Kingdom. , Victor TsangVictor Tsang From the Great Ormond Street Hospital for Children, London, United Kingdom. and Jan MarekJan Marek From the Great Ormond Street Hospital for Children, London, United Kingdom. Originally published1 Nov 2008https://doi.org/10.1161/CIRCIMAGING.108.792143Circulation: Cardiovascular Imaging. 2008;1:e17–e18A 1-day-old infant with a prenatal diagnosis of transposition of the great arteries was admitted to our unit. He was born at term, weighing 3.2 kg. He arrived in a stable condition, with saturations of 88%, on a prostaglandin infusion at a rate of 5 ng/kg per min in accordance with the prenatal plan. Echocardiogram demonstrated transposition of the great arteries with intact ventricular septum and usual coronary arrangement. There was adequate mixing via a moderate-sized atrial communication measuring 6 mm. In addition, there was a large persistent arterial duct with left-to-right shunting.Over the next 24 hours, the infant developed tachypnoea, poor systemic perfusion, and progressive metabolic acidosis. He was electively intubated and ventilated and commenced on ionotropes and antibiotics. Abdominal distension was noted without x-ray changes, and he was, therefore, started on prophylactic treatment for necrotizing enterocolitis. Repeat echocardiogram demonstrated the presence of major aortopulmonary collateral arteries in addition to a large persistent arterial duct and moderate atrial communication (Figure 1). Download figureDownload PowerPointFigure 1. Serial echocardiogram demonstrated large arterial duct (A), aortic origin of collateral vessel (B), and its tortuous course toward tight lung (C). Systolic-diastolic flow was documented on pulsed Doppler tracing (D).A cardiac catheter was performed to further elucidate the nature of the collateral vessels and perform an atrial septostomy. At the time of catheter, 2 major aortopulmonary collaterals were identified. These were successfully occluded with 2 and 1 detachable Cook patent ductus arteriosus coils (3 mm�3 loop), respectively (Figure 2). Download figureDownload PowerPointFigure 2. Serial angiogram indicated 2 major collateral vessels on aortogram (A) and on selective injections into right (B) and left (C) collateral vessels. After successful embolization, there was no antegrade flow seen on aortogram (D), and only 1 very small collateral remained patent (E).His condition improved, and an arterial switch procedure was performed on day 7 of life. He was extubated after 5 days and had no significant complications in the postoperative course.Major aortopulmonary collateral arteries or enlarged bronchial arteries are well described in transposition of the great arteries1 and can present problems on cardiopulmonary bypass with flow from the collaterals returning to the left atrium, resulting in blood in the surgical field and the potential for poor organ perfusion. The additional flow can also present problems in the postoperative period, with high pulmonary blood flow and cardiac volume overload requiring closure of collaterals.2These images illustrate the detection of these vessels by echocardiography before corrective surgery, allowing interventional catheter embolization of these vessels in advance of arterial switch procedure. Thus, the risk of complications during cardiopulmonary bypass and the risk of high postoperative pulmonary blood flow were avoided. Although postoperative embolization of major aortopulmonary collateral arteries has been described, this is the first report of embolization before a corrective surgical intervention in a patient with transposition of the great arteries.DisclosuresNone.FootnotesCorrespondence to Jan Marek, MD, PhD, Director of Echocardiography, Consultant Paediatric Cardiologist, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom. E-mail [email protected]References1 Wernovsky G, Bridges ND, Mandell VS, Castaneda AR, Perry SB. Enlarged bronchial arteries after early repair of transposition of the great arteries. J Am Coll Cardiol. 1993; 21: 465–470.CrossrefMedlineGoogle Scholar2 Santoro G, Carrozza M, Russo MG, Calabro R. Symptomatic aorto-pulmonary collaterals early after arterial switch operation. Paediat Cardiol. 2008;Epub ahead of print.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sarris G, Balmer C, Bonou P, Comas J, da Cruz E, Chiara L, Di Donato R, Fragata J, Jokinen T, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel E and Vouhé P (2017) Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezw360, 51:1, (e1-e32), Online publication date: 1-Jan-2017. Sarris G, Balmer C, Bonou P, Comas J, da Cruz E, Di Chiara L, Di Donato R, Fragata J, Jokinen T, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel E and Vouhé P (2017) Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum, Cardiology in the Young, 10.1017/S1047951117000014, 27:3, (530-569), Online publication date: 1-Apr-2017. Shikata F, Okamura T, Higaki T, Okura M, Yajima C, Kojima A, Uchita S, Sakashita Y, Namiguchi K, Yasugi T and Izutani H (2015) Aortopulmonary collateral arteries: a rare complication after arterial switch operation for transposition of the great arteries, Surgical Case Reports, 10.1186/s40792-015-0098-1, 1:1, Online publication date: 1-Dec-2015. Maddali M, Chackochan A, Al-Delamie T, Nasser Al-Maskari S and Thomas E (2013) Collateral Damage in a Neonate with Transposition of the Great Arteries, Journal of Cardiac Surgery, 10.1111/jocs.12076, 28:2, (180-182), Online publication date: 1-Mar-2013. (2012) Circulation: Cardiovascular Imaging Editors' Picks, Circulation: Cardiovascular Imaging, 5:1, (e1-e9), Online publication date: 1-Jan-2012. November 2008Vol 1, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCIMAGING.108.792143PMID: 19808537 Originally publishedNovember 1, 2008 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsCongenital Heart DiseaseEchocardiography
Referência(s)