A 17-month-old infant with multiple aorto-pulmonary collateral arteries (MAPCAs) and pulmonary hypertension presented for diagnostic catheterization. On the day of the procedure, the infant was asymptomatic with oxyge...A 17-month-old infant with multiple aorto-pulmonary collateral arteries (MAPCAs) and pulmonary hypertension presented for diagnostic catheterization. On the day of the procedure, the infant was asymptomatic with oxygen saturation in the 90’s on 1.0 L/min O2 nasal cannula. His parents denied any recent illness. During the procedure, one coil was inadvertently embolized into the right lung resulting in markedly increased pulmonary artery pressures. The Pa-etCO2 gradient increased to 25 mmHg from a baseline of 2 mmHg. Therapy was initiated to reduce the PaCO2. The patient could not be weaned from mechanical ventilation due to elevated PA pressures.展开更多
Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels that arise from the aorta or its first-order branches and are distally connected to the pulmonary arterial vasculature, thereby providing pulmon...Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels that arise from the aorta or its first-order branches and are distally connected to the pulmonary arterial vasculature, thereby providing pulmonary blood flow. MAPCAs are often associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Isolated MAPCAs are rare in patients without congenital heart disease with structurally normal hearts. Sometimes, isolated congenital MAPCAs can occur without any lung disease. Isolated MAPCAs represent the occurrence of collaterals in the absence of underlying heart disease, which commonly presents as heart failure, recurrent respiratory tract infection, and pulmonary artery hypertension. We report a rare case of congestive heart failure in a 6-year-old patient with dual arterial supply to an otherwise normal right lung, with a normal bronchial tree, and a structurally normal heart. The patient was successfully managed by the closure of collaterals by Amplatzer vascular plugs II (AVPII) and Amplatzer Piccolo Occluders.展开更多
Objective To assess the values of multidetector-row computed tomography （MDCT） on perioperative managements of pulmonary atresia with ventricular septal defect and major aortopulmonary arteries （PA/VSD/MAPCAs）.Met...Objective To assess the values of multidetector-row computed tomography （MDCT） on perioperative managements of pulmonary atresia with ventricular septal defect and major aortopulmonary arteries （PA/VSD/MAPCAs）.Methods From April 2004 to January 2006,consecutive 56 cases of PA/VSD/MAPCAs,including 35 males and 21 females,were admitted to Guangdong Provincial People＇s Hospital.展开更多
Background:Construction of a central shunt by connection of hypoplastic true pulmonary arteries to the ascending aorta(AO)can be performed as a first step in staged repair of pulmonary atresiawith ventricular septal d...Background:Construction of a central shunt by connection of hypoplastic true pulmonary arteries to the ascending aorta(AO)can be performed as a first step in staged repair of pulmonary atresiawith ventricular septal defect and major aorto-pulmonary collateral arteries(PA-VSD-MAPCAs)intended to promote growth and development of the central pulmonary arteries.Methods:To determine early and intermediate-termgrowth of true pulmonary arteries after their connection to the AO as a first step in staged repair of PA-VSD-MAPCAs,we reviewed all angiographic studies and CT imaging of patients,treated in our tertiary referral center in the last 26 years(1991 until 2017)for PAVSD-MAPCAs with such a shunt.Results:A total of 13 patients(6 male)underwent direct end-to-side connection of the true pulmonary artery with the AO.The absolutemedian size of both PAs showed statistically significant absolute growth over time.The absolute LPA growth was estimated to be 0.013 mm/day(p<0.001).The absolute RPA growth was estimated to be 0.010 mm/day(p=0.001).In total 9/13(69%)reached total repair and 4 were considered not suitable for final repair.Conclusions:Creation of a central shunt by connection of true pulmonary arteries to the AO promotes their growth in patients with PA-VSD-MAPCAs,particular the LPA,although not reaching normal size.Patients with pulmonary atresia,and diminutive pulmonary arteries are a high-risk group,with a lower complete repair rate compared to those with better sized PAs.Alternative techniques or interventions should be explored in these patients to augment the size of the pulmonary arteries.展开更多
文摘A 17-month-old infant with multiple aorto-pulmonary collateral arteries (MAPCAs) and pulmonary hypertension presented for diagnostic catheterization. On the day of the procedure, the infant was asymptomatic with oxygen saturation in the 90’s on 1.0 L/min O2 nasal cannula. His parents denied any recent illness. During the procedure, one coil was inadvertently embolized into the right lung resulting in markedly increased pulmonary artery pressures. The Pa-etCO2 gradient increased to 25 mmHg from a baseline of 2 mmHg. Therapy was initiated to reduce the PaCO2. The patient could not be weaned from mechanical ventilation due to elevated PA pressures.
文摘Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels that arise from the aorta or its first-order branches and are distally connected to the pulmonary arterial vasculature, thereby providing pulmonary blood flow. MAPCAs are often associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Isolated MAPCAs are rare in patients without congenital heart disease with structurally normal hearts. Sometimes, isolated congenital MAPCAs can occur without any lung disease. Isolated MAPCAs represent the occurrence of collaterals in the absence of underlying heart disease, which commonly presents as heart failure, recurrent respiratory tract infection, and pulmonary artery hypertension. We report a rare case of congestive heart failure in a 6-year-old patient with dual arterial supply to an otherwise normal right lung, with a normal bronchial tree, and a structurally normal heart. The patient was successfully managed by the closure of collaterals by Amplatzer vascular plugs II (AVPII) and Amplatzer Piccolo Occluders.
文摘Objective To assess the values of multidetector-row computed tomography （MDCT） on perioperative managements of pulmonary atresia with ventricular septal defect and major aortopulmonary arteries （PA/VSD/MAPCAs）.Methods From April 2004 to January 2006,consecutive 56 cases of PA/VSD/MAPCAs,including 35 males and 21 females,were admitted to Guangdong Provincial People＇s Hospital.
文摘Background:Construction of a central shunt by connection of hypoplastic true pulmonary arteries to the ascending aorta(AO)can be performed as a first step in staged repair of pulmonary atresiawith ventricular septal defect and major aorto-pulmonary collateral arteries(PA-VSD-MAPCAs)intended to promote growth and development of the central pulmonary arteries.Methods:To determine early and intermediate-termgrowth of true pulmonary arteries after their connection to the AO as a first step in staged repair of PA-VSD-MAPCAs,we reviewed all angiographic studies and CT imaging of patients,treated in our tertiary referral center in the last 26 years(1991 until 2017)for PAVSD-MAPCAs with such a shunt.Results:A total of 13 patients(6 male)underwent direct end-to-side connection of the true pulmonary artery with the AO.The absolutemedian size of both PAs showed statistically significant absolute growth over time.The absolute LPA growth was estimated to be 0.013 mm/day(p<0.001).The absolute RPA growth was estimated to be 0.010 mm/day(p=0.001).In total 9/13(69%)reached total repair and 4 were considered not suitable for final repair.Conclusions:Creation of a central shunt by connection of true pulmonary arteries to the AO promotes their growth in patients with PA-VSD-MAPCAs,particular the LPA,although not reaching normal size.Patients with pulmonary atresia,and diminutive pulmonary arteries are a high-risk group,with a lower complete repair rate compared to those with better sized PAs.Alternative techniques or interventions should be explored in these patients to augment the size of the pulmonary arteries.
