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Uygur L, Demirci O, Yücel IK. Pulmonary atresia and ventricular septal defect: How accurate is the fetal echocardiography, and do the major aortopulmonary collateral arteries matter? Echocardiography 2023; 40:1259-1268. [PMID: 37878331 DOI: 10.1111/echo.15706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/29/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. STUDY DESIGN The cases prenatally diagnosed with PAVSD between 2017 and 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the different pulmonary vascular supply types. RESULTS Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live-born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Postoperative survival was 69.2%. Mortality before surgery and postoperative survival did not differ between pulmonary supply groups. Survival was impaired by the extracardiac anomalies. The need for early interventions was significantly higher in the DA group. CONCLUSION Pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short-term outcomes significantly but it impacts the management. The associated anomalies highly contribute to postnatal mortality.
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Affiliation(s)
- Lütfiye Uygur
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ilker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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2
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Transcatheter Closure of a Coronary Artery Fistula in a Neonate with Tetralogy of Fallot. Pediatr Cardiol 2023; 44:951-954. [PMID: 36912925 DOI: 10.1007/s00246-023-03140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Coronary artery-to-pulmonary artery fistulae are a not uncommon finding in patients with Tetralogy of Fallot (TOF) and collateral-dependent pulmonary blood flow. Management for these fistulae is often primary surgical ligation or unifocalization at the time of complete repair, dependent on the presence of dual blood flow to the involved areas. We present the case of a 32-week premature boy weighing 1.79 kg with TOF, confluent branch pulmonary arteries, major aortopulmonary collaterals, and right coronary artery to main pulmonary artery fistula. The patient demonstrated evidence of coronary steal into the pulmonary vasculature with an elevation in the troponin level without hemodynamic instability, and subsequently underwent successful transcatheter occlusion of the fistula via right common carotid access using a Medtronic 3Q microvascular plug. This case demonstrates the realistic potential for early coronary steal in this physiology and possibility of transcatheter therapy even in a small neonate.
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3
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Sumitomo NF, Kodo K, Inoue T, Oyanagi T, Yamagishi H. Clinical Characteristics of Coronary-to-Pulmonary Artery Fistula in Patients with Pulmonary Atresia and Ventricular Septal Defect. J Cardiovasc Dev Dis 2023; 10:jcdd10010017. [PMID: 36661912 PMCID: PMC9867298 DOI: 10.3390/jcdd10010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/17/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023] Open
Abstract
The existence of a coronary-to-pulmonary artery fistula (CPF) in pulmonary atresia with ventricular septal defect (PAVSD) potentially affects treatment; however, its clinical features have not been comprehensively described due to the disease's rarity. We reviewed 69 cases from 42 studies to reveal the clinical overview of patients with CPF and PAVSD. Among the included patients, the male-to-female ratio was exactly 1:1, and only two patients (3%) exhibited the 22q11.2 microdeletion syndrome. Regarding anatomical features, CPFs originated from the left coronary artery in 65% of patients, and 62% had other major aortopulmonary collateral arteries. Thirty-nine percent of patients had a definitive CPF diagnosis at 0 years of age, whereas 10% were diagnosed in adulthood. Seventy percent underwent catheter angiography to obtain a definitive CPF diagnosis. Ninety-five percent of patients underwent cardiac surgery, and among them, 43% underwent palliative surgery, whereas 52% underwent one-stage repair. Four patients including three adult patients developed cardiac dysfunction due to myocardial ischemia, and three of them exhibited improved cardiac function after the intervention for CPF. Of all the patients, 88% survived and 12% died. The surgical strategy and prognosis were similar to those in PAVSD patients without CPF. This review provides detailed clinical phenotypes that are potentially useful in enhancing the management of patients with this rare disease.
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4
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Coronary artery-pulmonary artery fistula in pulmonary atresia with ventricular septal defect: report of two surgical cases. Cardiol Young 2022; 32:809-812. [PMID: 34521496 DOI: 10.1017/s1047951121003796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pulmonary atresia with ventricular septal defect is a complex congenital cardiac anomaly. The blood is supplied to the lungs through a patent ductus arteriosus, a major aortopulmonary collateral artery, or in very rare cases from a coronary artery-pulmonary artery fistula. We present two cases with coronary artery-pulmonary artery fistula which underwent surgical intervention. In our first patient, the main pulmonary artery was supplied from the left main coronary artery. In the second patient, the right pulmonary artery originated from the left main coronary artery and continued to the right lung posteriorly to the aorta, while the left pulmonary artery originated from the patent ductus arteriosus. The difference in our cases is that the coronary artery pulmonary artery fistulas behave like major aortopulmonary collateral arteries originating from the coronary arteries. These fistulas were the main source of pulmonary blood flow.
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5
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Alex A, Ayyappan A, Valakkada J, Kramadhari H, Sasikumar D, Menon S. Major Aortopulmonary Collateral Arteries. Radiol Cardiothorac Imaging 2022; 4:e210157. [PMID: 35782757 PMCID: PMC8893210 DOI: 10.1148/ryct.210157] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/23/2021] [Accepted: 11/29/2021] [Indexed: 06/15/2023]
Abstract
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 commonly associated with several congenital heart diseases that have compromised pulmonary circulation due to severe stenosis involving pulmonary valves or arteries or due to pulmonary atresia. Embryologically, MAPCAs are presumed to be persistent segmental arteries. MAPCAs can be imaged with CT and MRI, and such imaging findings are important for surgeons and interventionists. The management options for MAPCAs include unifocalization, surgical ligation, and endovascular interventions, such as coil embolization. This review highlights the role of reporting certain critical features of MAPCAs at CT and MRI, which will help to facilitate management decisions for systemic-to-pulmonary collateral vessels observed in patients with congenital heart disease. Keywords: Pediatrics, CT Angiography, Image Postprocessing, Interventional-Vascular, MR Angiography, Embolization, Stents, Cardiac, Vascular, Aorta © RSNA, 2022.
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6
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Verma M, Pandey NN, Yadav S, Kumar S. Coronary-to-pulmonary collateral artery from a superdominant morphologically right coronary artery. J Card Surg 2022; 37:682-684. [PMID: 35028980 DOI: 10.1111/jocs.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022]
Abstract
We present a case of a 16-year-old cyanotic male patient with ventricular septal defect, pulmonary atresia and discordant atrioventricular connections where computed tomography angiography demonstrated a large tortuous coronary-to-pulmonary collateral artery arising from the superdominant morphologically right coronary artery and coursing cranially to supply the pulmonary parenchyma.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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7
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Ventricular septal defect with pulmonary atresia: approaches, results, prognosticators and current status. Indian J Thorac Cardiovasc Surg 2022; 38:28-37. [PMID: 34898873 PMCID: PMC8630160 DOI: 10.1007/s12055-020-01133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 01/03/2023] Open
Abstract
Ventricular septal defect with pulmonary atresia and major aortopulmonary collateral arteries is a complex congenital cardiac anomaly with a wide spectrum of anatomical variations. Akin to the same, the management options are also very diverse ranging from aggressive single-stage repair with unifocalisation to surgical palliation and/or staged repair and also heart transplant. There is no consensus on the best management option. This review aims at highlighting the various surgical options and proposing a management pathway suited for the subcontinent patients.
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8
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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9
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Quinlan CA, Latham GJ, Joffe D, Ross FJ. Perioperative and Anesthetic Considerations in Tetralogy of Fallot With Pulmonary Atresia. Semin Cardiothorac Vasc Anesth 2021; 25:218-228. [DOI: 10.1177/10892532211027395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tetralogy of Fallot with pulmonary atresia (ToF-PA) is a rare diagnosis that includes an extraordinarily heterogeneous group of complex anatomical findings with significant implications for physiology and prognosis. In addition to the classic findings of ToF, this particular diagnosis is characterized by complete failure of forward flow from the right ventricle to the pulmonary arterial system. As such, pulmonary blood flow is entirely dependent on shunting from the systemic circulation, most frequently via a patent ductus arteriosus, major aortopulmonary collaterals, or a combination of the two. The pathophysiology of ToF-PA is largely attributable to the abnormalities of the pulmonary vasculature. Ultimately, these patients require operative intervention to create a reliable, controlled source of pulmonary blood flow and ideally complete intracardiac repair. Even after operative correction, these patients remain at risk for pulmonary arterial stenoses and pulmonary hypertension. Although there have been significant advances in surgical and interventional management of ToF-PA leading to dramatic improvements in survival and long-term functional status, there is ongoing debate about the optimal management strategy given the risk of development of irreversible abnormalities of the pulmonary vasculature and the morbidity and mortality associated with sometimes multiple, complex operative interventions often occurring early in infancy. This review will discuss the findings in patients with ToF-PA with a focus on the perioperative and anesthetic management and will highlight challenges faced by the anesthesiologist in caring for these patients.
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10
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Kumar P. Congenital Coronary Artery-to-Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of "Double Trouble". Radiol Cardiothorac Imaging 2021; 3:e210003. [PMID: 34498004 PMCID: PMC8415169 DOI: 10.1148/ryct.2021210003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Congenital coronary artery fistula is a rare coronary anomaly. Its clinical significance focuses mainly on the mechanism of coronary steal phenomenon. A combination of left main (LM) coronary artery-to-main pulmonary artery (MPA) fistula with anomalous origin of right coronary artery from the pulmonary artery (ARCAPA) was encountered in a 3-month-old infant who presented with tachypnea. Evaluation with echocardiography and CT confirmed the diagnosis. The patient underwent surgical ligation of LM-to-MPA fistula with direct reimplantation of ARCAPA to aortic root. Keywords: Pediatrics, CT, CT-Angiography, Echocardiography © RSNA, 2021.
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11
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Yadav A, Bhargava S, Buxi TBS, Sirvi K. Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect. Indian J Radiol Imaging 2021; 28:433-435. [PMID: 30662204 PMCID: PMC6319112 DOI: 10.4103/ijri.ijri_489_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
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Affiliation(s)
- Anurag Yadav
- Department of Radiodiagnosis, Sir Ganga Ram Hospital, New Delhi, India
| | - Salil Bhargava
- Department of Radiodiagnosis, Sir Ganga Ram Hospital, New Delhi, India
| | - T B S Buxi
- Department of Radiodiagnosis, Sir Ganga Ram Hospital, New Delhi, India
| | - Krishna Sirvi
- Department of Radiodiagnosis, Sir Ganga Ram Hospital, New Delhi, India
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12
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Panda S, Gandhi H, Surti J, Mishra A, Champaneri B. Anesthetic and intensive care management of left main coronary artery to main pulmonary artery fistula diagnosed in postoperative case of tetralogy of fallot. Ann Card Anaesth 2021; 24:272-274. [PMID: 33884995 PMCID: PMC8253020 DOI: 10.4103/aca.aca_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cases of coronary to pulmonary artery fistula are seen in patients of pulmonary atresia with ventricular septal defect (VSD). These fistulas are rarely seen in patients of Tetralogy of Fallot (TOF). In this case report, we have presented ICU management of a postoperative case of TOF, with missed diagnosis of left main coronary artery (LMCA) to main pulmonary artery (MPA) fistula.
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Affiliation(s)
- Suvendu Panda
- Department of Cardiac Anesthesia, U.N.Mehta Institute of Cardiology and Research Center, Ahmadabad, Gujarat, India
| | - Hemang Gandhi
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarva, Ahmedabad, Gujarat, India
| | - Jigar Surti
- Department of Cardiac Anesthesia, U.N.Mehta Institute of Cardiology and Research Center, Ahmadabad, Gujarat, India
| | - Amit Mishra
- Department of Pediatric Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center Ahmadabad, Gujarat, India
| | - Bhavik Champaneri
- Department of Pediatric Cardiology, U.N. Mehta Institute of Cardiology and Research Center Ahmadabad, Gujarat, India
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13
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Coronary artery to pulmonary artery collateral as the principal source of pulmonary blood supply in pulmonary atresia and ventricular septal defect with absent left pulmonary artery. Cardiol Young 2020; 30:1728-1729. [PMID: 33046174 DOI: 10.1017/s1047951120003315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pulmonary atresia and ventricular septal defect is associated with variable sources of pulmonary blood supply. We present a case of a coronary artery to pulmonary artery collateral as the principal source of pulmonary blood supply.
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14
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Barron DJ, Kutty RS, Stickley J, Stümper O, Botha P, Khan NE, Jones TJ, Drury NE, Brawn WJ. Unifocalization cannot rely exclusively on native pulmonary arteries: the importance of recruitment of major aortopulmonary collaterals in 249 cases†. Eur J Cardiothorac Surg 2020; 56:679-687. [PMID: 30891593 DOI: 10.1093/ejcts/ezz070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We sought to define the early and late outcomes of unifocalization based on a classification of the native pulmonary artery (nPA) system and major aortopulmonary collateral arteries (MAPCAs) with a policy of combined recruitment and rehabilitation and to analyse the role of unifocalization by leaving the ventricular septal defect (VSD) open with a limiting right ventricle-pulmonary artery (RV-PA) conduit in borderline cases. METHODS An analysis of 271 consecutive patients assessed for unifocalization at a single institution between 1988 and 2016 was performed. Patients were classified according to the pulmonary blood supply: group A, unifocalization based on nPA only; group B, based on nPA and MAPCAs; group C, MAPCAs only (absent nPAs). RESULTS Unifocalization was achieved in 249 (91.9%) cases with an early mortality of 2.8%. Group A included 72 (28.9%) patients, group B 119 (47.8%) patients and group C 58 (23.3%) patients with no difference in early survival between groups. Survival at 5, 10 and 15 years was 90.0% (85.9-94.3), 87.2% (83.5-91.2) and 82.3% (75.2-89.9), respectively. Late survival in groups A and B was similar but 10- and 15-year survival in group C decreased to 79.2% (68.2-92.1) and 74.3% (61.1-90.4) (P = 0.02), respectively. A mean of 1.9 (±0.6) MAPCAs were recruited per patient (range 0-6). The VSD was left open with a limiting RV-PA conduit in 97 (39.0%) cases, but subsequently closed in 48 patients, giving a total of 200 (80.3%) patients achieving VSD closure (full repair). Delaying VSD closure was not associated with increased risk for early or late survival. A central shunt to rehabilitate the nPAs was used in 56 (22.5%) cases. This was associated with a reduction in the number of MAPCAs recruited, but still required a mean of 1.8 (±0.5) MAPCAs recruited per patient to achieve unifocalization. In multivariate risk analysis, those suitable for single-stage full repair had the best long-term outcomes. Group C anatomy was associated with poor late survival compared to groups A and B (hazard ratio 2.7). CONCLUSIONS Survival is maximized by a combined approach of rehabilitation and recruitment. MAPCAs should always be recruited if they supply areas with absent nPA supply. A strategy of leaving the VSD open with a limiting RV-PA conduit is a safe and effective way of managing borderline cases.
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Affiliation(s)
- David J Barron
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Ramesh S Kutty
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - John Stickley
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Oliver Stümper
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Phil Botha
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Natasha E Khan
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Timothy J Jones
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nigel E Drury
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - William J Brawn
- Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
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15
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Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, Brockmeier K, Hellmund A, Geipel A, Gembruch U, Berg C. Prenatal Diagnosis and Postnatal Outcome of Fetuses with Pulmonary Atresia and Ventricular Septal Defect. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:514-525. [PMID: 30616264 DOI: 10.1055/a-0770-2832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess the intrauterine course, associated conditions and postnatal outcome of fetuses with pulmonary atresia with ventricular septal defect (PAVSD). METHODS All cases of PAVSD diagnosed prenatally over a period of 10 years with a minimum follow-up of 6.5 years were retrospectively collected in 3 tertiary referral centers. RESULTS 50 cases of PAVSD were diagnosed prenatally. 44.0 % of fetuses had isolated PAVSD, 4.0 % had associated cardiac anomalies, 10.0 % had extra-cardiac anomalies, 38.0 % had chromosomal anomalies, 4.0 % had non-chromosomal syndromes. Among the 32 liveborn children, 56.3 % had reverse flow in the patent arterial duct, 25.0 % had major aortopulmonary collateral arteries (MAPCAs) with ductal agenesis and 18.7 % had a double supply. 17 pregnancies were terminated (34.0 %), there was 1 intrauterine fetal death (2.0 %), 1 neonatal death (2.0 %), and 6 deaths (12.0 %) in infancy. 25 of 30 (83.3 %) liveborn children with an intention to treat were alive at the latest follow-up. The mean follow-up among survivors was 10.0 years (range 6.5-15.1). 56.0 % of infants underwent staged repair, 44.0 % had one-stage complete repair. After exclusion of infants with additional chromosomal or syndromal anomalies, 88.9 % were healthy, and 11.1 % had mild limitations. The presence of MAPCAs did not differ significantly between survivors and non-survivors (p = 0.360), between one-stage or staged repair (p = 0.656) and healthy and impaired infants (p = 0.319). CONCLUSION The prognosis in cases without chromosomal or syndromal anomalies is good. MAPCAs did not influence prognosis or postoperative health. The incidence of repeat interventions due to recurrent stenoses is significantly higher after staged compared with single-stage repair.
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Affiliation(s)
- Ingo Gottschalk
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christel Jehle
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Rüdiger Stressig
- Praenatal.plus Prenatal Medicine and Genetics, praenatal.plus Cologne, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Konrad Brockmeier
- Department of Pediatric Cardiology, University-Hospital of Cologne, Germany
| | - Astrid Hellmund
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christoph Berg
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
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16
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Careddu L, Angeli E, Assenza GE, Hasan T, Quarti A, Petridis FD, Donti A, Gargiulo GD. Aortopulmonary Collateral Artery from the Proximal Ascending Aorta: A Rare Anatomical Finding. World J Pediatr Congenit Heart Surg 2020; 11:669-671. [PMID: 32853066 DOI: 10.1177/2150135120918205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries is a rare congenital heart lesion in which pulmonary blood supply may arise from different segments of the aorta. We report an unusual case of a newborn with a major collateral artery originating from the proximal ascending aorta. Successful reparative surgery was undertaken.
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Affiliation(s)
- Lucio Careddu
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Gabriele Egidy Assenza
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Tammam Hasan
- Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Andrea Quarti
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Francesco Dimitri Petridis
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Andrea Donti
- Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric Cardiac Surgery, Pediatric Cardiology and GUCH Unit, 9296University of Bologna, Bologna, Italy
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17
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An Unusual Cause of Hypoxia: Ventricular Septal Defect, Pulmonary Artery Atresia, and Major Aortopulmonary Collaterals Diagnosed in the Adult Cardiac Catheterization Lab. Case Rep Cardiol 2020; 2020:4726529. [PMID: 32047673 PMCID: PMC7007747 DOI: 10.1155/2020/4726529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/22/2019] [Indexed: 11/24/2022] Open
Abstract
The association of pulmonary atresia, ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA) is an extreme form of tetralogy of Fallot (TOF). It carries a high mortality risk if not intervened on during infancy with only 20% of unoperated patients surviving into adulthood. We present the case of a 40-year-old man who presented for evaluation prior to retinal surgery and was found to have hypoxia and a loud murmur. Cardiac catheterization was performed in the general catheterization laboratory, demonstrating a membranous VSD, pulmonary atresia, and MAPCA. We highlight the challenges and limitations that an adult interventional cardiologist may have when encountering these patients.
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A Review of the Management of Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries. Ann Thorac Surg 2019; 108:601-612. [DOI: 10.1016/j.athoracsur.2019.01.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
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Abstract
The usual sources of pulmonary blood flow in pulmonary atresia (PA) with(VSD) are patent ductus arteriosus and aortopulmonary collaterals. However, rarely fistulous collaterals may also arise from the coronary arteries which usually open into the main pulmonary trunk or branch pulmonary arteries. In such cases, selective coronary angiogram may be required for the demonstration of pulmonary arterial anatomy. A case of PA with VSD with failure to demonstrate pulmonary arteries on routine catheterization study (ventricular, aortic root, and descending aortic angiograms) is being presented here. A coronary artery-to-pulmonary artery fistula was suspected in view of dilated left main coronary artery, and pulmonary arteries were well demonstrated with selective coronary angiogram.
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Affiliation(s)
- Raghav Bansal
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sunil Kumar Verma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Sasikumar D, Sasidharan B, Ayyappan A, Gopalakrishnan A, Krishnamoorthy KM. Coronary-to-pulmonary artery collaterals in pulmonary atresia. Ann Pediatr Cardiol 2018; 11:328-329. [PMID: 30271029 PMCID: PMC6146858 DOI: 10.4103/apc.apc_29_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 2-month-old baby with ventricular septal defect and pulmonary atresia was found to have coronary-to-pulmonary artery collaterals. Cardiac computed tomography confirmed the coronary collaterals and showed the absence of other systemic to pulmonary artery collaterals. Although these collaterals do not cause coronary ischemia, it is important to delineate them by accurate imaging to plan the appropriate surgical strategy.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics 2018; 38:688-703. [DOI: 10.1148/rg.2018170158] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gabin Yun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Tae Hyun Nam
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Eun Ju Chun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
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Alkhushi N, Al-Radi OO, Ajlan A, Abdelmohsen G, Attia W. Coronary-pulmonary arterial fistula in a neonate with pulmonary atresia-ventricular septal defect and single coronary artery. Echocardiography 2017; 34:1536-1539. [PMID: 28898455 DOI: 10.1111/echo.13674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In cases of pulmonary atresia with ventricular septal defect (PA-VSD), coronary-pulmonary arterial fistula (CPAF) as the main source of pulmonary blood supply is extremely rare. These fistulae may arise from the left coronary artery, right coronary artery, or a single coronary artery. Fistulae from a single coronary artery are unusual. We are reporting a case of PA-VSD with single coronary artery and CPAF as the main source of pulmonary supply in addition to two major aortopulmonary collateral arteries (MAPCAS). Successful surgical correction with VSD closure and right ventricle (RV) to the pulmonary artery (PA) conduit was made.
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Affiliation(s)
- Naif Alkhushi
- Division of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr Ajlan
- Department of Radiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Gaser Abdelmohsen
- Division of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wael Attia
- Division of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
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Najm HK, Jha NK, Godman M, Al Mutairi M, Rezk AI, Momenah T. Pulmonary Atresia, VSD in Association with Coronary-Pulmonary Artery Fistula. Asian Cardiovasc Thorac Ann 2016; 15:335-8. [PMID: 17664210 DOI: 10.1177/021849230701500415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital coronary-pulmonary artery fistula is rare in patients with pulmonary atresia and ventricular septal defect. The nomenclature, physiological, clinical, and surgical implications of these fistulas are yet to be defined. We report a one-year-old child with pulmonary atresia, ventricular septal defect, and a right coronary-pulmonary artery fistula who also had a diminutive, disconnected left pulmonary artery in addition to aortopulmonary collaterals. The patient underwent corrective surgery. However, the fate of diminutive pulmonary arteries is unknown. The literature was reviewed to explore the clinical or surgical implications of such fistulas for improved understanding and management in the future.
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Affiliation(s)
- Hani K Najm
- Department of Cardiac Surgery, King Fahad Hospital, Riyadh, Saudi Arabia
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Lee NS, Blanchard DG, Knowlton KU, McDivit AM, Pretorius V, Madani MM, Fedullo PF, Kerr KM, Kim NH, Poch DS, Auger WR, Daniels LB. Prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension. Pulm Circ 2015; 5:313-21. [PMID: 26064456 DOI: 10.1086/681225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/16/2014] [Indexed: 12/14/2022] Open
Abstract
This study sought to determine the prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to correlate their presence with the degree of clot burden. CTEPH is a treatable cause of severe pulmonary hypertension and right heart failure. Bronchopulmonary collateral vessels have been used as a supplementary diagnostic and prognostic tool for this disease. Coronary artery-pulmonary artery collaterals in this population have not been described. The coronary angiograms of 300 consecutive patients with CTEPH evaluated for pulmonary thromboendarterectomy (PTE) between January 1, 2007, and May 1, 2014, were examined. Of these patients, 259 (50% male; mean age, 58.3 ± 10.6 years) had cineangiographic images deemed adequate to definitively assess for the presence of coronary artery-pulmonary artery collaterals and were included in the final analyses. Pulmonary angiogram reports were reviewed for extent of pulmonary artery obstruction. The coronary angiograms of 259 age- and sex-matched control patients were also examined. Among 259 CTEPH patients with definitive imaging, 34 coronary artery-pulmonary artery collaterals were found in 28 patients (10.8%), versus 1 coronary artery-pulmonary artery collateral among control subjects (0.4%; P < 0.001). Compared with CTEPH patients without collaterals, patients with collaterals had a significantly higher prevalence of total occlusion of their right or left main pulmonary artery (P < 0.001) or lobar arteries (P < 0.001). In conclusion, the prevalence of coronary artery-pulmonary artery collaterals in CTEPH patients undergoing coronary angiography for possible PTE is approximately 11%. These vessels are associated with more severe pulmonary artery occlusion.
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Affiliation(s)
- Noel S Lee
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Daniel G Blanchard
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kirk U Knowlton
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
| | - Anna M McDivit
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
| | - Victor Pretorius
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Michael M Madani
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Peter F Fedullo
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kim M Kerr
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA
| | - Nick H Kim
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA
| | - David S Poch
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA
| | - William R Auger
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA
| | - Lori B Daniels
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
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Artery Fistula Causing Aortic Regurgitation in Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries. Ann Thorac Surg 2015; 99:e121-3. [DOI: 10.1016/j.athoracsur.2015.02.059] [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: 01/08/2015] [Revised: 02/07/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
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Ono M, Dong W, Kasnar-Samprec J, Vogt MO, Schreiber C. Left Pulmonary Artery Originating From the Right Coronary Artery in a Patient With Pulmonary Atresia and Ventricular Septal Defect. Ann Thorac Surg 2015; 99:e95-6. [DOI: 10.1016/j.athoracsur.2014.12.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/19/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
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Unusual variant of tetralogy of Fallot with pulmonary atresia: a right pulmonary artery from the ascending aorta and a coronary-to-left pulmonary artery collateral. Cardiol Young 2015; 25:554-6. [PMID: 24698028 DOI: 10.1017/s1047951114000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of a newborn with tetralogy of Fallot and pulmonary atresia, with a right pulmonary artery from the ascending aorta, and a left pulmonary artery arising from the right coronary artery via an indirect aortopulmonary collateral. The embryogenesis of this unusual combination of pulmonary blood supply has significant implications when considering normal migration of the aortopulmonary septum.
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Seetharama Bhat P, Girish Gowda S, Mahimarangaiah J, Manjunath CN. Giant coronary-pulmonary fistula with pulmonary atresia, ventricular septal defect, and coronary anomaly: A case report and review of literature. Ann Pediatr Cardiol 2014; 7:142-4. [PMID: 24987263 PMCID: PMC4070206 DOI: 10.4103/0974-2069.132496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital coronary-pulmonary artery fistula is a rare condition and is usually associated with pulmonary atresia. We present a 10-year-old girl with circumflex coronary artery to pulmonary artery (PA) fistula with a giant dilated circumflex coronary artery, ventricular septal defect (VSD), pulmonary atresia, and anomalous originofleft anterior descending (LAD) artery from right coronary sinus. The patient underwent surgical correction. We report the investigation, treatment, and review of literatureof this rare congenital anomaly associated with dilated circumflex coronary artery.
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Affiliation(s)
- Ps Seetharama Bhat
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Sl Girish Gowda
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Jayaranganath Mahimarangaiah
- Department of Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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Talwar S, Anderson RH, Keshri VK, Choudhary SK, Gulati GS, Airan B. Coronary-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia. Asian Cardiovasc Thorac Ann 2013; 22:1003-9. [DOI: 10.1177/0218492313505101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical correction of patients with tetralogy of Fallot with pulmonary atresia is now one of the routine procedures performed by pediatric cardiac surgeons. In one variant, the pulmonary arterial supply is derived from a fistulous communication from the coronary arteries. This rare and interesting situation poses a diagnostic and therapeutic dilemma, as well as providing specific management challenges to the surgical team. Here, we discuss important aspects of this rare variant, specifically its morphology, presentation, evaluation and management.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Mittal CM, Mohan B, Kumar R, Garg S, Grover S, Aslam N, Wander GS. A case of tetralogy of Fallot associated with left anterior descending coronary artery to pulmonary artery fistula. Ann Pediatr Cardiol 2012; 4:202-3. [PMID: 21976889 PMCID: PMC3180987 DOI: 10.4103/0974-2069.84673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Presence of coronary to pulmonary artery fistula is generally a feature of pulmonary atresia with ventricular septal defect. We present a rare case of left anterior descending coronary artery to pulmonary artery fistula in a patient of tetralogy of Fallot.
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Affiliation(s)
- Chander Mohan Mittal
- Department of Cardiovascular and Thoracic Surgery, Dayanand Medical College and Hospital, Ludhiana, India
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Garg P, Talwar S, Kothari SS, Rajashekar P, Gulati GS, Anderson RH, Airan B. Management of Pulmonary Arterial Supply Dependent on a Coronary Arterial Fistula in a Patient With Tetralogy of Fallot With Pulmonary Atresia. World J Pediatr Congenit Heart Surg 2012; 3:499-503. [DOI: 10.1177/2150135112450039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this report, we describe the surgical management of a patient with tetralogy of Fallot and pulmonary atresia, in whom a fistula from the anterior interventricular coronary artery was the predominant source of arterial supply to both the lungs.
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Affiliation(s)
- Pankaj Garg
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sundar Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Kapoor A, Walia R, Jain S, Kumar S. A Large Coronary-Pulmonary Artery Fistula in a Cyanotic Patient Leading to Severe Biventricular Dysfunction and Heart Failure. Echocardiography 2011; 28:E207-11. [DOI: 10.1111/j.1540-8175.2011.01494.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sathanandam SK, Loomba RS, Ilbawi MN, Van Bergen AH. Coronary artery-to-pulmonary artery fistula in a case of pulmonary atresia with ventricular septal defect. Pediatr Cardiol 2011; 32:1017-22. [PMID: 21769503 DOI: 10.1007/s00246-011-0043-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/20/2011] [Indexed: 11/30/2022]
Abstract
Pulmonary atresia with ventricular septal defect (PA-VSD) can be associated with varying pulmonary artery connections. The origin of pulmonary blood flow can vary greatly among patients, and some case reports have described the presence of left coronary artery-to-pulmonary artery fistula. Two cases of patients found to have coronary artery-to-pulmonary artery fistula in the settings of PA-VSD are reported.
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Affiliation(s)
- Shyam K Sathanandam
- The Heart Institute for Children, Advocate Hope Children's Hospital, 4440 W 95th Street, Oak Lawn, IL 60453, USA
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Talwar S, Sharma P, Gulati GS, Kothari SS, Choudhary SK. Tetralogy of Fallot with Coronary Artery to Pulmonary Artery Fistula and Unusual Coronary Pattern: Missed Diagnosis. J Card Surg 2009; 24:752-5. [DOI: 10.1111/j.1540-8191.2009.00917.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Sharma
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Gurpreet Singh Gulati
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
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Unifocalization of major aortopulmonary collateral arteries in pulmonary atresia with ventricular septal defect is essential to achieve excellent outcomes irrespective of native pulmonary artery morphology. J Thorac Cardiovasc Surg 2009; 138:1269-75.e1. [PMID: 19846121 DOI: 10.1016/j.jtcvs.2009.08.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 07/02/2009] [Accepted: 08/09/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is a complex lesion with a high rate of natural attrition. We evaluated the outcomes of our strategy of unifocalization in the management of these patients. METHODS From 1989 to 2008, 216 patients entered a pathway aiming for complete repair by unifocalizing major aortopulmonary arteries to a right ventricle-pulmonary artery conduit with ventricular septal defect closure. Where ventricular septation was not possible, definitive repair was considered to include pulmonary artery reconstruction and a right ventricle-pulmonary artery conduit or systemic shunt. Native pulmonary artery morphology was classified into confluent intrapericardial (n = 139), confluent intrapulmonary (n = 51), and nonconfluent intrapulmonary (n = 26). RESULTS A total of 203 patients (85%) had definitive repair at a median age of 2.0 years. There was no statistically significant difference in survival after complete repair among the 3 morphologic pulmonary artery groups (P = .18). A total of 132 patients (56%) had complete repair with ventricular septal defect closure, as a single procedure in 111 patients and a staged procedure in 21 patients. Focalization of major aortopulmonary collateral arteries with proven long-term patency with the right ventricle was associated with a survival benefit compared with 14 patients in whom unifocalization was not possible and who had only systemic shunts. Overall survival was 89% at 3 years after definitive repair. During follow-up, 190 patients required 196 catheter reinterventions and 60 surgical reinterventions. CONCLUSION By using a strategy of unifocalization, intrapericardial pulmonary artery reconstruction, and right ventricle-pulmonary artery conduit, excellent long-term survival can be achieved in this group of patients even in the absence of native intrapericardial pulmonary arteries.
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Eren NK, Nazli C, Ergene AO. A late presentation of tetralogy of Fallot with pulmonary atresia and coronary-pulmonary artery collateral and a congenital aortic stenosis. CONGENIT HEART DIS 2008; 3:213-5. [PMID: 18557886 DOI: 10.1111/j.1747-0803.2008.00194.x] [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] [Indexed: 11/30/2022]
Abstract
We report a 40-year-old man with an unoperated tetralogy of Fallot with pulmonary atresia and congenital aortic valvular stenosis. A well-developed coronary-pulmonary arterial collateral arising from the left main coronary artery was also demonstrated. Although rare cases of tetralogy of Fallot with congenital aortic stenosis has been reported, this is the first particular case demonstrating a triad of these abnormalities.
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Affiliation(s)
- Nihan Kahya Eren
- Cardiology Department, Izmir Ataturk Medical Institude Hospital, Izmir, Turkey.
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38
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Collison SP, Dagar KS, Kaushal SK, Radhakrishanan S, Shrivastava S, Iyer KS. Coronary Artery Fistulas in Pulmonary Atresia and Ventricular Septal Defect. Asian Cardiovasc Thorac Ann 2008; 16:29-32. [DOI: 10.1177/021849230801600108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary atresia with ventricular septal defect is an anomaly with highly variable anatomy. Rarely, a coronary artery-to-pulmonary artery fistula may contribute to pulmonary blood flow. Since 1996, we have treated 4 patients with coronary-pulmonary fistula associated with pulmonary atresia and ventricular septal defect. Two fistulas originated from the left coronary, one from the right coronary, and one from a right-sided solitary coronary system. All terminated in the main pulmonary artery, which was adequate in all cases. The fistulas were managed by direct internal closure. Total intracardiac repair was then accomplished in all patients at the same sitting. There was one death. In children with favorable anatomy, direct closure of the fistula from the pulmonary artery is adequate and allows single-stage intracardiac repair.
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Affiliation(s)
| | | | - Sunil K Kaushal
- Escorts Heart Institute and Research Center, New Delhi, India
| | | | | | - Krishna S Iyer
- Escorts Heart Institute and Research Center, New Delhi, India
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39
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Geyik S, Yavuz K, Keller FS. Unusual Systemic Artery to Pulmonary Artery Malformation Without Evidence of Systemic Disease, Trauma or Surgery. Cardiovasc Intervent Radiol 2006; 29:897-901. [PMID: 16404502 DOI: 10.1007/s00270-004-0289-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Connections between the systemic and pulmonary arterial systems are rare conditions that can be due to either congenital or acquired diseases such as anomalous systemic arterial supply to normal lung, pulmonary sequestration, and systemic supply to pulmonary arteriovenous malformations. Herein, a unique case of systemic artery to pulmonary arterial malformation and its endovascular treatment in a patient with no history of the usual etiologies is reported.
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Affiliation(s)
- Serdar Geyik
- Dotter Interventional Institute, Oregon Health and Sciences University, L342, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA
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40
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Boshoff D, Gewillig M. A review of the options for treatment of major aortopulmonary collateral arteries in the setting of tetralogy of Fallot with pulmonary atresia. Cardiol Young 2006; 16:212-20. [PMID: 16725060 DOI: 10.1017/s1047951106000606] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2005] [Indexed: 11/07/2022]
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Vesel S, Rollings S, Jones A, Callaghan N, Simpson J, Sharland GK. Prenatally diagnosed pulmonary atresia with ventricular septal defect: echocardiography, genetics, associated anomalies and outcome. Heart 2006; 92:1501-5. [PMID: 16547205 PMCID: PMC1861018 DOI: 10.1136/hrt.2005.083295] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the accuracy of prenatal diagnosis, the association with genetic and extracardiac anomalies, and outcome in fetuses with isolated pulmonary atresia with ventricular septal defect (PA-VSD). DESIGN AND SETTING Retrospective study in a tertiary centre for fetal cardiology. PATIENTS AND OUTCOME MEASURES Echocardiographic video recordings of 27 consecutive fetuses with PA-VSD were reviewed for: (1) intracardiac anatomy; (2) presence of confluence and size of the branch pulmonary arteries; (3) source of pulmonary blood supply; and (4) side of the aortic arch. Postmortem and postnatal data were added. Karyotyping was performed in 25 patients and, in 23 of these, fluorescent in situ hybridisation to identify 22q11.2 deletion. RESULTS PA-VSD was correctly diagnosed in 19 of 21 patients (90%) with postnatal or autopsy confirmation of diagnosis. Central pulmonary arteries were correctly identified in 79% (15/19), the source of pulmonary blood supply in 62% (13/21) and major aortopulmonary collateral arteries in 44% (4/9). Aneuploidy was detected in 4 of 25 patients (16%) and 22q11.2 deletion in 6 of 23 patients (26%). Five of 27 patients (19%) had extracardiac anomalies. Eleven pregnancies were interrupted. Eleven of 16 liveborn babies survived. Neonatal survival was 15 of 16 (94%, 95% confidence interval (CI) 70 to 100), one-year survival was 9 of 12 (75%, 95% CI 43 to 95) and two-year survival was 5 of 9 (56%, 95% CI 21 to 86). CONCLUSION PA-VSD can be diagnosed by fetal echocardiography with a high degree of accuracy. However, it can be difficult to determine the morphology of the central pulmonary arteries and to locate the source of pulmonary blood supply. In most liveborn infants, complete surgical repair can be achieved.
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Affiliation(s)
- S Vesel
- University Medical Centre, Department of Paediatrics, Cardiology Unit, Ljubljana, Slovenia
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