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Large isolated major aortopulmonary collateral artery causing dilated left ventricle. Radiol Case Rep 2023; 18:1530-1535. [PMID: 36815146 PMCID: PMC9939544 DOI: 10.1016/j.radcr.2023.01.063] [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] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Isolated major aortopulmonary collateral artery (MAPCA), in the absence of evidence of structural heart disease, is a very rare observation. This anomaly usually appears in preterm newborns. In the majority of babies, isolated MAPCAs cause no symptoms and regress spontaneously after birth and their conservative management is usually sufficient. We report a case of an asymptomatic full-term 5-month-old infant presenting with heart murmur as the only sign during clinical evaluation. Echocardiography revealed a dilated left ventricle, with no pulmonary hypertension. Computed tomography angiogram showed a large MAPCA arising from the descending thoracic aorta and supplying blood to the left lower lobe. The condition was managed successfully by percutaneous obliteration with Amplatzer vascular plugs. Isolated MAPCA is usually a benign anomaly, presenting no clinical finding and requiring no specific treatment. However, in a small minority of infants, this congenital disorder may progress, with detrimental impacts on cardiac structure before clinical symptoms appear. Early intervention may be required to prevent irreversible sequelae.
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2
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Harshith K, Anoop A, Jineesh V. A Rare Cause of Hemoptysis in West Syndrome-Isolated Aortopulmonary Collaterals in Structurally Normal Heart. Indian J Radiol Imaging 2021; 31:745-747. [PMID: 34790328 PMCID: PMC8590566 DOI: 10.1055/s-0041-1735865] [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: 11/28/2022] Open
Abstract
Major aortopulmonary collateral arteries (MAPCAs) are abnormal systemic to pulmonary collateral vessels originating from the persistent segmental arteries. The common conditions concomitant with MAPCA are congenital heart diseases with reduced pulmonary blood flow. Isolated MAPCAs represent occurrence of collaterals in the absence of underlying heart disease, which commonly present as heart failure, recurrent respiratory tract infection, and pulmonary artery hypertension. Here, we describe a case of West syndrome presenting with hemoptysis due to isolated MAPCAs and its causal relation and management.
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Affiliation(s)
- Kramadhari Harshith
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ayyappan Anoop
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Valakkada Jineesh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Hayek C, Cayabyab R, Thompson I, Ebrahimi M, Siassi B, Ramanathan R. Systemic to Pulmonary Collaterals in Extremely Low Birth Weight Infants: Incidence, Clinical Significance, and Hemodynamic Features. Am J Perinatol 2021; 38:145-149. [PMID: 31430815 DOI: 10.1055/s-0039-1695012] [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: 10/26/2022]
Abstract
OBJECTIVE This study aimed to determine the incidence of systemic to pulmonary collaterals (SPCs) in extremely low birth weight infants and to assess its clinical and hemodynamic significance beyond the neonatal period. STUDY DESIGN Retrospective cohort study was conducted on 61 infants with echocardiogram performed at the time of discharge to determine the presence of SPC and to measure the right and left ventricular outputs and left atrium to aortic ratio. We compared two groups: small or no SPC (Group 1) to moderate or large SPC (Group 2) on demographics, clinical outcomes, and echocardiographic parameters. RESULTS Sixty-one infants were included. The incidence of SPC was 57%; 21% of infants had moderate or large shunts and 31% had small SPC. Demographics, clinical outcomes, and echocardiographic parameters were not significantly different between small or no SPC and moderate to large SPC. CONCLUSION More than half of the infants had SPC. The size of the shunt did not affect the clinical outcomes nor the echocardiographic parameters measured. All infants had cardiac output above the normative mean.
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Affiliation(s)
- Cynthia Hayek
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California.,Division of Neonatal Medicine, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rowena Cayabyab
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California
| | - Ima Thompson
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California.,Division of Neonatal Medicine, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mahmood Ebrahimi
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California
| | - Bijan Siassi
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, California.,Division of Neonatal Medicine, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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4
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Gower WA, Birnkrant DJ, Black JB, Noah TL. Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing. Pediatr Pulmonol 2019; 54:1655-1662. [PMID: 31402599 DOI: 10.1002/ppul.24461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 12/31/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article, we highlight the past year's publications in the topic areas of rare lung diseases, respiratory complications of neuromuscular disorders, and diagnostic testing, as well as selected literature in these areas from other journals.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Claretti M, Pradelli D, Borgonovo S, Boz E, Bussadori CM. Clinical, echocardiographic and advanced imaging characteristics of 13 dogs with systemic-to-pulmonary arteriovenous fistulas. J Vet Cardiol 2018; 20:415-424. [PMID: 30526957 DOI: 10.1016/j.jvc.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 09/10/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective is to describe the clinical, radiographic, echocardiographic and angiographic findings in dogs with systemic-to-pulmonary arteriovenous fistula (SPAVF). ANIMALS Thirteen medical records of client-owned dogs with a diagnosis of SPAVF were reviewed/analysed. METHODS This is a retrospective study of case records. Thoracic radiography, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), three-dimensional TEE, intracardiac echocardiography, fluoroscopy-guided or computed tomography (CT) angiography were carried out. RESULTS Based on the TTE, SPAVF was identified in seven of the included dogs. In eight cases, TEE and angiography were both performed and confirmed the diagnosis. Computed tomography angiography was performed in three dogs. A case was diagnosed by TEE alone, another one by three-dimensional TEE and the latter by intracardiac echocardiography. CONCLUSIONS Transthoracic echocardiography identified seven cases of SPAVF, while definitive diagnosis in the remaining dogs required selective angiography or computed tomography angiography.
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Affiliation(s)
- M Claretti
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - D Pradelli
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy.
| | - S Borgonovo
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - E Boz
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - C M Bussadori
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
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Goel D, Gupta P, Cooper S, Klimek J. A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance. Acta Paediatr 2018; 107:1867-1878. [PMID: 29869341 DOI: 10.1111/apa.14434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/18/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
AIM Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point-of-care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. METHODS Medline, PubMed, EMBASE and the Internet were searched up to November 2017 for articles in English which included SPCs in preterm infants without CHD. This comprised title, abstract and full-text screening of relevant data. RESULTS A total of 10 studies which included case reports, retrospective observational studies and one small prospective cohort study were identified and analysed in detail. The studies had varying focus such as variable incidence, clinical presentation, association with chronic lung disease, pathophysiology and clinical importance of SPCs. SPCs were overall thought to be prevalent, underdiagnosed and of clinical significance in preterm infants. CONCLUSION Systemic to pulmonary collaterals are a potential left-to-right shunt in preterm infants and may contribute to worsening chronic lung disease (CLD) or heart failure. They should be carefully looked for when performing bedside cardiac ultrasound as the findings can mimic those seen in patent ductus arteriosus (PDA).
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Affiliation(s)
- Dimple Goel
- Westmead Hospital; Sydney Australia
- University of Sydney; Sydney Australia
- Children's Hospital at Westmead; Sydney Australia
| | - Pankaj Gupta
- Children's Hospital at Westmead; Sydney Australia
| | | | - Jan Klimek
- Westmead Hospital; Sydney Australia
- University of Sydney; Sydney Australia
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7
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Zaidi SJ, Schweig L, Patel D, Javois A, Akhter J. A novel approach to the diagnosis and treatment of hemoptysis in infants: A case series. Pediatr Pulmonol 2018; 53:1504-1509. [PMID: 30226294 PMCID: PMC7168067 DOI: 10.1002/ppul.24160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/19/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hemoptysis in children is an uncommon presenting symptom but can be life-threatening if massive. Cardiac catheterization and coil embolization of aorto-pulmonary collateral vessels (APCs) is uncommon in pediatric hemoptysis patients without congenital heart disease. METHODS We present a series of seven infants (≤12 months of age) with hemoptysis, all of whom underwent cardiac catheterization to look for and intervene upon APCs, if found. Only those patients who underwent both bronchoscopy as well as cardiac catheterization from January 1995 to January 2015 were included in this retrospective review. RESULTS Seven patients met inclusion criteria, and three had a history of recurrent hemoptysis. The mean age was 3 months. Four had evidence of bleeding on bronchoscopy. All seven had respiratory distress which necessitated ICU admission; five required mechanical ventilation. Cardiac catheterization showed significant APCs (>2 mm) in six of the seven studied patients, all of which were coil embolized. One patient had no significant APCs and therefore, no embolization. All patients had complete resolution with no recurrences during the 10-20-year outpatient follow-up period. Chest CT scans were not helpful in delineating the site or etiology of bleeding in any patient. CONCLUSIONS APCs should be considered as a differential diagnosis for pulmonary hemorrhage in infants after more common causes have been ruled out.
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Affiliation(s)
- S Javed Zaidi
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Lorene Schweig
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Dhaval Patel
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Alexander Javois
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Javeed Akhter
- Department of Pediatric Pulmonology, Advocate Children's Hospital, Oak Lawn, Illinois
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8
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Diagnostic Approach to Pulmonary Hypertension in Premature Neonates. CHILDREN-BASEL 2017; 4:children4090075. [PMID: 28837121 PMCID: PMC5615265 DOI: 10.3390/children4090075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/01/2017] [Accepted: 08/09/2017] [Indexed: 02/01/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease in premature infants following respiratory distress at birth. With increasing survival of extremely low birth weight infants, alveolar simplification is the defining lung characteristic of infants with BPD, and along with pulmonary hypertension, increasingly contributes to both respiratory morbidity and mortality in these infants. Growth restricted infants, infants born to mothers with oligohydramnios or following prolonged preterm rupture of membranes are at particular risk for early onset pulmonary hypertension. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy, results in developmental lung arrest leading to BPD with pulmonary hypertension (PH). Early recognition of PH in infants with risk factors is important for optimal management of these infants. Screening tools for early diagnosis of PH are evolving; however, echocardiography is the mainstay for non-invasive diagnosis of PH in infants. Cardiac computed tomography (CT) and magnetic resonance are being used as imaging modalities, however their role in improving outcomes in these patients is uncertain. Follow-up of infants at risk for PH will help not only in early diagnosis, but also in appropriate management of these infants. Aggressive management of lung disease, avoidance of hypoxemic episodes, and optimal nutrition determine the progression of PH, as epigenetic factors may have significant effects, particularly in growth-restricted infants. Infants with diagnosis of PH are managed with pulmonary vasodilators and those resistant to therapy need to be worked up for the presence of cardio-vascular anomalies. The management of infants and toddlers with PH, especially following premature birth is an emerging field. Nonetheless, combination therapies in a multi-disciplinary setting improves outcomes for these infants.
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Isolated Major Aortopulmonary Collateral as the Sole Pulmonary Blood Supply to an Entire Lung Segment. Case Rep Cardiol 2017; 2017:5218321. [PMID: 28785488 PMCID: PMC5529621 DOI: 10.1155/2017/5218321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022] Open
Abstract
Congenital systemic-to-pulmonary collateral arteries or major aortopulmonary collaterals are associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Though it is usually associated with congenital heart diseases, there is an increased incidence of isolated acquired aortopulmonary collaterals in premature infants with chronic lung disease. Interestingly, isolated congenital aortopulmonary collaterals can occur without any lung disease, which may cause congestive heart failure and require closure. We present a neonate with an echocardiogram that showed only left-sided heart dilation. Further workup with a CT angiogram demonstrated an anomalous systemic artery from the descending thoracic aorta supplying the left lower lobe. He eventually developed heart failure symptoms and was taken to the catheterization laboratory for closure of the collateral. However, with the collateral being the only source of blood flow to the entire left lower lobe, he required surgical unifocalization. Isolated aortopulmonary collaterals without any other congenital heart disease or lung disease are rare. Our patient is the first reported case to have an isolated aortopulmonary collateral being the sole pulmonary blood supply to an entire lung segment. Due to its rarity, there is still much to learn about the origin and development of these collaterals that possibly developed prenatally.
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10
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Awasthy N, Garg R, Khurana P, Radhakrishnan S. Use of ADO II device in a large aorto-pulmonary collateral -an interesting case. Indian Heart J 2015; 67:462-4. [PMID: 26432736 DOI: 10.1016/j.ihj.2015.06.008] [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: 02/22/2015] [Revised: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022] Open
Abstract
A 11month old girl was diagnosed to have a large aorto pulmonary collateral during evaluation for respiratory distress and seizures. Echocardiographic evaluation showed a large collateral from the descending aorta to left lung with ventricular dysfunction (left ventricular ejection fraction of 40%). This was confirmed on computed tomography angiogram (CT) scan. The collateral was closed with Amplatzer Ductal Occluder II device under fluoroscopic guidance. To the best of our knowledge, this is the first reported case of large aorto-pulmonary collateral closed successfully with an Amplatzer Ductal Occluder II device.
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Affiliation(s)
- N Awasthy
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India.
| | - R Garg
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - P Khurana
- Department of Radiology, Fortis Escorts Heart Institute, New Delhi, India
| | - S Radhakrishnan
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
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11
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Pelizzo G, Calcaterra V, Mannarino S, Moramarco LP, Leati G, Quaretti P. Aortopulmonary collateral artery in prenatal exposure to carbamazepine - endovascular therapy and technical considerations: a case report. J Med Case Rep 2015; 9:183. [PMID: 26311236 PMCID: PMC4551368 DOI: 10.1186/s13256-015-0645-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aortopulmonary collateral arteries are an uncommon variant of alternative blood supply in cases of complex congenital heart disease. Although surgery may still be the classic approach for this condition, mini-invasive endovascular occlusion has been recently attempted as an alternative less traumatic procedure. Children born to women with epilepsy are at increased risk of congenital malformations. CASE PRESENTATION A cardiovascular malformation in a 6-year-old white boy with prenatal exposure to carbamazepine is described. At birth, he underwent atrial-ventricular septal defects repair. At 6 years of age, he was diagnosed to have an aberrant aortopulmonary artery from the descending aorta. He presented with recurrent respiratory infections and no cardiovascular signs, but there was associated right upper lobe hyperperfusion. Collateral percutaneous plug embolization was performed because of risk for cardiorespiratory infections, pulmonary hypertension and atrioventricular dilatation. The post-releasing control showed a complete occlusion of the aberrant artery. A chest radiogram and computed tomography showed normalization of vascular pattern of his right lung at 9-months follow-up. No complications and no respiratory infections in the first follow-up year were observed. A good growth gain was obtained. CONCLUSIONS Plug embolization in an aortopulmonary collateral artery is an interesting alternative to surgery and is suitable for children with minor congenital heart disease and without severe respiratory and/or cardiovascular symptoms. Management and long-term pediatric multidisciplinary follow-up is recommended. Prenatal exposure to carbamazepine could be considered in the pathogenesis and diagnosis of the malformation.
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Affiliation(s)
- Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia, P.le Golgi n.2, 27100, Pavia, Italy.
| | - Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .,Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | - Savina Mannarino
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Giovanni Leati
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
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del Cerro MJ, Sabaté Rotés A, Cartón A, Deiros L, Bret M, Cordeiro M, Verdú C, Barrios MI, Albajara L, Gutierrez-Larraya F. Pulmonary hypertension in bronchopulmonary dysplasia: clinical findings, cardiovascular anomalies and outcomes. Pediatr Pulmonol 2014; 49:49-59. [PMID: 23788443 DOI: 10.1002/ppul.22797] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/10/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PH) worsens the prognosis of bronchopulmonary dysplasia (BPD). The following items have not been fully established for PH in BPD: clinical characterization, incidence of cardiovascular anomalies (CVAs), response to PH treatment, and outcome. STUDY DESIGN A review of clinical records, computed tomography (CT) images and catheterization data of 36 patients with PH-BPD referred to our PH Unit (March 2006 to December 2011) was performed. Twenty-nine patients without major congenital heart defects and with complete follow-up data were included. RESULTS The diagnosis of PH was made at a median age of 4.5 months (IQR 2.4-7.8), with an echocardiography estimated median right ventricular pressure/systemic pressure ratio of 70% (IQR 60-80%). CT scanning was performed in 21 patients and catheterization in 14 patients. CVAs were found in 19 patients (65.5%): aortopulmonary collaterals (n = 9), pulmonary vein stenosis (n = 7), ASD (n = 4), and PDA (n = 9). Hemodynamic data: PVRI 4.3 UW m(2) (2.7-7); PVRI/SVRI 0.44 (0.32-0.8); and transpulmonary gradient 28 mmHg (19-40). At a median follow-up of 35 months (IQR 21-91), 6 patients had undergone shunts closure, 22 received specific PH drugs, 3 spontaneously improved of their PH, and 8 (26%) had died. CONCLUSION PH in BPD is not always a transient condition; it can be diagnosed at later stages and can have a protracted course. The incidence of associated CVAs is high. Prompt diagnosis, detection, and treatment of CVAs, and specific drug therapy can improve the outcome in these patients, although the mortality rate remains high.
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Patra S, Srinivas SK, Agrawal N, Jayaranganath M. Isolated major aortopulmonary collateral artery in an infant presenting with recurrent lower respiratory tract infection. BMJ Case Rep 2013; 2013:bcr-2013-200421. [PMID: 24334468 DOI: 10.1136/bcr-2013-200421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Soumya Patra
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka, India
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14
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Abstract
A 7-month-old girl was diagnosed to have large aortopulmonary collateral during evaluation for congestive heart failure. There was no other evidence of cardiopulmonary disease. The collateral was successfully closed with multiple coils delivered sequentially. We describe the issues associated during closure of the aortopulmonary collateral in this case. To the best of our knowledge, this is the first reported case of large aortopulmonary collateral presenting with heart failure in an otherwise structurally normal heart that was closed successfully with multiple coils delivered sequentially.
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Affiliation(s)
- Sumanta S Padhi
- Department of Cardiology, Innova Children's Heart Hospital, Secunderabad, India
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15
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Yu CH, Chen MR. Clinical investigation of systemic-pulmonary collateral arteries. Pediatr Cardiol 2008; 29:334-8. [PMID: 17876652 DOI: 10.1007/s00246-007-9086-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 06/14/2007] [Accepted: 06/26/2007] [Indexed: 11/24/2022]
Abstract
Systemic-pulmonary collateral arteries are known to develop in children with congenital heart disease, chronic pulmonary infection, and prematurity. At present, these abnormal connections between the systemic and the pulmonary systems are thought to develop from the vascular plexus, which normally gives rise to the pulmonary and bronchial vasculature. The objective of this study was to review our patients with systemic-pulmonary collateral arteries and evaluate possible risk factors. The records of patients with systemic-pulmonary collateral arteries seen at our hospital over a 4-year period were retrospectively reviewed. They were grouped into one of the following five categories: premature, heart disease, pulmonary disease, healthy, and others. Age, gender, weight, and the results of echocardiography were recorded, as was the condition on follow-up. We reviewed the records of 284 patients: 130 premature, 13 heart disease, 30 pulmonary disease, 92 healthy, and 19 others. Over the same period, 3314 healthy 1-month-old infants had undergone echocardiography for health screening. Among the 92 healthy children with systemic-pulmonary collateral arteries, 52 were diagnosed at the health-screening exam. Therefore, we estimate the incidence of unsuspected systemic-pulmonary collateral arteries in healthy 1-month-old infants to be 1.57% (52/3314). We conclude that systemic-pulmonary collateral arteries may be present normally after birth and then gradually disappear. However, if there are certain predisposing factors, they may persist in order to augment pulmonary flow.
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Affiliation(s)
- Chang-Hsien Yu
- Division of Pediatric Cardiology, Department of Pediatrics, Mackay Memorial Hospital, 92, Sec 2, Chun-San N. Road, Taipei, 104, Taiwan.
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16
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Evans WN, Acherman RJ, Collazos JC, Restrepo H, Mayman GA, Rothman A. Expedited oxygen wean after coil embolization of systemic-to-pulmonary collaterals in a premature infant with bronchopulmonary dysplasia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:695-7. [PMID: 17460015 DOI: 10.7863/jum.2007.26.5.695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- William N Evans
- Children's Heart Center, 3006 S Maryland Pkwy, Suite 690, Las Vegas, NV 89109, USA.
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17
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Galambos C, deMello DE. Molecular mechanisms of pulmonary vascular development. Pediatr Dev Pathol 2007; 10:1-17. [PMID: 17378630 DOI: 10.2350/06-06-0122.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/04/2006] [Indexed: 11/20/2022]
Abstract
In this era of rapidly advancing vascular biology research, a vast array of growth factors and signaling molecules have been recognized as key players in the mechanisms that control lung vascular development. In the lung, vascular development is a complex, multistep process that includes specialization of primitive cells to vascular progenitors; formation of primitive vascular networks; remodeling with local regression and branching; specialization toward arteries, veins, and lymphatics; stabilization of vessels by matrix production and recruitment of supporting cells; and maintenance of the vascular structure. This complex, highly organized process requires exquisite orchestration of the regulatory activity of multiple molecules in a specific temporospatial order. Most of these molecules are members of 3 major growth factor families that have been recently identified. They are the vascular endothelial growth factor, angiopoietin, and ephrin families. Understanding the functional reach of several members of these growth factor families is integral to an appreciation of the etiology and pathogenesis of developmental lung vascular disorders affecting newborns. This review summarizes recent advances in the molecular bases of lung vascular development and some of the pulmonary diseases resulting from aberrant vascular growth, including bronchopulmonary dysplasia, alveolar capillary dysplasia, congenital cystic pulmonary disorders, congenital pulmonary hemangiomatosis, and lung hypoplasia.
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Affiliation(s)
- Csaba Galambos
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh, PA 15213, USA.
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Suda K, Matsumura M, Sano A, Yoshimura S, Ishii T. Hemoptysis from collateral arteries 12 years after a fontan-type operation. Ann Thorac Surg 2005; 79:e7-8. [PMID: 15620904 DOI: 10.1016/j.athoracsur.2004.08.026] [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] [Accepted: 08/10/2004] [Indexed: 10/26/2022]
Abstract
A 20-year-old patient who had a single ventricle and pulmonary stenosis presented with recurrent hemoptysis 12 years after a Fontan-type operation. He was referred to us because of unsuccessful treatment with a tentative diagnosis of lung tuberculosis for 3 months. He had been relatively well for the prior 12 years, although he had attacks of paroxysmal supraventricular tachycardia and had underwent successful catheter ablation 3 years ago. Aortography revealed multiple collateral arteries as a cause of hemoptysis and coil embolization of these collateral arteries successfully stopped the hemoptysis. This case illustrates that collateral arteries may stay open or develop, and these collateral arteries can become a source of hemoptysis long after a Fontan-type operation.
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Affiliation(s)
- Kenji Suda
- Division of Pediatric Cardiology, Department of Pediatrics, Tenri Hospital, Tenri, Japan.
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20
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Smith J. An update on bronchopulmonary dysplasia: is there a relationship to the development of childhood asthma? Med Hypotheses 2004; 61:495-502. [PMID: 13679019 DOI: 10.1016/s0306-9877(03)00204-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There appears to be some interesting commonalities between asthma and BPD. The prevalence of both conditions is on the rise, both conditions tend to cluster in families, and they share wheezing phenotypes, i.e., mild-moderate reversible airway obstruction and a similar degree of response to pharmacological provocation. Furthermore, significant overlap exists with regard to the presence of elevated concentrations of airway inflammatory mediators concurrent with reduced levels of anti-inflammatory activity, in serum and BAL fluid, as well as histological evidence for airway 'remodelling'. Both BPD and asthma are characterized by increased smooth muscle contraction, and in asthma, the smooth muscle may be involved in the primary development of the asthmatic phenotype. Since wheezing is a common finding among children with BPD, an interesting question is whether BPD is a phenotypic variant of asthma?
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Affiliation(s)
- J Smith
- Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
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Sim JY, Alejos JC, Moore JW. Techniques and applications of transcatheter embolization procedures in pediatric cardiology. J Interv Cardiol 2003; 16:425-48. [PMID: 14603802 DOI: 10.1046/j.1540-8183.2003.01009.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transcatheter embolization of congenital or acquired superfluous vascular structure has become routine procedures performed by interventional pediatric cardiologists. Embolization procedure is often part of a collaborative effort with cardiac surgeons to palliate complex congenital heart defect, such as in embolizing aortopulmonary collateral arteries in patient with single ventricle physiology. In other cases, the procedure is the definitive treatment as in embolizing coronary artery fistula. Pediatric cardiologists performing embolization procedures should be familiar with available technologies as well as understand the underlying cardiac anatomy and pathophysiology. This article provides a comprehensive review of presently available embolization agents and technologies. Some of the technologies are used only by interventional radiologists but may be useful to pediatric cardiologists. Specific clinical applications in pediatric cardiology are also discussed with summary of current literature. With continue advancement in transcatheter technology and operator expertise, all unwanted vascular communication should be amenable to transcatheter embolization.
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Affiliation(s)
- James Y Sim
- Division of Pediatric Cardiology, Mattel Children's Hospital, UCLA, David Geffen School of Medicine, Los Angeles, California, 90095-1743, USA
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Abstract
Radiology in the evaluation of congenital heart disease has changed over the years but still has an important role to play. Although we can rarely make the definitive diagnosis of the intracardiac abnormalities, we can direct the clinicians' attention when cardiac disease is unsuspected and we can assist in the evaluation of complications of the disease or its treatment.
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Affiliation(s)
- B J Wolfson
- Department of Radiologic Sciences, MCP-Hahnemann School of Medicine, Philadelphia, Pennsylvania, USA
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