Pulmonary Collateral Arteries Research Articles

Single-center 10-year retrospective analysis of Amplatzer Vascular Plug 4 embolization for pulmonary arteriovenous malformations with feeding arteries of

To evaluate the efficacy and safety of Amplatzer Vascular Plug 4 (AVP4) embolization in pulmonary arteriovenous malformations (PAVMs) with small- to medium-sized feeding arteries (<6 mm) and to identify factors affecting persistence and the main persistence patterns after embolization. Between June 2013 and February 2023, we retrospectively reviewed 100 patients with 217 treated PAVMs. We included PAVMs with feeding arteries <6 mm, treated with AVP4 embolization, and followed adequately with computed tomography (CT). Technical success was defined as flow cessation observed on angiography. Persistence was defined as less than a 70% reduction of the venous sac on CT. We evaluated adverse events for each embolization session. Patterns of persistence were assessed using follow-up angiography. Univariate and multivariate analyses were performed to evaluate factors affecting persistence based on the 70% CT criteria. Fifty-one patients (48 women, 3 men; mean age: 50.8 years; age range: 16-71 years) with 103 PAVMs met the inclusion criteria. The technical success rate was 100%. The persistence rate was 9.7% (10/103), and the overall adverse event rate was 2.9% (3/103) during a mean follow-up of 556 days (range: 181-3,542 days). In two cases, the persistence pattern confirmed by follow-up angiography involved reperfusion via adjacent pulmonary artery collaterals. The location of embolization relative to the last normal branch of the pulmonary artery was the only factor substantially affecting persistence. Embolization with AVP4 appears to be safe and effective for small- to medium-sized PAVMs. The location of the embolization relative to the last normal branch of the pulmonary artery was found to be the main determinant of persistence. Given the increasing demand for the treatment of small PAVMs, AVP4 embolization could be considered a viable and effective option for managing PAVMs with feeding arteries <6 mm.

OUTCOMES OF PALLIATIVE RIGHT VENTRICLE TO PULMONARY ARTERY CONNECTION FOR TETRALOGY OF FALLOT WITH PULMONARY ATRESIA AND MAPCAS

<h3>BACKGROUND</h3> Tetralogy of Fallot with pulmonary atresia with major aorto pulmonary artery collaterals (TOF-PA MAPCAS) is a rare and complex cyanotic congenital heart malformation with a high incidence of early mortality and morbidity. Different surgical interventions have been described including construction of a systemic to pulmonary artery shunt (Modified Blalock-Taussig shunt or central shunt) and unifocalization, however the perioperative mortality remains significant due to the high incidence of thrombosis, obstruction, and pulmonary artery (PA) distortion. Another alternative is a palliative right ventricle to pulmonary artery connection (RVPAC) to bring antegrade flow to diminutive PAs. The objective of our study was to evaluate the impact of RVPAC on mortality, survival, morbidity, PA growth and eligibility for biventricular repair. We believe that the RVPAC approach allows for better PA growth and obviates the need for a conduit at the time of complete repair. <h3>METHODS AND RESULTS</h3> We performed a retrospective single-institution study from January 2016 to March 2021 that included 15 consecutive patients diagnosed with TOF-PA MAPCAS who underwent an RVPAC at CHU Sainte-Justine as their initial palliation. Median age at palliation and complete repair was 18 (4 -100) and 309 (96 – 1044) days respectively. Mortality after a RVPAC was 0 % with a median hospital length of stay of 14,5 days (6 - 55), while the late interstage mortality rate was 0 %. Overall survival was 100 %. 9 patients (60%) had a biventricular repair, and 6 patients (40%) are awaiting repair. RVPAC allowed significant growth of the native pulmonary arteries with a mean Nakata index at CT scan of 70 ± 48,04 mm2/m2 before the RVPAC and 251 ± 121,05 mm2/m2 after (P = 0.001). 4 patients (44%) required reinterventions after completed repair by catheterization for stenotic pulmonary artery branches, while no patients required a late reoperation. 8 patients (53,33%) had embolization of collaterals and none required unifocalization. <h3>CONCLUSION</h3> This reproducible and safe technique allows for excellent growth of the PA tree. Biventricular repair was possible in most cases without the use of a conduit or unifocalization of collaterals. This technique appears to be suitable for any type of TOF-PA MAPCAS with confluent native branch pulmonary arteries.

Homograft durability after correction of pulmonary atresia and ventricular septal defect with or without systemic pulmonary collateral arteries

BackgroundPulmonary atresia and ventricular septal defect (PA-VSD), with or without systemic pulmonary collateral arteries (SPCAs), represents a complex anatomic and surgical spectrum of congenital heart disease. Currently, there is limited evidence on homograft durability after complete correction, which potentially could be affected by anatomic differences in pulmonary vasculature. MethodsThis retrospective single-center study included all 69 consecutive PA-VSD patients (46 with SPCAs, 23 without SPCAs) operated on between 1978 and 2018. The primary interest was in homograft durability after complete repair. Longitudinal echocardiographic homograft function and right ventricular systolic pressure were analyzed with linear mixed-effects models. ResultsThe median duration of follow-up was 20 years. Of the 46 patients with SPCAs, 37 (80.4%) underwent biventricular correction at a median age of 2.7 years (interquartile range [IQR], 1.8-6.3 years). Two patients are currently awaiting unifocalization and correction. All 23 patients without SPCAs underwent successful complete correction at a median age of 1.6 years (IQR, 1.1-3.6 years). Freedom from any reintervention after 20 years was 15%. When a homograft was used during correction, freedom from homograft replacement after 20 years was comparable in the 2 groups (P = .925), at 32 ± 11% in the SPCA group and 32 ± 13% in the non-SPCA group. Indications for homograft replacement were isolated stenosis (n = 7; 46.7%), isolated regurgitation (n = 3; 20.0%), and mixed stenosis and regurgitation (n = 5; 33.3%) in the SPCA group and isolated stenosis (n = 8; 88.9%) and stenosis and regurgitation (n = 1; 11.1%) in the non-SPCA group. Peak homograft gradient was significantly (P = .0003) higher in patients without SPCA, with a comparable rate of progression in the 2 groups. However, the prevalence of severe pulmonary regurgitation (PR) was higher in patients with SPCAs, estimated at 35% at 10 years, compared with 15% in patients without SPCAs. ConclusionsHomografts used for right ventricular outflow tract reconstruction in patients with PA-VSD, either with or without SPCAs, have similar limited durability. Repeated reintervention is common, and careful follow-up with attention to severe PR is warranted.

Rehabilitation of Pulmonary Arteries in Pulmonary Atresia, VSD and Mapcas

Patients with pulmonary atresia, Ventricular septal defect (VSD), and Major Aorto Pulmonary Collateral Arteries have a lung circulation depending primarily from perfusion by collateral arteries. A large proportion of them will have central pulmonary vessels connected to a variable proportion of segmental pulmonary vessels. A strategy of rehabilitation of central pulmonary vessels consist in the realization of shunts and conduits between the aorta or the right ventricle and these central vessels in order to obtain a dilatation of these vessels to assist the reconstruction of a pulmonary vascularization. Repetitive patch reconstruction of the central pulmonary vessels or even their replacement are often necessary. Additional procedural steps may be needed at the time of the repair to reconnect to the central pulmonary circulation large intrapulmonary vessels dependent of collateral flow.

Determination of the Frequency of Right and Left Internal Mammary Artery Embolization in Single Ventricle Patients: A Two-Center Study.

Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to evaluate the frequency and implications of internal mammary artery (IMA) embolization in the single ventricle (SV) population. A retrospective chart review was performed of SV patients who underwent cardiac catheterization before and after Fontan procedure between February 2007 and 2017. Data were collected from two tertiary care centers in the Midwest. Of the 304 SV patients, 62 (20.4%) underwent embolization of one or more IMAs, whereas 242 (79.6%) did not. The rate of embolization of IMA was 40.5% in one center and 14.5% in the second center. Among patients who received IMA embolization, left internal mammary artery (LIMA) embolization was seen in 6 (9.7%) patients. Majority of patients underwent either right internal mammary artery (RIMA) embolization (n = 25; 40.3%) or RIMA and LIMA embolization (n = 27; 43.5%). IMA embolization in SV patients is common. Embolizing IMAs early in life will likely eliminate a valuable graft option for coronary artery bypass grafting should it be required in the future care of these patients. Multi-center, prospective, nation-wide studies are warranted to examinecoronary artery disease in the SV population and true frequency of IMA embolization. Delineation of which IMAs were embolized is a necessary in surgical and cardiac intervention national data, such as Society of Thoracic Surgeons (STS) database. All measures should be taken to preserve IMAs patency, if deemed feasible and safe.

Routine Cardiac Catheterization Prior to Fontan Operation: Is It a Necessity?

Prior to the Fontan procedure, patients with single ventricle physiology with Glenn shunt are typically referred for cardiac catheterization to assess hemodynamics and potentially provide interventional measures. Currently, echocardiography provides detailed information which together with other non-invasive imaging such as CT scan and MRI may obviate the need for routine cardiac catheterization prior to the Fontan procedure. In this study, we examine the findings in cardiac catheterization in this population to determine: (a) the accuracy of echocardiography in providing adequate information prior to the Fontan procedure, particularly in identifying those in need of per-catheter intervention, and (b) the percentage of patients requiring interventional procedures during cardiac catheterization. We performed a retrospective chart review of echocardiographic and cardiac catheterization data for patients who underwent pre-Fontan cardiac catheterization at our center in the period from 02/01/2008 to 02/28/2017. We aimed to re-examine the necessity of routine cardiac catheterization in all single ventricle patients. This was performed through examining pre-catheterization echocardiography reports and comparing them to findings of the subsequent cardiac catheterization reports. Echocardiography reports were evaluated for accuracy in identifying significant anatomical or hemodynamic findings, which may impact success of Fontan procedure as well as the ability of echocardiography to predict findings important to know prior to the Fontan procedure. In this cohort of 40 children, 3 patients were found to have significant hemodynamic findings through cardiac catheterization which were not previously known by echocardiography. In addition, 28 out of 40 patients (70%) required interventional procedures to address significant abnormalities (systemic to pulmonary arterial collaterals, pulmonary artery stenosis, aortic arch stenosis, etc.). All cases of aortic arch stenosis were detected by echocardiography, however, all patients who required systemic to pulmonary arterial or left SVC embolization were not detected by echocardiography. Furthermore, echocardiography did not detect the need for branch pulmonary artery stenosis in 50% of cases. Cardiac catheterization appears to be an essential part of patient assessment prior to Fontan completion in patients with single ventricle physiology. This current practice may change in the future if a non-invasive screening tool is found to have high positive and negative predictive values in identifying the subset of patients who require potential intervention in pre-Fontan cardiac catheterization.

Durable Benefit of Particle Occlusion of Systemic to Pulmonary Collaterals in Select Patients After Superior Cavopulmonary Connection.

Systemic to pulmonary arterial collaterals (SPC) are commonly found in patients undergoing staged operative palliation for single ventricle heart disease. Occlusion of SPC as part of pre-Fontan catheterization has been shown to improve hemodynamics acutely. Anecdotally, the effect of this intervention appears to be transient, and to our knowledge there is no data supporting its durability in these patients. Between 1/1/2016 and 5/1/2017, 24 children underwent Glenn operations at our institution. Of these, 3 patients had signs and symptoms deteriorating clinical status suggestive of volume overload in the period between their Glenn operation and Fontan completion, prompting heart catheterization. SPC were occluded with a combination of polyvinyl alcohol embolization particles, and in some cases coils or vascular plugs. Clinical course and data from echocardiograms and serial catheterizations are presented. SPC occlusion was performed over 6 procedures in 3 subjects with technical success in each case. Hemodynamic evaluation was repeated in 2/3 patients with improvement in collateral burden and hemodynamics in both cases. One patient previously thought to be unsuitable for Fontan completion improved sufficiently to undergo late Fontan completion, which was ultimately successful. In all patients, there was improvement in clinical status. In patients with severe SPC collateral durable benefit was seen, suggesting that in certain cases intervention on SPC remote from Fontan completion may have clinical benefit.

Clinical study of incidence of significant major aorto pulmonary collateral arteries in patients of TOF and its correlation with pulmonary artery anatomy

Introduction: Tetralogy of Fallot (TOF) with hypoplastic pulmonary arteries and major aorto pulmonary collateral arteries (MAPCAs) is the most extreme variant of TOF. MAPCAs are frequently present and the main source of pulmonary flow in patients with TOF with hypoplastic arteries in the absence of patent ductus arteriosus (PDA). Objective: To study the incidence of significant MAPCAs in patients of TOF and its correlation with pulmonary artery anatomy. Patients and Methods: This prospective study has been conducted on a cohort of 100 consecutive TOF patients of 0-15 years of age. All the clinical and demographic parameters were collected. Two dimensional ECHO and CT pulmonary angiography was performed to define PA anatomy and MAPCAs morphology. Cardiac catheterization was performed as and when required. All the patients selected for the study, had PDA absent. Results: A total 56 patients had MAPCAs. Hypoplastic LPA was observed in 31 patients, of which 27 (87%) had significant MAPCAs, and hypoplastic RPA was found in 46 patients with 40 (87%) having significant MAPCAs. The mean diameter found was 5.78 ± 3.52 mm. Direct arborization pattern was observed in 45 patients. The mean oxygen saturation was 76.72 ± 7. Conclusion: Patients with TOF and hypoplastic pulmonary arteries had significant incidence of MAPCAs. The majority had MAPCAs with direct origin from descending aorta and larger diameter. A statistically significant difference was observed in the oxygen saturation levels in patients with and without MAPCAs.

Prevalence of Coronary Artery to Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension: Retrospective Analysis from a Single Center.

Our aim was to determine the prevalence of coronary artery - pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by retrospectively evaluating coronary angiograms of eligible consecutive patients who had undergone pulmonary endarterectomy (PEA). We also aimed to evaluate predictors and potential clinical associates of these collaterals. Coronary angiograms of 83 consecutive CTEPH patients who had undergone coronary angiography before PEA operation between January 1, 2012 and June 1, 2015 were retrospectively evaluated for presence of coronary artery - pulmonary artery collaterals. Medical records of all patients were also retrospectively reviewed for demographic information, cardiovascular risk factors, preoperative right heart catheterization reports, operation reports, and follow-up data. Data of CTEPH patients with coronary artery - pulmonary artery collaterals were compared with data of CTEPH patients without such collaterals. There were 15 patients (18.1%) with definite and 4 patients (4.8%) with probable coronary artery - pulmonary artery collaterals among the study population. CTEPH patients with collaterals had higher preoperative pulmonary artery pressures, higher pulmonary vascular resistance (PVR) and lower cardiac index values compared with CTEPH patients without collaterals. However, CTEPH patients with collaterals displayed higher amount of reduction in PVR after PEA compared with patients without collaterals. There were no significant differences between groups regarding incidence of reperfusion injury or mortality. Prevalence of coronary artery - pulmonary artery collaterals seems to be increased in our CTEPH patients compared with the general population. The presence of coronary artery - pulmonary artery collaterals is often combined with proximal disease with the possibility of increased reduction of PVR after PEA operation.

Prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension.

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.

Surgical ligation of Major Aorto Pulmonary Collateral Arteries (MAPCAs) in Tetralogy of Fallot at the time of primary repair

At our institution, in patients of Tetralogy of Fallot (TOF), we have adopted a policy of surgically ligating Major Aortopulmonary Collateral Arteries (MAPCAs) which supply areas of lung with dual blood supply, which for various reasons could not be coiled preoperatively. MAPCAs are arteries that develop to supply blood to the lungs when native pulmonary circulation is underdeveloped. Instead of coming from the pulmonary trunk, supply develops from the aorta and other systemic arteries [1]. A large number of patients with Tetralogy of Fallot have significant MAPCAs. Traditionally MAPCAs were approached surgically either through median sternotomy or lateral thoracotomy [2]. Now, MAPCAs which supply areas of lungs with dual blood supply are usually coiled by percutaneous techniques in catheterization laboratory [3, 4]. MAPCAs are coiled to prevent excessive return during cardiotomy, which may cause underperfusion of the patient and obscures vision during surgery, excessive flooding of the operative field and over distension of the heart, excessive return causing rewarming of the heart, postoperatively, excessive Left Atrial (LA) return and high LA pressures and postoperative endotracheal bleeding. Preoperative coil embolization is the treatment of choice, but is not always feasible in setups available in developing countries due to various reasons. These include:

MAJOR AORTOPULMONARY COLLATERAL ARTERY NOMENCLATURE

The anatomic variability in tetralogy of Fallot with pulmonary atresia (PA) or pulmonary stenosis (PS) and major aortopulmonary collateral arteries (MAPCA) makes it difficult to compare outcomes for different therapeutic approaches. We developed a novel anatomy-based classification system and risk

Quantitative analysis of pulmonary artery and pulmonary collaterals in preoperative patients with pulmonary artery atresia using dual-source computed tomography

Objective To evaluate the value of dual-source computed tomography (DSCT) in quantitatively measuring pulmonary arteries and major aortopulmonary collateral vessels in comparison with conventional angiographic (CA) on preoperative patients with pulmonary artery atresia and ventricular septal defect (PAA-VSD). Materials and methods Twenty PAA-VSD patients who had complete imaging data of DSCT, CA and echocardiography (ECHO) studies were retrospectively analyzed. Using final clinical diagnosis as the standard, results of DSCT, CA and ECHO on the detection of cardiac malformations, measurement of diameters of pulmonary artery and collateral vessel, as well as the values of McGoon ratio, pulmonary arterial index (PAI) and total neopulmonary arterial index (TNPAI) were derived and compared. Results In 20 patients, 51 of 54 (94.4%) cardiac malformations were visualized by DSCT, whereas 42 (77.8%) by ECHO ( p = 0.027). Fourteen cases with aortopulmonary collateral vessels were all (100%) detected by DSCT, whereas 5 cases (35.7%) by ECHO ( p = 0.001), and 13 cases (92.9%) by CA ( p = 0.995). Sixteen cases with confluence of native pulmonary arteries were diagnosed by DSCT, whereas 10 cases by CA ( p = 0.024). Measurement of the diameters of pulmonary arteries, collateral vessels, and descending aorta at the level of diaphragm were correlated well between DSCT and CA ( r = 0.95–0.99). McGoon ratio (DSCT = 1.18 ± 0.60, CA = 1.23 ± 0.64), PAI (DSCT = 130.96 ± 99.38 mm 2/m 2, CA = 140.91 ± 107.87 mm 2/m 2) and TNPAI (DSCT = 160.31 ± 125.62 mm 2/m 2, CA = 169.14 ± 122.81 mm 2/m 2) were calculated respectively, without significant differences between DSCT and CA by paired t-tests (all p > 0.05). Conclusion DSCT was efficient for evaluating and measuring native pulmonary artery and aortopulmonary collateral vessels prior to surgical procedures in PAA-VSD patients. Combined with echocardiography, DSCT showed potential to replace CA for evaluating pulmonary artery atresia noninvasively.

Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary collateral arteries: Challenges and controversies

Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary collateral arteries: Challenges and controversies

An overview of pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries

The management of infants and children with pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries has proven to be challenging. Therapeutic approaches have included unifocalization, shunting, coiling of collateral vessels, and heart/lung transplantation. Results have been variable and frustrating. This review will cover the anatomy, physiology, initial medical management, subsequent surgical management, and controversies surrounding various therapeutic approaches. The evolving understanding of genetic considerations in this condition will also be explored.

Tetralogy of Fallot and Absence of Left Pulmonary Artery

Unilateral absence of the pulmonary artery is a rare congenital lesion usually caused by backward displacement of the conical artery of the truncus arteriosus. The purpose of this report is to describe and discuss the treatment of an 8-year-old patient who presented with cyanosis and was diagnosed with tetralogy of Fallot together with an absence of the left pulmonary artery and major aortopulmonary collateral arteries.

Imaging of Extralobar Pulmonary Sequestration in a Patient with Tetralogy of Fallot with Pulmonary Atresia, Ventricular Septal Defect and Multiple Aorto-pulmonary Collateral Arteries with Multidetector Computed Tomography

Complex pulmonary vascular blood supply is common in patients with tetralogy of Fallot with pulmonary atresia, major systemic to pulmonary collateral arteries and hypoplastic or deficient central pulmonary arteries. An extralobar lung sequestration, which has not been described previously in these patients, was imaged in a 6-week-old infant with multidetector computed tomography with sub-millimeter resolution. Arterial and venous vessels were analyzed using three-dimensional vascular exploration tools and results were confirmed with cardiac catheterization.

A case of congenital agenesis of the right pulmonary artery presenting with hemoptysis and mimicking pulmonary hemosiderosis

Congenital unilateral absence of a pulmonary artery is a rare anomaly most frequently accompanied by other cardiovascular anomalies. We report a 10-year-old girl presenting with fatigue and recurrent hemoptysis who was initially misdiagnosed with idiopathic pulmonary hemosiderosis. Her symptoms did not resolve despite treatment so she was referred to our center for further evaluation. We carried out an angiography which revealed the absence of the right pulmonary artery and multiple collaterals originating from the right subclavian and right internal mammary arteries supplying the right lung. During the follow-up the patient developed a severe episode of pulmonary infection and pulmonary hypertension which responded well to medical treatment. Physicians should be aware of the congenital absence of the right pulmonary artery especially in patients presenting with recurrent respiratory symptoms. Although this condition is generally considered to have a good prognosis, close observation is mandatory in order to prevent further complications and comorbidities.

Time‐resolved three‐dimensional contrast‐enhanced magnetic resonance angiography in patients who have undergone a Fontan operation or bidirectional cavopulmonary connection: Initial experience

To evaluate the usefulness of time-resolved three-dimensional (3D) magnetic resonance angiography (MRA) using diluted contrast agent (CA) in patients who had undergone a Fontan operation or bidirectional cavopulmonary connection (BCPC). Time-resolved 3D MRA (10 dynamic data sets, two seconds per dynamic data set) using parallel imaging and keyhole data sampling was performed on 15 patients (median age=10 years, range=1-20 years) who had undergone a Fontan operation (N=11) or BCPC (N=4). Diluted gadolinium (Gd) contrast agent (CA) was intravenously injected into the arm and/or leg veins. The flow dynamics and morphology of pulmonary circulation, and lung perfusion were assessed. Preferential or balanced pulmonary blood flow from each systemic vein was visualized on time-resolved 3D MRA in all patients. In addition, occlusion/stenosis of the central thoracic vein (N=4) and pulmonary artery (N=6), systemic venous (N=5) and arterial (N=6) collaterals, and lung perfusion defect (N=4) were identified. Persistent hepatic venous plexus, pulmonary arteriovenous malformation, and axillary arteriovenous fistula were delineated in three patients, respectively. Time-resolved 3D MRA with diluted CA is useful for evaluating patients who have undergone a Fontan operation or BCPC because it can reveal the flow dynamics and morphology of pulmonary circulation, and lung perfusion status.

SYSTEMIC TO PULMONARY COLLATERALS IN A PREMATURE INFANT WITH BRONCHOPULMONARY DYSPLASIA.

Introduction Systemic to pulmonary artery collaterals (SPCs) occur in a variety of pathologic conditions, including congenital heart disease, chronic pulmonary infections, lung tumors, pulmonary emboli, and bronchopulmonary dysplasia. SPCs may result in symptomatic left-to-right shunts. We describe a preterm infant with two SPCs who we weaned from chronic supplemental oxygen following coil embolization of persistent SPCs. Case A 580 g female infant product of a twin pregnancy was born by cesarean section at 28 weeks9 gestation. The patient was hospitalized for a total of 116 days. On day 13 of life an echocardiogram demonstrated a patent ductus arteriosus and left ventricular volume overload, requiring surgical ligation. After surgery the infant continued to experience pulmonary congestion and ventilator dependency. Extubation was successful at 51 days of age, but the patient continued to receive oxygen via nasal canula. On day 98, the echocardiogram demonstrated SPCs, and a cardiac catheterization was performed. The aortogram showed two small to moderate collaterals from the descending aorta to the right lung, each measuring approximately 1.5 mm in diameter. Both were occluded by coil embolization. Nine days after the procedure, the infant was weaned to room air. Conclusion SPCs may contribute to prolonged ventilatory support in premature infants. SPCs can be demonstrated by echocardiographic color Doppler interrogation of the aortic arch and the proximal descending aorta. Coil embolization by interventional cardiac catheterization is indicated in symptomatic patients. Careful echocardiographic evaluation is necessary to rule out SPCs in premature infants with a prolonged supplemental oxygen requirement.