Aortopulmonary collateral arteries: a rare complication after arterial switch operation for transposition of the great arteries
© Shikata et al. 2015
Received: 4 June 2015
Accepted: 1 October 2015
Published: 6 October 2015
Collateral vascular arteries from the descending aorta to the pulmonary arteries are uncommon after arterial switch operation. Here, we report the case of a baby girl treated with coil embolization for abnormal blood flow from the descending aorta to the pulmonary arteries after arterial switch operation. A baby girl weighing 1324 g was delivered at 32 weeks 4 days of gestation, and she had D-transposition of the great arteries and a ventricular septal defect. She underwent nitrogen inhalation to reduce pulmonary blood flow before arterial switch operation. After the operation, she presented with left heart failure due to the presence of abnormal blood flow from the descending aorta to the pulmonary arteries, and she was successfully treated with coil embolization. After the treatment, her condition improved dramatically, and she was discharged without any complications.
The outcomes of neonatal cardiac surgery have improved dramatically owing to advancements in surgical techniques and perioperative care . For D-transposition of the great arteries (D-TGA), which needs neonatal cardiac surgery, selection of the surgical strategy mainly depends on the anomalous heart and vascular factors, such as coronary anatomy, ventricular septal defect (VSD) location, and associated vascular malformations . Collateral vascular arteries from the descending aorta to the pulmonary arteries are uncommon after arterial switch operation, and their presence can lead to several critical conditions such as pulmonary bleeding and low cardiac output . Here, we report the case of a baby treated with coil embolization for abnormal blood flow from the descending aorta to the pulmonary arteries after arterial switch operation.
We reported the case of a baby girl treated with coil embolization for abnormal blood flow from the descending aorta to the pulmonary arteries after arterial switch operation. The occurrence of aortopulmonary collateral shunts after transposition of the great arteries is considered rare . One of the possible reasons for overlooking collateral arteries is that the identification of collateral flow may be difficult as it can be obscured by the patent ductus arteriosus. However, large collateral arteries can be problematic immediately after arterial switch operations if they are left untreated [3–6].
In a report by Wernovsky et al., in which neonatal arterial switch operation was the standard surgical treatment for D-TGA, 46 % of patients had abnormal collateral arteries as in our case, and most of the cases had silent symptoms, with only 5 of 119 cases needing coil embolization after arterial switch operation . One of the possible reasons for the development of anomalous vessels is a long period of desaturation . Therefore, we believe that it is crucial to consider the presence of abnormal aortopulmonary shunts in patients with congestive heart failure, who have received nitrogen inhalation to control pulmonary blood flow before operations. In our case, we decided to perform arterial switch operation after the baby gained sufficient body weight. While some babies with low body weight have undergone arterial switch operation in the neonatal period , we believe that some institutions need to follow our strategy. The decision to perform arterial switch operations in babies with low body weight depends on the experience and skill of the surgical team. Patients receiving nitrogen inhalation should be carefully checked for collateral vessels after arterial switch operations so that any abnormal vessels can be ligated with surgical techniques or catheter embolization to avoid critical postoperative conditions .
The presence of an aortopulmonary shunt should be considered in patients with unexplained congestive heart failure after arterial switch operation, although the probability of severe symptoms is relatively low.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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