Clinical investigation of aortopulmonary collateral arteries / 临床儿科杂志

Objectives To investigate the clinical manifestation and distribution characteristics of aortopulmonary collateral arteries (APCAs) without cyanotic congenital heart defect, and to analyze the reason of misdiagnosis. Methods The clinical data of 137 APCAs patients without cyanotic congenital heart defect in our hospital from April, 2009 to October, 2010 were reviewed. Clinical characteristics, radiographic findings were analyzed. Results In 137 patients, 99 were combined with pulmonary diseases, 115 cases with heart diseases. Six cases were misdiagnosed in 137 patients. Three cases were misdiagnosed as patent ductus arteriosus. One case was misdiagnosed as cardiomyopathy. One case was misdiagnosed as pulmonary tuberculosis. One case was prolonged the time of antituberculosis therapy because of the lung lesion. There were 130 APCAs (94.9%) originated from descending aorta, five (3.6%) from subclavian artery, one (0.73%) from intercostals artery, one (0.73%) from vertebral artery. Conclusions APCAs exist in the patients without cyanotic congenital heart defect, and APCAs will be narrowed and blocked gradually after birth. However, certain predisposing factors sustain APCAs and increase the pulmonary flow. Patients with APCAs combined with pulmonary disease or heart diseases may be misdiagnosed or diagnosed as a specific disease. Early diagnosis and treatment is critical to prognosis.

Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery / 中国胸心血管外科临床杂志

@#Objective     Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods     This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results     Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion     Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.

The impact of one-step hybrid procedure on kidney function in tetralogy of Fallot children with major aortopulmonary collateral arteries / 中华胸心血管外科杂志

Objective To investigate the impact of one-step hybrid procedure(HP) which combined surgical and interventional approaches simultaneously on kidney function in tetralogy of Fallot(TOF) with major aortopulmonary collateral arteries (MAPCAs).Methods The children with TOF who underwent corrective procedures,whether underwent one-step HP,aged less than 3-years during the period of January 2014 to June 2015,were reviewed in this retrospective cohort study.Univariate analyse was performed to compare with traditional operation(control group) and one-step HP(HP group).Multivariable analyses was carried out to identify significant determinants of one-step HP.Results In univariate analyses,the age,preoperative oxygen saturation,Nakata indext、McGoon index、LVEDIV、CPB time、ACC time and transannular patch had no significant difference between HP group and control group.The morbidity of acute kidney injury(AKI) was 59.38％ in one-step HP group as well as 23.76％ in traditional operation group.The one-step HP could significantly increased AKI compared with control group.Multivariable logistic regression showed that younger children who had less mechanical ventilation time(OR:0.971,95 ％ CI:0.949-0.994,P =0.003),less time to negative fluid balance (OR:0.984,95 ％ CI:0.967-0.998,P =0.015) and higher morbidity of AKI(OR:4.817,95％ CI:2.597-8.937,P =0.001) in HP group.Conclusion The one-step HP could significantly decrease the mechanical ventilation time and time to negative fluid balance while it increased the morbidity of mild AKI.Moreover,the mild AKI was not associated with poor outcomes when children was prophylactically implemented renal protection.

Clinical study application of Amplatzer duct occluder Ⅱ to occlude aortopulmonary collateral arteries / 中国介入心脏病学杂志

Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ (ADOⅡ) in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female, with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5 - 71 months old and weight 4. 2 - 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ, 22 non-detachable coils ( Cook corp. ) and 2 detachable micro-coils ( Boston Scientific corp. ). Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1 patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded. Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.

Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals Associated with Left Pulmonary Artery Interruption

A multistage plan and multidisciplinary approach are the keys to successful repair in patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs). In this article, we present a multidisciplinary approach adopted to treat a patient with PA with VSD and MAPCAs associated with left pulmonary artery interruption.

Surgical treatment and research progress of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries / 国际儿科学杂志

Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is a rare kind of congenital heart disease. Nowadays, staged surgical treatment has been recognized by more and more surgeons with the surgical treatment of the disease continuing to progress and a deeper understanding of surgical treatment.