Background: Inadequate pulmonary blood flow in tetralogy of Fallot (TOF) can lead to the development of major aortopulmonary collateral arteries (MAPCA), which interferes with surgical repair. The present study evaluated the features of MAPCAs among patients with TOF and their treatment approaches. Besides, perioperative parameters and mortality rates of our TOF patients with and without MAPCA were compared. Methods: This retrospective case-control study was conducted from 2011 to 2020 at Namazi and Shahid Faghihi Hospitals, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. The significant aspects of MAPCAs, including their quantity, the presence of dual or single supply lung segments, and the employed devices for closure were evaluated. The patients were divided into three groups: TOF patients without MAPCAs as the control group, those with preoperative percutaneous MAPCA closure (Closed MAPCA), and those with small MAPCAs deemed unsuitable for percutaneous closure (Open MAPCA). A comparative analysis, encompassing hospital and surgical data, such as the presence of MAPCA, blood transfusion volume, intubation time, ICU stay, and mortality rates during and post-surgery, was performed among the aforementioned groups. The Chi square, Mann-Whitney, and Kruskal-Wallis tests were used to analyze the data. Results: 59 patients were enrolled, with a mean age of 27.98±24.19 months. The control group included 34 patients with no collaterals, the closed MAPCA group had 12 patients with occluded collaterals, and the open MAPCA group had 13 patients with small collaterals unsuitable for closure. Blood transfusion volume and intensive care unit (ICU) stay were significantly higher in the open MAPCA group than the control group (P=0.01 and P=0.04, respectively). The highest mortality rate was seen in the Iranian Journal of Medical Sciences group (P<0.001). Conclusion: In TOF patients, percutaneous MAPCA closure prior to surgical repair was recommended. This approach could potentially decrease the occurrence of complications both during and post-surgery. |
- Duncan BW, Mee RB, Prieto LR, Rosenthal GL, Mesia CI, Qureshi A, et al. Staged repair of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg. 2003;126:694-702. doi: 10.1016/s0022-5223(03)00700-1. PubMed PMID: 14502141.
- Sadiq N, Ullah M, Mahmoud A, Akhtar K, Younis U. Perioperative major aortopulmonary collateral arteries (MAPCAs) coiling in tetralogy of fallot patients undergoing for total correction. J Cardiol Curr Res. 2015;3:2373-4396. doi: 10.15406/jccr.2015.03.00123.
- Kim HS, Grady RM, Shahanavaz S. Isolated Major Aortopulmonary Collateral as the Sole Pulmonary Blood Supply to an Entire Lung Segment. Case Rep Cardiol. 2017;2017:5218321. doi: 10.1155/2017/5218321. PubMed PMID: 28785488; PubMed Central PMCID: PMCPMC5529621.
- Joshi A, Agarwal S, Satsangi DK. Surgical ligation of major aorto pulmonary collateral arteries (MAPCAs) in tetralogy of fallot at the time of primary repair. Indian Journal of Thoracic and Cardiovascular Surgery. 2013;29:157-8. doi: 10.1007/s12055-013-0212-6.
- Mainwaring RD, Punn R, Reddy VM, Hanley FL. Surgical reconstruction of pulmonary stenosis with ventricular septal defect and major aortopulmonary collaterals. Ann Thorac Surg. 2013;95:1417-21. doi: 10.1016/j.athoracsur.2013.01.007. PubMed PMID: 23434256.
- Asija R, Koth AM, Velasquez N, Chan FP, Perry SB, Hanley FL, et al. Postoperative Outcomes of Children With Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals Undergoing Reconstruction of Occluded Pulmonary Artery Branches. Ann Thorac Surg. 2016;101:2329-34. doi: 10.1016/j.athoracsur.2015.12.049. PubMed PMID: 26947013.
- Fouilloux V, Bonello B, Kammache I, Fraisse A, Mace L, Kreitmann B. Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: Focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis. 2012;105:666-75. doi: 10.1016/j.acvd.2012.08.003. PubMed PMID: 23199622.
- Asija R, Roth SJ, Hanley FL, Peng L, Liu K, Abbott J, et al. Reperfusion pulmonary edema in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries undergoing unifocalization procedures: A pilot study examining potential pathophysiologic mechanisms and clinical significance. J Thorac Cardiovasc Surg. 2014;148:1560-5. doi: 10.1016/j.jtcvs.2014.01.017. PubMed PMID: 24534681.
- Amoozgar H, Edraki MR, Naghshzan A, Mehdizadegan N, Mohammadi H, Ajami G, et al. Midterm follow up of transcatheter closure of coronary artery fistula with Nit-Occlud(R) patent ductus arteriosus coil. BMC Cardiovasc Disord. 2021;21:192. doi: 10.1186/s12872-021-01999-3. PubMed PMID: 33879042; PubMed Central PMCID: PMCPMC8056487.
- Cho JM, Puga FJ, Danielson GK, Dearani JA, Mair DD, Hagler DJ, et al. Early and long-term results of the surgical treatment of tetralogy of Fallot with pulmonary atresia, with or without major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg. 2002;124:70-81. doi: 10.1067/mtc.2002.120711. PubMed PMID: 12091811.
- Liu YL, Shen XD, Li SJ, Wan X, Yan J, Guo J, et al. [An integral approach for cyanotic congenital heart disease with major aortopulmonary collateral arteries]. Zhonghua Yi Xue Za Zhi. 2006;86:228-31. PubMed PMID: 16677500.
- 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. doi: 10.1017/S1047951106000606. PubMed PMID: 16725060.
- Petrou A, Tzimas P, Siminelakis S. Massive bleeding in cardiac surgery. Definitions, predictors and challenges. Hippokratia. 2016;20:179-86. PubMed PMID: 29097882; PubMed Central PMCID: PMCPMC5654433.
- Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg. 2011;40:179-84. doi: 10.1016/j.ejcts.2010.11.038. PubMed PMID: 21227714.
- Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011;12:e122-6. doi: 10.1097/PCC.0b013e3181e912bd. PubMed PMID: 20625334
- De Cocker J, Messaoudi N, Stockman BA, Bossaert LL, Rodrigus IE. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg. 2011;39:60-7. doi: 10.1016/j.ejcts.2010.04.015. PubMed PMID: 20627608.
- Vivacqua A, Koch CG, Yousuf AM, Nowicki ER, Houghtaling PL, Blackstone EH, et al. Morbidity of bleeding after cardiac surgery: is it blood transfusion, reoperation for bleeding, or both? Ann Thorac Surg. 2011;91:1780-90. doi: 10.1016/j.athoracsur.2011.03.105. PubMed PMID: 21619974.
- Bauser-Heaton H, Borquez A, Han B, Ladd M, Asija R, Downey L, et al. Programmatic Approach to Management of Tetralogy of Fallot With Major Aortopulmonary Collateral Arteries: A 15-Year Experience With 458 Patients. Circ Cardiovasc Interv. 2017;10. doi: 10.1161/CIRCINTERVENTIONS.116.004952. PubMed PMID: 28356265.
- Pourarian S, Rezaie M, Amoozgar H, Shakiba AM, Edraki MR, Mehdizadegan N. High-Dose Oral Ibuprofen in Treatment of Patent Ductus Arteriosus in Full-Term Neonates. Iran J Pediatr. 2015;25:e2005. doi: 10.5812/ijp.2005. PubMed PMID: 26396694; PubMed Central PMCID: PMCPMC4575792.
- Grosse-Wortmann L, Yoo SJ, van Arsdell G, Chetan D, Macdonald C, Benson L, et al. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg. 2013;146:1185-90. doi: 10.1016/j.jtcvs.2013.01.032. PubMed PMID: 23414777.
- Carotti A. Surgical Management of Fallot’s Tetralogy With Pulmonary Atresia and Major Aortopulmonary Collateral Arteries: Multistage Versus One-Stage Repair. World J Pediatr Congenit Heart Surg. 2020;11:34-8. doi: 10.1177/2150135119884914. PubMed PMID: 31835990.
- Soquet J, Barron DJ, d’Udekem Y. A Review of the Management of Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries. Ann Thorac Surg. 2019;108:601-12. doi: 10.1016/j.athoracsur.2019.01.046. PubMed PMID: 30831109.
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