Abdelmohsen Gaser, AlKhushi Naif, Alassiri Abdullah, Al-Radi Osman
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia.
Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.
Egypt Heart J. 2023 Mar 30;75(1):23. doi: 10.1186/s43044-023-00349-2.
The occurrence of major aortopulmonary collateral arteries (MAPCAs) is infrequent in patients with D-transposition of great arteries (D-TGA) with intact ventricular septum (IVS). Hemodynamically significant MAPCAs may complicate the postoperative course of these patients after arterial switch operation (ASO).
We present a rare case of neonatal D-TGA-IVS associated with extensive MAPCAs. After the ASO, the patient developed pulmonary hemorrhage, chest wall edema, and deterioration of lung compliance with the need for high-frequency ventilation (HFV). The patient also had a significant capillary leak with skin edema, high chest tube drainage, and high peritoneal drainage. Cardiac catheterization revealed extensive MAPCAs supplying the whole lung segments. After the catheter closure of most of these MAPCAs, the patient had clinical improvement.
Although the occurrence of MAPCAs with D-TGA-IVS is infrequent, clinicians should suspect their presence in cases with unexplained heart failure, pulmonary hemorrhage, or cardiovascular compromise after ASO. Catheter closure of MAPCAs is feasible with an acceptable short-term outcome.
在室间隔完整的大动脉转位（D-TGA）患者中，主-肺动脉侧支动脉（MAPCAs）的发生并不常见。具有血流动力学意义的MAPCAs可能会使这些患者在动脉调转手术（ASO）后的术后病程复杂化。
我们报告一例罕见的新生儿D-TGA-IVS合并广泛MAPCAs的病例。ASO术后，患者出现肺出血、胸壁水肿以及肺顺应性恶化，需要高频通气（HFV）。患者还存在明显的毛细血管渗漏，伴有皮肤水肿、胸腔闭式引流液量多以及腹腔引流液量多。心导管检查显示广泛的MAPCAs为整个肺段供血。在通过导管封堵大部分这些MAPCAs后，患者的临床症状有所改善。
尽管D-TGA-IVS合并MAPCAs的情况并不常见，但临床医生在ASO后出现不明原因的心力衰竭、肺出血或心血管功能不全的病例中应怀疑其存在。通过导管封堵MAPCAs是可行的，且短期预后可接受。
