Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shengli ¹ ,  LI Shoujun ² , WANG Xu ¹

1. Pediatric Intensive Care Unit, Pediatric Cardiac Center, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, 100037, P.R. China;
2. Department of Surgery, Pediatric Cardiac Center, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, 100037, P.R. China;

Corresponding author：

LI Shoujun, Email: victlee@126.com

Keywords：

Congenital heart defect; heart surgery; major aortopulmonary collateral arteries; percutaneous occlusion

DOI：

10.7507/1007-4848.201802012

Video：

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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.

Citation： LI Shengli, LI Shoujun, WANG Xu. Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 555-559. doi: 10.7507/1007-4848.201802012 Copy

1.	Soquet J, Liava’a M, Eastaugh L, et al. Achievements and limitations of a strategy of rehabilitation of native pulmonary vessels in pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. Ann Thorac Surg, 2017, 103(5): 1519-1526.
2.	Fouilloux V, Bonello B, Kammache I, et al. 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(12): 666-675.
3.	Liava’a M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93(1): 185-191.
4.	Carrillo SA, Mainwaring RD, Patrick WL, et al. Surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals with absent intrapericardial pulmonary arteries. Ann Thorac Surg, 2015, 100(2): 606-614.
5.	Asija R, Koth AM, Velasquez N, 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(6): 2329-2334.
6.	Amark KM, Karamlou T, O’Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47(7): 1448-1456.
7.	Amark KM, Karamlou T, O’Carroll A, et al. Postoperative respiratory failure in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals: a pilot study. Pediatr Crit Care Med, 2013, 14: 384-389.
8.	d’Udekem Y, Alphonso N, Nørgaard MA, et al. Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits. J Thorac Cardiovasc Surg, 2005, 130(6): 1496-1502.
9.	Ma X, Barboza LA, Siyahian A, et al. Tetralogy of Fallot: aorto-pulmonary collaterals and pulmonary arteries have distinctly different transcriptomes. Pediatr Res, 2014, 76(4): 341-346.
10.	Chen Q, Ma K, Hua Z, et al. Multistage pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary artery. Eur J Cardiothorac Surg, 2016, 50(1): 160-166.
11.	Li S, Zhang Y, Li S, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenit Heart Dis, 2015, 10(3): 254-262.
12.	Zhang J, Jiang Z, Bao C, et al. Cardiopulmonary bypass increases pulmonary microvascular permeability through the src kinase pathway: involvement of caveolin-1 and vascular endothelial cadherin. Mol Med Rep, 2016, 13(3): 2918-1924.
13.	Patrick WL, Mainwaring RD, Reinhartz O, et al. Major aortopulmonary collateral arteries with anatomy other than pulmonary atresia/ventricular septal defect. Ann Thorac Surg, 2017, 104(3): 907-916.
14.	Cunningham ME, Donofrio MT, Peer SM, et al. Optimal timing for elective early primary repair of tetralogy of Fallot: analysis of intermediate term outcomes. Ann Thorac Surg, 2017, 103(3): 845-852.
15.	Li SJ, Zhang H, Sheng XD, et al. Intraoperative hybrid cardiac surgery for neonates and young children with congenital heart disease: 5 years of experience. Ann Thorac Cardiovasc Surg, 2010, 16(6): 406-409.
16.	Nicholson GT, Kim DW, Vincent RN, et al. Cardiac catheterization in the early post-operative period after congenital cardiac surgery. JACC Cardiovasc Interv, 2014, 7(12): 1437-1443.
17.	Zahn EM, Dobrolet NC, Nykanen DG, et al. Interventional catheterization performed in the early postoperative period after congenital heart surgery in children. JACC, 2004, 43(7): 1264-1269.

1. Soquet J, Liava’a M, Eastaugh L, et al. Achievements and limitations of a strategy of rehabilitation of native pulmonary vessels in pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. Ann Thorac Surg, 2017, 103(5): 1519-1526.
2. Fouilloux V, Bonello B, Kammache I, et al. 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(12): 666-675.
3. Liava’a M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93(1): 185-191.
4. Carrillo SA, Mainwaring RD, Patrick WL, et al. Surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals with absent intrapericardial pulmonary arteries. Ann Thorac Surg, 2015, 100(2): 606-614.
5. Asija R, Koth AM, Velasquez N, 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(6): 2329-2334.
6. Amark KM, Karamlou T, O’Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47(7): 1448-1456.
7. Amark KM, Karamlou T, O’Carroll A, et al. Postoperative respiratory failure in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals: a pilot study. Pediatr Crit Care Med, 2013, 14: 384-389.
8. d’Udekem Y, Alphonso N, Nørgaard MA, et al. Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits. J Thorac Cardiovasc Surg, 2005, 130(6): 1496-1502.
9. Ma X, Barboza LA, Siyahian A, et al. Tetralogy of Fallot: aorto-pulmonary collaterals and pulmonary arteries have distinctly different transcriptomes. Pediatr Res, 2014, 76(4): 341-346.
10. Chen Q, Ma K, Hua Z, et al. Multistage pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary artery. Eur J Cardiothorac Surg, 2016, 50(1): 160-166.
11. Li S, Zhang Y, Li S, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenit Heart Dis, 2015, 10(3): 254-262.
12. Zhang J, Jiang Z, Bao C, et al. Cardiopulmonary bypass increases pulmonary microvascular permeability through the src kinase pathway: involvement of caveolin-1 and vascular endothelial cadherin. Mol Med Rep, 2016, 13(3): 2918-1924.
13. Patrick WL, Mainwaring RD, Reinhartz O, et al. Major aortopulmonary collateral arteries with anatomy other than pulmonary atresia/ventricular septal defect. Ann Thorac Surg, 2017, 104(3): 907-916.
14. Cunningham ME, Donofrio MT, Peer SM, et al. Optimal timing for elective early primary repair of tetralogy of Fallot: analysis of intermediate term outcomes. Ann Thorac Surg, 2017, 103(3): 845-852.
15. Li SJ, Zhang H, Sheng XD, et al. Intraoperative hybrid cardiac surgery for neonates and young children with congenital heart disease: 5 years of experience. Ann Thorac Cardiovasc Surg, 2010, 16(6): 406-409.
16. Nicholson GT, Kim DW, Vincent RN, et al. Cardiac catheterization in the early post-operative period after congenital cardiac surgery. JACC Cardiovasc Interv, 2014, 7(12): 1437-1443.
17. Zahn EM, Dobrolet NC, Nykanen DG, et al. Interventional catheterization performed in the early postoperative period after congenital heart surgery in children. JACC, 2004, 43(7): 1264-1269.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery

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