Abstract
Introduction. Major aortopulmonary collateral arteries (MAPCA) in combination with transposition of the great arteries (TGA) is a described but rarely detected pathology, which in some cases significantly aggravates the course of the postoperative period. More often, such collateral vessels do not lead to any symptoms, but in some case they can be cause pulmonary hypervolemia and heart failure in the postoperative period.
Objective. To assess the incidence of BALCA in patients with TGA, to analyze the clinical course of the postoperative period, to consider options for conservative and surgical treatment of this in such patients. Material and methods. From 2004 to 2022 arterial switch procedure were performed in our clinic. The median age of patients at admission was 2 [1; 180] days, body weight on average 3.5±0.5 kg. Among all patients in the preoperative period, according to the results of an echocardiographic study, MAPCA were not identified.
Results. Among the most common complications after a standard arterial switch procedure (cardiac and respiratory failure, capillary leak syndrome, cardiac arrhythmias and conduction disturbances), we noted two patients whose postoperative period proceeded with signs of severe heart and respiratory failure for a long time without positive dynamics against the background of ongoing multicomponent therapy. According to the results of an additional examination, abnormal systolic-diastolic flows from the descending part of the aorta to the pulmonary artery – MAPCA – were detected in both cases. These patients underwent surgical intervention in the amount of MAPCA clipping from lateral thoracotomy, after which they were transferred to the department on the 5–7th day, and then discharged from the hospital in a satisfactory condition.
Conclusion. It was previously thought that symptomatic aortopulmonary collateral circulation in patients after TGA correction is a rare phenomenon, but recent reports suggest otherwise. In most patients, collaterals have no hemodynamic significance, however, in some patients, they can cause pulmonary hyperperfusion syndrome, systemic hypoxemia, development of respiratory and heart failure in the early postoperative period, up to critical conditions. This problem is rarely remembered, linking the unfavorable condition of the patient with a number of more superficial and obvious reasons. Therefore, it is necessary to be aware of the possible presence of MAPCA in patients with transposition of the great arteries, especially in cases of inexplicably complicated postoperative period after the arterial switch procedure.
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About the authors
- Georgiy A. Efimochkin, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Maksim V. Boriskov, Cand. Med. Sci., Head of Cardiac Surgery Department No 1; ORCID
- Tatyana V. Serova, Pediatric Cardiologist; ORCID
- Angelina A. Pereverzeva, Cardiovascular Surgeon; ORCID
- Pavel Yu. Petshakovskiy, Cardiovascular Surgeon; ORCID
- Oleg A. Vanin, Cardiovascular Surgeon; ORCID
- Ilya A. Tkachenko, Cardiovascular Surgeon; ORCID
- Elena I. Iofe, Cardiovascular Surgeon; ORCID
