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Coil Occlusion of Aortopulmonary Collateral Arteries Before Arterial Switch Procedure in an Infant With Transposition of the Great Arteries

Victoria Jowett, MBBS, BSc, MRCPCH; Graham Derrick, BMedSci, BM, BS; Victor Tsang, MD and Jan Marek, MD, PhD

From the Great Ormond Street Hospital for Children, London, United Kingdom.

Correspondence to Jan Marek, MD, PhD, Director of Echocardiography, Consultant Paediatric Cardiologist, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom. E-mail Marekj@gosh.nhs.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 1-day-old infant with a prenatal diagnosis of transposition of the great arteries was admitted to our unit. He was born at term, weighing 3.2 kg. He arrived in a stable condition, with saturations of 88%, on a prostaglandin infusion at a rate of 5 ng/kg per min in accordance with the prenatal plan. Echocardiogram demonstrated transposition of the great arteries with intact ventricular septum and usual coronary arrangement. There was adequate mixing via a moderate-sized atrial communication measuring 6 mm. In addition, there was a large persistent arterial duct with left-to-right shunting.

Over the next 24 hours, the infant developed tachypnoea, poor systemic perfusion, and progressive metabolic acidosis. He was electively intubated and ventilated and commenced on ionotropes and antibiotics. Abdominal distension was noted without x-ray changes, and he was, therefore, started on prophylactic treatment for necrotizing enterocolitis. Repeat echocardiogram demonstrated the presence of major aortopulmonary collateral arteries in addition to a large persistent arterial duct and moderate atrial communication (Figure 1).

View larger version (40K):   Figure 1. Serial echocardiogram demonstrated large arterial duct (A), aortic origin of collateral vessel (B), and its tortuous course toward tight lung (C). Systolic-diastolic flow was documented on pulsed Doppler tracing (D).

 
A cardiac catheter was performed to further elucidate the nature of the collateral vessels and perform an atrial septostomy. At the time of catheter, 2 major aortopulmonary collaterals were identified. These were successfully occluded with 2 and 1 detachable Cook patent ductus arteriosus coils (3 mmx3 loop), respectively (Figure 2. . . [Full Text of this Article]