Symptomatic aorto-pulmonary collaterals early after arterial switch operation

Area of Science:

• Cardiology
• Pediatric Surgery
• Interventional Radiology

Background:

• Enlarged bronchial arteries and systemic-to-pulmonary collaterals are common in transposition of the great arteries (TGA).
• These vessels can lead to pulmonary vascular obstructive disease or cardiac volume overload post-repair.
• Their clinical significance, especially in neonates, requires careful consideration.

Purpose of the Study:

• To report a case of a low-weight neonate with TGA and intact ventricular septum.
• To describe the management of multiple aorto-pulmonary collaterals causing a stormy postoperative course after arterial switch operation (ASO).
• To evaluate the efficacy of percutaneous coil embolization for these anomalous vessels.

Main Methods:

• The study involved a neonate diagnosed with TGA and intact ventricular septum.
• The patient underwent a successful arterial switch operation.
• Postoperatively, multiple aorto-pulmonary collaterals were identified and treated with percutaneous coil embolization.

Main Results:

• The neonate experienced a complicated postoperative course due to multiple aorto-pulmonary collaterals.
• Percutaneous coil embolization was successfully performed to occlude these anomalous vessels.
• Following embolization, the patient showed rapid improvement, including successful weaning from mechanical ventilation.

Conclusions:

• Percutaneous coil embolization is an effective treatment for aorto-pulmonary collaterals in neonates with TGA.
• This intervention can significantly improve postoperative outcomes, reducing the need for prolonged mechanical ventilation.
• Early diagnosis and management of these collaterals are crucial for successful surgical repair of TGA.