A Deep Dive Into Retroesophageal Major Aortopulmonary Collateral Arteries
Richard D Mainwaring1, L Mac Felmly1, Frank L Hanley1
1Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA.
World Journal for Pediatric & Congenital Heart Surgery
|July 27, 2023
Summary
Retroesophageal major aortopulmonary collateral arteries (MAPCAs) are common and usually require unifocalization. Mid-term follow-up shows that 95% of these surgically treated MAPCAs remain widely patent, indicating successful intervention.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Anatomy
Background:
- Major aortopulmonary collateral arteries (MAPCAs) exhibit significant anatomical variability.
- Retroesophageal MAPCAs course posterior to the esophagus and bronchus before lung entry.
Purpose of the Study:
- To review the anatomy, physiology, and surgical characteristics of retroesophageal MAPCAs.
- To analyze surgical outcomes and long-term patency of unifocalized retroesophageal MAPCAs.
Main Methods:
- Retrospective analysis of data from three institutional studies over ten years.
- Surgical identification and unifocalization of retroesophageal MAPCAs.
- Post-operative catheterization for patency assessment.
Main Results:
- Retroesophageal MAPCAs were identified in two-thirds of evaluated patients, more frequent with left arches.
- The majority (96%) of identified retroesophageal MAPCAs required unifocalization.
- At a median of 17 months post-surgery, 95% of unifocalized MAPCAs were patent (widely patent or stenotic).
Conclusions:
- Retroesophageal MAPCAs are a frequent finding and typically necessitate surgical unifocalization.
- Unifocalization of retroesophageal MAPCAs demonstrates excellent mid-term patency rates.
- Surgical management of these complex vessels leads to favorable long-term outcomes.
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