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Ann Thorac Surg 2006;82:153-157
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Clinical Implications of Major Aortopulmonary Collateral Arteries in Patients With Right Isomerism

Jui-Yu Hsu, MD a , b , Jou-Kou Wang, MD, PhD a , Ming-Tai Lin, MD a , En-Ting Wu, MD a , * , Sheunn-Nan Chiu, MD a , Chun-An Chen, MD a , Hung-Chi Lue, MD, PhD a , Mei-Hwan Wu, MD, PhD a

a Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
b Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan

Accepted for publication February 6, 2006.

* Address correspondence to Dr Mei-Hwan Wu, Department of Pediatrics, National Taiwan University, No. 7 Chung-Shan South Road, 100 Taipei, Taiwan (Email: mhwu{at}ha.mc.ntu.edu.tw).

BACKGROUND: The presence of major aortopulmonary collateral arteries (MAPCA) in patients with right isomerism may alter the prognosis, which is still unclear.

METHODS: From 1994 to 2003, 138 out of 155 patients (89%) with right isomerism had pulmonary stenosis or pulmonary atresia and constituted the study population.

RESULTS: Two groups of patients were identified, one with MAPCA and the other without. The MAPCA originating from descending thoracic aorta or aortic arch was noted in 9 patients (6.5%), with a median number of MAPCA being 3 (range, 2 to 4). Patients with MAPCA commonly had congestive heart failure (8/9, 89%) and frequent lower airway infection (6/9, 67%). In comparison with patients with MAPCA and without, the intrapericardial pulmonary artery was more frequently absent (2 of 9 vs 1 of 129, p < 0.001), and the pulmonary arterial size was smaller (McGoon ratio <1.5, 8 of 9 vs 57 of 129, p = 0.009) in the MAPCA group. The mean pulmonary arterial pressure measured was often higher than the suggested limit for Fontan circulation. Major aortopulmonary collateral arteries were addressed at a median of 6 months old (2 to 19 months old) in 5 patients. Although surgical mortality was not different for first-stage palliation and Glenn shunt in both groups, total cavopulmonary connection could only be performed in one patient with MAPCA with poor results. However, the 5-year survival of patients with and without MAPCA was not statistically different (74.1% vs 55.2%, p = 0.19).

CONCLUSIONS: The presence of MAPCA was uncommon but still noted in patients with right isomerism. It may cause heart failure and a less favorable pulmonary vasculature for a complete Fontan-type operation.






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