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Frequency of Major Aorto-Pulmonary Collaterals in Patients with Tetralogy of Fallot in Our Patients

Syed Najam Hyder*, Gul Afshan, Tehmina Kazmi, Usaid Qurashi

Introduction: Major Aortopulmonary Collateral Arteries (MAPCAs) are blood vessels that bring systemic blood flow to the pulmonary arteries, are a complex and heterogeneous condition. They develop in response to decreased pulmonary blood flow and cyanosis. Our institutional approach to this lesion emphasizes early management before complete repair.

Objectives: To determine the frequency of major aorto-pulmonary collaterals in patients with tetralogy of fallot in our patients.

Materials and Methods: Cross sectional retrospective study planed in Children's Hospital and ICH Lahore, from January 2010 to December 2018. All children having Tetralogy of Fallot form 1 year above enrolled in the study underwent standard cine-angiograms after obtaining written consent following basic laboratory workup and ethical committee approval. Data was analysed using SPSS version19.The frequency, median with range was calculated for ordinal and scalar variables due to non-normally distributed data. Student T test was applied to check any significant difference between various variables with p less than 0.05 considered as significant.

Results: 425 patients of tetralogy of fallot were enrolled and 398 completed cardiac catheterization. The median age was ± 6yrs with male predominance of 2.1:1. Confluent Branch pulmonary arteries were present in 395 (99%) children with 2 having disconnected LPA and 1 having PDA continuing as RPA. Pulmonary artery abnormalities seen in 72(18%) patients. 211(53%) patients had MAPCAs, while 88 (22.11%) had 2 or more MAPCAs. 195(92%) had hemodynamically significant MAPCAs i.e., supplying 3 or more lung segments.54 (28%) had small i.e., <1.33mm at origin caliber. 105 (54%) had moderate size i.e., 1.33-1.67mm and 36(18%) had large size i.e.,>1.67mm at origin caliber. 166 (57%) MAPCAs were mainly arising from descending aorta, 54(19%) arising from right Subclavian artery, 45 (16%) from left Subclavian artery. 14(5%) from right internal mammary artery and 9(3%) left internal mammary artery.

Conclusion: The frequencies of major aortopulmonary collateral arteries were quite high in our population. Diagnostic cardiac catheterization is still a relevant invasive diagnostic as well as therapeutic procedure in children with tetralogy of fallot.