Pre-operative assessment of Major Aorto-Pulmonary Collateral Arteries (MAPCA): What the Surgeon wants to know.

Congress:

ECR 2020

Poster Number:

C-08085

Type:

Educational Exhibit

Keywords:

Not applicable, Congenital, Diagnostic procedure, CT-Angiography, Cardiovascular system, Cardiac, Arteries / Aorta

Authors:

J. Gaduputi¹, B. Nagabhushana Reddy², A. Goel³, P. Reddy², S. Viswamitra²; ¹Bangalore, Ka/IN, ²Bangalore/IN, ³SAHARANPUR, New Delhi/IN

DOI:

10.26044/ecr2020/C-08085

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08085

Fig. 1: Barbero-Marcial classification of pulmonary atresia with ventricular septal...

Fig. 2: Somerville classification of pulmonary atresia.

Fig. 3: Cardiac CT angiography axial image demonstrating MAPCA arising from descending...

Fig. 4: Cardiac CT axial image demonstrating a 4mm MAPCA, measuring 4.4 cm length, ...

Learning objectives

Aims and Objectives: ·To briefly illustrate the spectrum of MAPCAs. ·To discuss commonly encountered MAPCAs and their implication in surgical planning.

Background

INTRODUCTION: Pulmonary atresia with ventricular septal defect (VSD) belongs to a group of complex congenital cardiac malformations, characterized by lack of luminal continuity and blood flow from ventricle/pulmonary artery with variable sources of pulmonary blood supply and arborization abnormalities. The pulmonary blood supply in these anomalies can be derived from a variety of sources, including native pulmonary artery, patent ductus arteriosus and major aorto-pulmonary collaterals(MAPCA) with significant variability in pulmonary blood supply from patient to patient.As MAPCAs supply pulmonary circulation in congenital cardiac disease when...

Findings and procedure details

MAPCAs are persistent intersegmental arteries-persistence of the branches from the dorsal aorta. These normally regress during fetal life if there is an adequate flow to the native pulmonary arteries(5). These can arise from descending thoracic aorta, subclavian artery, aortic arch, ascending aorta, rarely from the abdominal aorta, intercostal and coronary arteries. Are they bronchial arteries? • MAPCAs do not branch in their mediastinal course and anastomose with the intrapulmonary arteries typically at or near the pulmonary hilum instead of in the periphery. •MAPCAs may accompany...

Conclusion

The surgical planning and managementof PA with VSD depends upon various parameters as disussed. Hence it is important for the cardiac imager to understand the significance and the need for appropriate description to guide the surgeons.

Personal information and conflict of interest

J. Gaduputi; 560054, KA/IN - nothing to disclose B. Nagabhushana Reddy; Bangalore/IN - nothing to disclose P. Reddy; Bangalore/IN - nothing to disclose A. Goel; Saharanpur, NEW DELHI/IN - nothing to disclose S. Viswamitra; Bangalore/IN - nothing to disclose

References

1.Murthy KS, Krishnanaik S, Coelho R, Punnoose A, Arumugam SB, Cherian KM. Median sternotomy single stage complete unifocalization for pulmonary atresia. Major aorto pulmonary collateral arteries and VSD: Early experience.Eur J Cardiothorac Surg.1999;16:21–5 2.Liu J, Li H, Liu Z , Wu Q , Xu Y. Complete Preoperative Evaluation of Pulmonary Atresia with Ventricular Septal Defect with Multi-Detector Computed Tomography. PLoS One2016;11:e0146380. doi:https://doi.org/10.1371/journal.pone.0146380 3.Walker C. M. et al. Bronchial Arteries: Anatomy, Function, Hypertrophy, and Anomalies. RadioGraphics 2015; 35:32–49 4.The value of dual-source multidetector-row computed tomography in...