Aortopulmonary collateral arteries: a rare complication after arterial switch operation for transposition of the great arteries
A 1-day-old infant with a prenatal diagnosis of transposition of the great arteries was admitted to our unit. He was born at term, weighing 3.2 kg. He arrived in a stable condition, with saturations of 88%, on a prostaglandin infusion at a rate of 5 ng/kg per min in accordance with the prenatal plan. Echocardiogram demonstrated transposition of the great arteries with intact ventricular septum and usual coronary arrangement. There was adequate mixing via a moderate-sized atrial communication measuring 6 mm. In addition, there was a large persistent arterial duct with left-to-right shunting. Over the next 24 hours, the infant developed tachypnoea, poor systemic perfusion, and progressive metabolic acidosis. He was electively intubated and ventilated and commenced on ionotropes and antibiotics. Abdominal distension was noted without x-ray changes, and he was, therefore, started on prophylactic treatment for necrotizing enterocolitis. Repeat echocardiogram demonstrated the presence of major aortopulmonary collateral arteries in addition to a large persistent arterial duct and moderate atrial communication (Figure 1). A cardiac catheter was performed to further elucidate the nature of the collateral vessels and perform an atrial septostomy. At the time of catheter, 2 major aortopulmonary collaterals were identified. These were successfully occluded with 2 and 1 detachable Cook patent ductus arteriosus coils (3 mm 3 loop), respectively (Figure 2).