[An integral approach for cyanotic congenital heart disease with major aortopulmonary collateral arteries].

OBJECTIVE

To demonstrate the feasibility of combined collateral embolization with surgical repair for tetralogy of Fallot or pulmonary atresia with major aorta pulmonary collateral arteries.

METHODS

The clinical, catheterization and surgical data of 15 such patients from November 1992 to September 2003 were analyzed retrospectively.

RESULTS

All 15 patients underwent combined therapy of major-aorto pulmonary collateral arteries (MAPCAs) occlusion and complete repair with a mortality of 26.7%. Of the 46 collateral arteries, 35 were occluded with a successful rate of 90.6%. Embolization was performed before corrective surgery in 12 patients. The causes of early death in three patients were low cardiac output syndrome, pulmonary hemorrhage, and pulmonary infarction respectively. Complications included extensive pulmonary infiltration in 1 patient and right ventricular dysfunction in another patient. The other 7 patients recovered smoothly with the arterial oxygen saturation greater than 97% at discharge. Embolization was performed after corrective surgery in 3 patients with postoperative congestive heart failure. One patient died of congestive heart failure. The symptoms and signs of heart failure was significently relieved in the other two cases.

CONCLUSIONS

In selective group of patients with dual pulmonary blood supply by both MAPCA and native pulmonary arteries, this combined therapy of collateral embolization and surgical repair simplifies complete surgical operation and enhances surgical results. It is necessary to minimize the error in distinguish sole pulmonary blood supply from dual pulmonary blood supply to avoid postoperative pulmonary infarction. Embolization after surgical correction is an important rescue measurement to congestive heart failure.