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Effect of Embolization of Major Aortopulmonary Collateral Arteries on Cardiopulmonary Circulation in Congenital Heart Disease

Assessment with Lung Perfusion Scan

Kan Takeda, M.D.

Tomoyasu Tagami, M.D.

Kaname Matsumura, M.D.

Maki Ooi, M.D.

Tsuyoshi Nakagawa, M.D.

Department of Radiology, Mie university School of Medicine, Mie, Japan

Major aortopulmonary collateral arteries (MAPCAs) may affect pulmonary hemodynamics significantly in patients with cyanotic congenital heart diseases. Occluding such collateral arteries is expected not only to diminish systemic-to-pulmonary shunt but also to increase pulmonary perfusion via the central pulmonary artery. The authors performed coil embolization of MAPCAs communicating with the central pulmonary artery or its branches in 3 patients aged from three to fifteen years (2: tetralogy of Fallot, 1: pulmonary atresia with ventricular septal defect). On chest roentgenogram, the cardiac size diminished after embolization in 2 subjects owing probably to decreased systemic-topulmonary blood flow. The pulmonary perfusion scintigram with Tc 99m macroaggregated albumin was performed before and after embolization. Before embolization, multiple segmental or lobar perfusion defects or hypoperfusion areas were observed in all cases. After embolization, however, the scintigrams unexpectedly did not show any improvement. These results suggest that the occlusion of MAPCAs is effective in decreasing systemic-to-pulmonary blood flow but not effective in increasing lung perfusion. The authors speculate that obliterative and irreversible pulmonary vascular damages might have occurred in all cases.

Vascular and Endovascular Surgery, Vol. 29, No. 3, 199-207 (1995)
DOI: 10.1177/153857449502900305


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