EFFECT OF EMBOLIZATION OF MAJOR AORTOPULMONARY COLLATERAL ARTERIES ONCARDIOPULMONARY CIRCULATION IN CONGENITAL HEART-DISEASE - ASSESSMENT WITH LUNG PERFUSION SCAN
Y. Okuda et al., EFFECT OF EMBOLIZATION OF MAJOR AORTOPULMONARY COLLATERAL ARTERIES ONCARDIOPULMONARY CIRCULATION IN CONGENITAL HEART-DISEASE - ASSESSMENT WITH LUNG PERFUSION SCAN, Vascular surgery, 29(3), 1995, pp. 199-207
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 pe
rfusion via the central pulmonary artery. The authors performed coil e
mbolization of MAPCAs communicating with the central pulmonary artery
or its branches in 3 patients aged from three to fifteen years (2: tet
ralogy of Fallot, 1: pulmonary atresia with ventricular septal defect)
. On chest roentgenogram, the cardiac size diminished after embolizati
on in 2 subjects owing probably to decreased systemic-to-pulmonary blo
od flow. The pulmonary perfusion scintigram with Tc 99m macroaggregate
d albumin.-was performed before and after embolization, Before emboliz
ation, multiple segmental or lobar perfusion defects or hypoperfusion
areas were observed in all cases. After embolization, however, the sci
ntigrams unexpectedly did not show any improvement. These results sugg
est that the occlusion of MAPCAs is effective in decreasing systemic-t
o-pulmonary blood flow but not effective in increasing lung perfusion.
The authors speculate that obliterative and irreversible pulmonary va
scular damages might have occurred in all cases.