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Anatomy of the retro-oesophageal major aortopulmonary collateral arteries in patients with pulmonary atresia with ventricular septal defect: results from preoperative CTA

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A Correction to this article was published on 07 May 2018

This article has been updated

Abstract

Objectives

To assess the frequency and anatomy of retro-oesophageal aortopulmonary collateral arteries (REMs) in patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD-MAPCAs).

Methods

A total of 130 consecutive PA-VSD-MAPCA patients with preoperative CT angiography (CTA) data who underwent cardiac surgery were included. A detailed analysis of MAPCA anatomy was performed using CTA.

Results

A REM was identified in 82/130 included patients (63 %). A total of 277 MAPCAs were observed in these 82 patients and were divided into groups based on REM status: REM (n=94) and non-REM (n=183). Compared with non-REMs, REMs originated at a lower level and tended to originate from the lateral side of the aorta (all p<0.01). REMs had a higher probability of suffering stenosis (χ2=9.79, p<0.01), particularly midsegment stenosis (χ2=6.27, p=0.01). REMs were more posterior to the bronchus at the pulmonary hilum than non-REMs (91 % vs. 51 %) (χ2=50.81, p<0.01).

Conclusions

REMs are associated with a lower level, more lateral origin, stenosis and more posterior location with respect to the bronchus at the pulmonary hilum. The unique CTA data obtained in this study showing the anatomy of REMs will be highly useful for surgeons in identifying REMs.

Key Points

Unifocalization is a very important surgical approach for PA-VSD-MAPCA patients.

The anatomical variability of REMs becomes clinically relevant in unifocalization.

CTA provides a non-invasive way to observe the anatomy of REMs.

REMs are associated with lower level, more lateral origin, more midsegment stenosis.

REMs tend to be posterior to the bronchus at the pulmonary hilum.

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Change history

  • 07 May 2018

    The original version of this article, originally published online ahead of printing on January 05, 2018, unfortunately contained mistakes.

Abbreviations

CA:

Conventional angiography

MAPCAs:

Major aortopulmonary collateral arteries

PA:

Pulmonary atresia

REM:

Retro-oesophageal major aortopulmonary collateral artery

RVOTR:

Right ventricular outflow tract reconstruction

VSD:

Ventricular septal defect

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Funding

This work was supported by the National Natural Science Foundation of China (no. U1401255), the National 11th and 12th Five-Year Support Projects of China (no.2006BAI01A08 and 2011BAI11B22), Guangdong International Cooperative Project of China (no. 2014A050503048), Guangdong Provincial Key Laboratory of South China Structural Heart Disease (no. 2012A061400008), Guangdong Province Science and Technology Planning Project of China (no. 2009B030801257, no. 2013B031800006, no.2014A020212228) and Guangzhou City Science and Technology Planning Project of China (no. 201510010255).

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Correspondence to Meiping Huang or Changhong Liang.

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Guarantor

The scientific guarantor of this publication is Changhong Liang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Jia, Q., Cen, J., Li, J. et al. Anatomy of the retro-oesophageal major aortopulmonary collateral arteries in patients with pulmonary atresia with ventricular septal defect: results from preoperative CTA. Eur Radiol 28, 3066–3074 (2018). https://doi.org/10.1007/s00330-017-5224-y

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  • DOI: https://doi.org/10.1007/s00330-017-5224-y

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