Repair of Untreated Older Patients With Tetralogy of Fallot With Major Aortopulmonary Collaterals

Background: Surgical repair of tetralogy of Fallot and major aortopulmonary collaterals (TOF/MAPCAs) involves unifocalization of MAPCAs and reconstruction of the pulmonary arterial circulation. Surgical and cardiopulmonary bypass (CPB) times are long and suture lines are extensive. Maintaining patency of the newly anastomosed vessels while achieving hemostasis is important, and assessment of transfusion practices is critical to successful outcomes. Methods: Clinical, surgical, and transfusion data in patients with TOF/MAPCAs repaired at our institution (2013-2018) were reviewed. Types and volumes of blood products used in the perioperative period, in addition to the use of antifibrinolytics and/or procoagulants (factor VIII inhibitor bypassing activity [FEIBA]; anti-inhibitor coagulant complex), were assessed. Outcome measures included days on mechanical ventilation (DOMV), postoperative intensive care unit and hospital length of stay (LoS), and incidence of thrombosis. Results: Perioperative transfusion data from 279 patients were analyzed. Surgical (879 ± 175 minutes vs 684 ± 257 minutes) and CPB times (376 ± 124 minutes vs 234 ± 122 minutes) were longer in patients who received FEIBA than those who did not. Although the indexed volume of packed red blood cells (128.4 ± 82.2 mL/kg) and fresh frozen plasma (64.2 ± 41.1 mL/kg) was similar in patients who did and did not receive FEIBA, the amounts of cryoprecipitate (5.5 ± 5.2 mL/kg vs 5.8 ± 4.8 mL/kg) and platelets (19.5 ± 20.7 mL/kg vs 20.8 ± 13 mL/kg) transfused were more in those who did receive FEIBA. Conclusion: Perioperative transfusion is an important component in the overall surgical and anesthetic management of patients with TOF/MAPCAs. The intraoperative use of FEIBA was not associated with a decrease in the amount of blood products transfused, DOMV, or LoS or with an increase in thrombotic complications.

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Postoperative Respiratory Failure in Children With Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e318272062b ◽

2013 ◽

Vol 14 (4) ◽

pp. 384-389 ◽

Cited By ~ 17

Author(s):

Ritu Asija ◽

Frank L. Hanley ◽

Stephen J. Roth

Keyword(s):

Respiratory Failure ◽

Tetralogy Of Fallot ◽

Pulmonary Atresia ◽

Postoperative Respiratory Failure ◽

Aortopulmonary Collaterals ◽

Major Aortopulmonary Collaterals

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Use of pre-intervention imaging with a novel image fusion software for guidance of cardiac catheterisation in a patient with pulmonary atresia and major aortopulmonary collaterals

Cardiology in the Young ◽

10.1017/s1047951116000895 ◽

2016 ◽

Vol 26 (7) ◽

pp. 1438-1440 ◽

Cited By ~ 3

Author(s):

Sebastian Goreczny ◽

Pawel Dryzek ◽

Tomasz Moszura

Keyword(s):

Image Fusion ◽

Ct Scan ◽

Tetralogy Of Fallot ◽

Pulmonary Atresia ◽

Cardiac Catheterisation ◽

Two Dimensional ◽

Heart Catheterisation ◽

Aortopulmonary Collaterals ◽

Selective Cannulation ◽

Major Aortopulmonary Collaterals

AbstractWe present a 3.5-year-old patient with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals, after repeat implantation of a central shunt, in whom we successfully re-purposed previous imaging scans with a novel image fusion software to guide diagnostic heart catheterisation. The pre-registered CT scan was segmented before the procedure and subsequently manually fused with two-dimensional fluoroscopy images. The overlaid roadmap enhanced selective cannulation of all major vessels originating from the aorta, making aortography unnecessary.

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Tetralogy of Fallot with pulmonary atresia associated with aortopulmonary window and major aortopulmonary collaterals

Cardiology in the Young ◽

10.1017/s1047951100003115 ◽

1995 ◽

Vol 5 (3) ◽

pp. 289-290 ◽

Cited By ~ 1

Author(s):

A. R. Bhagwat ◽

R. J. Pinto ◽

Satyavan Sharma

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Atresia ◽

Postoperative Recovery ◽

Aortopulmonary Window ◽

Descending Thoracic Aorta ◽

Additional Source ◽

Collateral Arteries ◽

Arterial Blood ◽

Aortopulmonary Collaterals ◽

Major Aortopulmonary Collaterals

SummaryWe report a patient with tetralogy of Fallot and pulmonary atresia in whom the predominant extracardiac supply of arterial blood was via an aortopulmonary window. Major aortopulmonary collateral arteries originating from the descending thoracic aorta provided an additional source of pulmonary blood flow. The patient underwent successful correction and the postoperative recovery was uneventful.

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Tetralogy of Fallot with Major Aortopulmonary Collaterals: Early Total Repair

Pediatric Cardiology ◽

10.1007/s002469900312 ◽

1998 ◽

Vol 19 (4) ◽

pp. 289-296 ◽

Cited By ~ 36

Author(s):

D.B. McElhinney ◽

V.M. Reddy ◽

F.L. Hanley

Keyword(s):

Tetralogy Of Fallot ◽

Aortopulmonary Collaterals ◽

Major Aortopulmonary Collaterals

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Clinical Study to Individual Treatment for Major Aortopulmonary Collaterals of Tetralogy of Fallot

BioMed Research International ◽

10.1155/2019/1603712 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Qing Guan ◽

Jiarong Li ◽

Kai Deng ◽

Xiaoming Wu ◽

Shiyuan Tang ◽

...

Keyword(s):

Retrospective Study ◽

Prospective Study ◽

Tetralogy Of Fallot ◽

Large Population ◽

Individual Treatment ◽

K Value ◽

Aortopulmonary Collaterals ◽

Resident Time ◽

The Individual ◽

Major Aortopulmonary Collaterals

Objectives. To build a guideline for the individual treatment of Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) and tentatively establish the occlusion index of MAPCAs. Methods. According to the diameter of the aortopulmonary collaterals (R: mm) and the bodyweight of the children (weight: kg), K= ((∑R2)/Wt) was set as the occlusion index of TOF with MAPCAs. A retrospective study was initially performed in 171 patients who suffered from TOF with MAPCAs and underwent cardiac malformation repair to investigate the intervals of the K value: K≥2, 1<K<2, and K≤1. In order to examine the reliability of the intervals derived from the retrospective study, a prospective study was conducted in the following 209 cases. When K≥2, the collaterals occlusion was performed immediately behind surgical corrections. The postoperative condition changes in patients with 1<K<2 were observed first and managed by extending mechanical ventilation, while taking further treatments as their conditions worsen. As for patients with K≤1, no occlusion was performed. Finally, the circumstances of collaterals occlusion, postoperative ventilator assist time, and ICU resident time were collected and analyzed. Result. The proportion of the patients treated with occlusion and the postoperative ICU resident time (p<0.05) in patients with 1<K<2 in the prospective study did dramatically decrease when compared with those of the retrospective studies. Conclusion. Due to restrictions on medical conditions in China with a large population base, a standard individual treatment of TOF with MAPCAs should be established based on the Aortopulmonary Collaterals Occlusion Index K= ((∑R2)/Wt), which can effectively avoid unnecessary collateral occlusion, minimize trauma, and shorten the length of ICU and hospital stay. When K≥2, the collateral occlusion and surgical correction are recommended to be performed simultaneously. When 1<K<2, whether to occlude collaterals depends on the patients’ postoperative conditions with extending ventilator time. When K≤1, do not deal with collaterals.

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Postoperative feeding problems in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing unifocalisation surgery

Cardiology in the Young ◽

10.1017/s1047951118001270 ◽

2018 ◽

Vol 28 (11) ◽

pp. 1329-1332

Author(s):

Andrew M. Koth ◽

Charlotte Sakarovitch ◽

Douglas R. Sidell ◽

Lisa M. Schultz ◽

Allison Freccero ◽

...

Keyword(s):

Mechanical Ventilation ◽

Tetralogy Of Fallot ◽

Prolonged Mechanical Ventilation ◽

Pulmonary Atresia ◽

Feeding Tube ◽

Tube Placement ◽

22Q11 Deletion ◽

Feeding Problems ◽

Aortopulmonary Collaterals ◽

Major Aortopulmonary Collaterals

AbstractBackgroundPatients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals are at risk for prolonged hospitalisation after unifocalisation. Feeding problems after congenital heart surgery are associated with longer hospital stay. We sought to determine the impact of baseline, intra-operative, and postoperative factors on the need for feeding tube use at the time of discharge.MethodsWe included patients with the aforementioned diagnosis undergoing unifocalisation from ages 3 months to 4 years from 2010 to 2016. We excluded patients with a pre-existing feeding tube. Patients discharged with an enteric tube were included in the feeding tube group. We compared the feeding tube group with the non-feeding-tube group by univariable and multi-variable logistic regression.ResultsOf the 56 patients studied, 41% used tube feeding. Median age and weight z-score were similar in the two groups. A chromosome 22q11 deletion was associated with the need for a feeding tube (22q11 deletion in 39% versus 15%, p=0.05). Median cardiopulmonary bypass time in the feeding tube group was longer (335 versus 244 minutes, p=0.04). Prolonged duration of mechanical ventilation was associated with feeding tube use (48 versus 3%, p=0.001). On multi-variable analysis, prolonged mechanical ventilation was associated with feeding tube use (odds ratio 10.2, 95% confidence intervals 1.6; 63.8).ConclusionAmong patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals who were feeding by mouth before surgery, prolonged mechanical ventilation after unifocalisation surgery was associated with feeding tube use at discharge. Anticipation of feeding problems in this population and earlier feeding tube placement may reduce hospital length of stay.

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