Aneurysmally dilated major aorto-pulmonary collateral in tetralogy of Fallot

Abstract

Haemodynamically significant systemic-to-pulmonary artery collaterals may present as a cause of cardiorespiratory compromise in tetralogy of Fallot (TOF) with pulmonary atresia. We present here a case of TOF with pulmonary atresia with aneurysmally dilated aorto-pulmonary collateral causing compression over trachea, presenting as dry irritating cough who died suddenly with haemoptysis probably due to rupture of hypertrophied bronchial collaterals or direct erosion of large major aorto-pulmonary collateral arteries (MAPCA) into the respiratory tract.

Ruptured aneurysm of major aortopulmonary collateral artery: management using amplatzer vascular plug

“…Occasionally they may arise from the abdominal aorta or uncommonly from other systemic arteries such as carotid or coronary arteries (5). Aneurysmal dilatation of MAPCA has been described which may occasionally cause symptoms due to the compression of adjacent structures (1). It may also cause life threatening hemoptysis due to rupture or even death (1,2).…”

“…Aneurysmal dilatation of MAPCA has been described which may occasionally cause symptoms due to the compression of adjacent structures (1). It may also cause life threatening hemoptysis due to rupture or even death (1,2). These collaterals may also predispose to pleural effusions (6).…”

“…Pulmonary atresia and ventricular septal defect (PA-VSD) belong to a group of congenital cardiac malformations and is usually associated with presence of major aortopulmonary collateral arteries (MAPCAs). Aneurysmal dilatation of MAPCAs has also been described and may be associated with compression of adjacent structures, persistent pleural effusions, hemoptysis and sudden death (1,2). Elective curative management usually involves staged approach which provides individualized treatment by matching the approach to the specific anatomy and physiology of each patient.…”

Left Main Bronchus Compression Due to Main Pulmonary Artery Dilatation in Pulmonary Hypertension: Two Case Reports

“…Our review of the literature found 2 cases of tracheobronchial compression from dilated pulmonary arteries in adults. Symptomatic tracheobronchial compression was reported in an 18-year-old female with newly diagnosed absent pulmonary valve syndrome, 14 and asymptomatic left bronchial compression was reported in a 55-year-old male with chronic thromboembolic disease and congenital pulmonary stenosis with consequent pulmonary arterial dilatation. 15 Left main coronary artery compression and left recurrent laryngeal nerve compression are otherwise well-reported complications of pulmonary arterial dilatation.…”

“…9 In adults, patients are likely to be unsuitable for surgical intervention. In the 2 cases previously reported in the literature, one patient died soon after diagnosis, 14 and the other managed with pulmonary vasodilators. 15 Endobronchial stenting has not been performed.…”