Isolated major aortopulmonary collateral artery causing CCF in a Newborn: A case report

A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance

“…There are multiple reports of infants with symptomatic systemic to pulmonary shunt despite ductal closure. Such cases may be more common than previously suspected .…”

“…Supporting the argument that SPC may be a consequence of CLD, similar to the hypoxia and hypoperfusion theories, a neonate with CLD may develop systemic‐to‐pulmonary shunts which may be relatively benign or can lead to congestive heart failure . However, large haemodynamically significant SPCs has been reported to cause prolonged ventilator dependency and/or clinical signs of heart failure with a coil occlusion resulting in subsequent clinical improvement, suggesting that congenital SPC could be a cause rather than an effect of CLD . In the only prospective study of SPC in preterm infants, Acherman et al concluded that the presence of SPC was associated with an increased need for postnatal steroid treatment for CLD, a longer duration of invasive ventilation and an increased length of stay when compared to infants with no SPC.…”

“…The SPC usually originates from the aorta but origin from the innominate , and internal mammary artery and even a coronary artery have been reported. At the pulmonary end, the connection could be peripheral as part of the embryonic connections, or more central into a branch pulmonary or the main pulmonary artery . The latter would make it difficult to differentiate from a PDA on echocardiography.…”

“…On the other hand, a SPC can mimic the clinical signs of a PDA such as a systolic murmur, wide pulse pressure, signs of cardiac failure and/or worsening lung disease . Haemodynamically significant left‐to‐right shunts such as PDA are believed to prolong the course of ventilator support in premature infants with respiratory distress syndrome and increase the risk of CLD .…”

“…In the 1980s, surgical ligation of the SPC had been the mode of SPC closure . However, more recently, coil or device occlusion has been widely used as the preferred treatment method if the SPC can be accessed by cardiac catheterisation (). SPCs that have been thought to be significant and required closure in the literature have varied from 1.5 to 4 mm in diameter .…”