Clinical study of incidence of significant major aorto pulmonary collateral arteries in patients of TOF and its correlation with pulmonary artery anatomy
Abstract
Introduction: Tetralogy of Fallot (TOF) with hypoplastic pulmonary arteries and major aorto pulmonary collateral arteries (MAPCAs) is the most extreme variant of TOF. MAPCAs are frequently present and the main source of pulmonary flow in patients with TOF with hypoplastic arteries in the absence of patent ductus arteriosus (PDA).
Objective: To study the incidence of significant MAPCAs in patients of TOF and its correlation with pulmonary artery anatomy.
Patients and Methods: This prospective study has been conducted on a cohort of 100 consecutive TOF patients of 0-15 years of age. All the clinical and demographic parameters were collected. Two dimensional ECHO and CT pulmonary angiography was performed to define PA anatomy and MAPCAs morphology. Cardiac catheterization was performed as and when required. All the patients selected for the study, had PDA absent.
Results: A total 56 patients had MAPCAs. Hypoplastic LPA was observed in 31 patients, of which 27 (87%) had significant MAPCAs, and hypoplastic RPA was found in 46 patients with 40 (87%) having significant MAPCAs. The mean diameter found was 5.78 ± 3.52 mm. Direct arborization pattern was observed in 45 patients. The mean oxygen saturation was 76.72 ± 7.
Conclusion: Patients with TOF and hypoplastic pulmonary arteries had significant incidence of MAPCAs. The majority had MAPCAs with direct origin from descending aorta and larger diameter. A statistically significant difference was observed in the oxygen saturation levels in patients with and without MAPCAs.
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References
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