PMC3959058_01
Preoperative angiography with 5F pigtail catheter in descending thoracic aorta (DTA) shows a large aortopulmonary collateral (APC) filling of both the right and left pulmonary arteries (RPA and LPA, respectively). Arrow points to the atretic pulmonary valve
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F1
Cardiac catheterization prior to surgical repair showed bilateral confluent adequate size pulmonary arteries filling through multiple large APCs from the descending thoracic aorta (DTA) [Figure 1] and the child underwent gel foam/coil embolization of multiple APCs.
Postoperative digital substraction angiography (DSA) with 4F Cobra catheter in the ostium of APC shows persistent filling of bilateral pulmonary arteries from this vessel
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F2
However, no diagnostic or guiding catheter could be advanced across the ostium of the collateral due to the severe angulation [Figures 2 and 3].
DSA image (45 degree left anterior oblique (LAO) projection) showing the severe angulation (arrow) of the APC after its origin from the aorta
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F3
However, no diagnostic or guiding catheter could be advanced across the ostium of the collateral due to the severe angulation [Figures 2 and 3].
DSA image showing placement of Amplatzer TorqVue delivery system via the right femoral vein across the right atrium (RA), right ventricle (RV), and pulmonary valve, RPA into the DTA through the APC
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F4
USA) was advanced with difficulty from the venous side through the conduit, pulmonary artery, collateral, and then into the DTA [Figure 4]. Using this sheath, a 10 x 8 mm
DSA image (LAO projection) showing successfully deployed ADO device in the APC with no flow across the device
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F5
ADO device was deployed in the APC successfully. Angiography showed good position of the device with no flow across the APC into the pulmonary artery [Figure 5].