Image in Cardiology
Giant major aortopulmonary collateral artery: A rare cause of heart murmur in newborns
Major aortopulmonary collateral artery (MAPCA) gigante – causa rara de sopro em recém-nascidos
Luís Martins
, Rita S. Oliveira, Patrícia Silva, Joana Marinho, Graça Sousa, Eduardo Castela
Corresponding author
Serviço de Cardiologia, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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"apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "Patrícia" "apellidos" => "Silva" ] 3 => array:2 [ "nombre" => "Joana" "apellidos" => "Marinho" ] 4 => array:2 [ "nombre" => "Graça" "apellidos" => "Sousa" ] 5 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Castela" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Major aortopulmonary collateral artery</span> (MAPCA) gigante – causa rara de sopro em recém-nascidos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 796 "Ancho" => 1000 "Tamanyo" => 105316 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Angiography of the aorta showing giant MAPCA (red arrow) emerging from the aorta and vascularizing the lower right lung, and venous drainage (blue arrow) to the right inferior pulmonary vein.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Major aortopulmonary collateral arteries (MAPCAs) are anomalous vessels that develop from the aorta or its main branches and supply the pulmonary parenchyma with oxygenated blood. They are usually associated with congenital heart disease and are rare in isolation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a newborn girl, full term, with no relevant history, in whom a III/VI murmur was detected on the left sternal border on the first day of life. At seven days a remote cardiology consultation raised the suspicion of right inferior pulmonary vein stenosis despite normal pulmonary artery systolic pressure. Echocardiography in the Hospital Pediátrico Carmona da Mota showed “an anomalous vessel draining into the right inferior pulmonary vein”.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At one month of age computed tomography angiography revealed a single MAPCA emerging from the celiac trunk to the right lung, draining into the right inferior pulmonary vein (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnostic and therapeutic catheterization at five months showed normal systemic and pulmonary pressures. Angiography of the pulmonary artery revealed branches of reasonable caliber and normal venous return with mixed perfusion of the right inferior pulmonary field by the pulmonary artery and the MAPCA (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>), while angiography of the aorta showed a wide collateral (7 mm), emerging from the celiac trunk to the right inferior lung (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). It was decided to embolize the collateral with a 10/7-mm Amplatzer Vascular Plug II, leaving a residual shunt (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient had a good clinical course with regular cardiological follow-up. She is currently two years old and has no shunt after three months of embolization, normal height, weight and development, and no clinical or echocardiographic signs of heart failure.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-14" "fechaAceptado" => "2014-02-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martins L, Oliveira RS, Silva P, et al. Giant major aortopulmonary collateral artery – causa rara de sopro em recém-nascidos. Rev Port Cardiol. 2014;33:483–485.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1175 "Ancho" => 1000 "Tamanyo" => 150039 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography angiography (three-dimensional reconstruction). Green arrow: major aortopulmonary collateral artery (MAPCA) emerging from the celiac trunk.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 748 "Ancho" => 1000 "Tamanyo" => 102846 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Angiography of the pulmonary artery showing vascularization of the right inferior pulmonary artery branch (red arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 796 "Ancho" => 1000 "Tamanyo" => 105316 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Angiography of the aorta showing giant MAPCA (red arrow) emerging from the aorta and vascularizing the lower right lung, and venous drainage (blue arrow) to the right inferior pulmonary vein.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 729 "Ancho" => 1000 "Tamanyo" => 93095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Post-procedural angiography of the aorta showing Amplatzer Vascular Plug II in the MAPCA.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001652/v2_201411090043/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000078/v2_201411090043/S2174204914001652/v2_201411090043/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001652?idApp=UINPBA00004E" ]
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| 2016 January | 91 | 18 | 109 |
| 2015 December | 85 | 11 | 96 |
| 2015 November | 70 | 17 | 87 |
| 2015 October | 75 | 12 | 87 |
| 2015 September | 71 | 15 | 86 |
| 2015 August | 55 | 8 | 63 |
| 2015 July | 51 | 7 | 58 |
| 2015 June | 40 | 3 | 43 |
| 2015 May | 47 | 4 | 51 |
| 2015 April | 64 | 10 | 74 |
| 2015 March | 69 | 10 | 79 |
| 2015 February | 50 | 10 | 60 |
| 2015 January | 46 | 12 | 58 |
| 2014 December | 63 | 12 | 75 |
| 2014 November | 50 | 14 | 64 |
| 2014 October | 88 | 24 | 112 |
| 2014 September | 80 | 23 | 103 |
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