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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A six-year-old girl&#44; native of Guinea-Bissau&#44; with a history of dyspnea on minimal exertion&#44; recurrent respiratory infections and poor weight gain&#44; was admitted to a reference center due to suspected tetralogy of Fallot with a view to possible surgery&#46; Physical examination revealed central cyanosis with digital clubbing&#59; oxygen saturation was 30&#8211;50&#37; on pulse oximetry and pulmonary auscultation showed no murmur and normal pulses&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The echocardiogram revealed complex cyanotic heart disease including transposition of the great arteries &#40;TGA&#41;&#44; pulmonary atresia&#44; a large interventricular communication and systemic-pulmonary collateral arteries&#46; No pulmonary arteries were visible but there was a persistent left superior vena cava with dilated coronary sinus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Cardiac catheterization confirmed the existence of collaterals originating from the supra-aortic trunks&#44; the absence of central pulmonary arteries&#44; and left juxtaposition of the atrial appendages &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; Computed tomography angiography revealed three major aortopulmonary collateral arteries &#40;MAPCAs&#41;&#44; one of which originated from the upper portion of the aortic arch&#44; with severe stenosis at its origin and dilatation more proximally&#46; It also showed absence of the pulmonary arteries&#44; a 25-mm interventricular communication&#44; and normal drainage of the pulmonary veins into the left atrium &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The authors present a rare case of complex heart disease&#44; diagnosed late&#44; which remains a common problem in less developed countries&#46; The presence of MAPCAs allowed the patient to survive&#44; but their natural evolution to stenosis led to progressive worsening of the patient&#39;s condition&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical repair in this case will depend on unifocalization of the MAPCAs&#44; which will be a highly complex operation due to the complete absence of the pulmonary arteries and the presence of TGA&#46; The prognosis is accordingly reserved&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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