ABSTRACT
Aortopulmonary collaterals occur in a variety of congenital heart diseases, in chronic
pulmonary infection and abscesses, in association with lung tumors, and after multiple
pulmonary emboli. In patients with congenital cyanotic heart disease aortopulmonary
collaterals mainly occur in conditions with reduced pulmonary blood flow. We investigated
12 preterm low-birth-weight infants, gestational age 29.3 ± 3.3 weeks, with respiratory
failure who suffered from moderate to severe chronic lung disease after a period of
mechanical ventilation. All patients developed aortopulmonary collaterals after closure
of a patent ductus arteriosus. Aortopulmonary collaterals could be displayed clearly
by color Doppler echocardiography and originated mainly from the descending aorta
or the aortic arch. Hypoxic and hypercapnic episodes favored the development of aortopulmonary
collaterals, which disappeared after pulmonary hemodynamics and respiratory function
had improved. In only one patient coiling of a large collateral vessel had to be performed.
Systemic-to-pulmonary collateral vessels potentially aggravate chronic lung disease
by increasing collateral pulmonary blood flow and reducing lung compliance. We conclude
that aortopulmonary collaterals occur in bronchopulmonary dyspla-sia and can cause
major problems in ventilated premature infants. Echocardiographic evaluation is important
to prevent aggravation of chronic lung disease of infants at risk.
Keywords
Aortopulmonary collaterals - BPD - echocardiography - ductus arteriosus - chronic
lung disease - pulmonary hypertension
