Cannot Extubate a Newborn Patient after an Arterial Switch Operation? Check Major Aortopulmonary Collaterals!

Abstract The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.摘要 大动脉转位（transposition of the great arteries）的标准治疗方案为动脉调转术（arterial switch operation, ASO）。尽管手术矫正成功，术后患者仍无法耐受拔管。主-肺侧支循环（major aortopulmonary collaterals, MAPCAs）可引发显著血流动力学改变，是导致机械通气时长延长的罕见病因之一。本文报道1例28日龄大动脉转位合并室间隔缺损（ventricular septal defect, VSD）患儿，该患儿接受了动脉调转术联合室间隔缺损修补术。术后两次拔管失败后，心导管检查发现4支粗大主-肺侧支循环。经导管封堵该4支侧支循环后，患儿成功拔管，并于该操作后27日出院。