Major Aortopulmonary Collaterals in Transposition of the Great Arteries: A Cause for Preoperative and Postoperative Hemodynamic Imbalance

We describe a case of transposition of the great arteries (TGA) with significant aortopulmonary collateral vessels causing management difficulties before and after an arterial switch operation. Preoperatively, the presence of collaterals exacerbated aortic diastolic runoff and led to myocardial ischemia. Postoperatively, despite uneventful extubation, the infant developed clinical heart failure characterized by pericardial and pleural effusions and feeding difficulties, which promptly resolved with percutaneous embolization of collaterals. Major aortopulmonary collaterals are rarely associated with TGA, but if present they may cause important hemodynamic imbalance in infants with TGA.