Major Aortopulmonary Collateral Artery as a Rare Cause of Heart Failure in a Neonate with Transposition of the Great Arteries: An Unexpected Turn in an Otherwise Routine Case

The association of a major aortopulmonary collateral artery (MAPCA) with simple trans-position of the great arteries (TGA) is uncommon. Such high-flow lesions in the postoper-ative period following arterial switch operation (ASO) may lead to pulmonary hyperten-sion, pulmonary hemorrhage, heart failure (HF), failure to thrive and prolonged mechan-ical ventilation. We report a neonate who developed pulmonary overcirculation and HF in the early postoperative period due to a hemodynamically significant MAPCA. Although the association of MAPCA with simple TGA is infrequent, such lesions should be considered in cases of unexplained cardiovascular compromise following ASO. Fol-lowing transcatheter occlusion of the MAPCA with a vascular coil, rapid hemodynamic stabilization and subsequent extubation of the patient were achieved.