Coil Closure of a Major Aortopulmonary Collateral Artery (MAPCA)

Coil closure of a major aortopulmonary collateral artery (MAPCA)

Coil closure of a major aortopulmonary collateral artery (MAPCA)
Coil closure of a major aortopulmonary collateral artery (MAPCA)

Sternal wires are seen, indicating that it is a post sternotomy case. A radio opaque coil is seen overlapping the posterior end of the left fourth rib, just below the medial end of the left clavicle on the X-ray. The appearance is suggestive of coil closure of a major aortopulmonary collateral artery, which remained patent after the surgical correction. A coil delivered into a patent ductus arteriosus is the differential diagnosis, which we expect to be at a lower level. Coil closure of patent ductus arteriosus or MAPCA remaining after surgery is a preferred method as it avoids an open surgical procedure.

The coil can be delivered under fluoroscopic control in a cardiac catheterisation laboratory, under local anesthesia with sedation or light general anesthesia. Using a bioptome to hold the coil prior to delivery gives a better control for accurate positioning of the coil. Check angiogram is needed after coil delivery to exclude residual shunt. Residual shunts can lead to hemolysis, hemoglobinuria and anemia. Patients are asked to check the colour of urine regularly and report if there is any colour change suggestive of hemoglobinuria. Residual shunts can be closed by further coils or device delivery. Only very rarely will they need a surgery for open closure in view of hemolysis due to residual shunt.