Postoperative appearance of tetralogy of Fallot with pulmonary atresia
after RV-PA conduit (pulmonary homograft) repair, unifocalization of the
MAPCAs, and angioplasty of the bilateral pulmonary arteries in a
14-year-old boy. (A) Sagittal oblique maximum intensity
projection (MIP) CT image shows a VSD patch (black arrow).
(B) Sagittal oblique and (C) axial oblique
MIP CT images show RV-PA conduit with multifocal degenerative
calcifications in conduit wall. Patent stents are observed in the LPA
and RPA (yellow arrow). Stent placement was performed to relieve
recurrent branch PA stenosis. (D) Axial oblique MIP CT
image shows a stent in the osteoproximal RPA. Another good-sized vessel
is observed arising from the RPA which has a unifocalized MAPCA attached
to it (white arrow). (E) Sagittal oblique multiplanar
reconstruction and (F) volume-rendered images show the
origin of the unifocalized MAPCA (white arrow) just proximal to the RPA
stent (black arrow in E, white arrow in F).
Severe stenosis is noted in the osteoproximal segment of the
unifocalized MAPCA. Ao = aorta, C = conduit, LPA = left PA, LV = left
ventricle, MAPCA = major aorto-pulmonary collateral arteries, PA =
pulmonary artery, RPA = right PA, RV = right ventricle, VSD =
ventricular septal defect.