I found that the angiographic investigation of congenital heart disease was the most enjoyable of tasks. No more so than in Fallot pulmonary atresia, which even today can need angiography to fully show the pathology. In this case, I was hunting down the pulmonary collaterals. The first image shows an aortogram and there is an abnormal vessel coming off the right side of the lower thoracic aorta as well as something coming from the right subclavian artery.
This was the first case where I used a hydrophilic wire for subselective cannulation, rather than a tip deflector system. I found that a Gensisni or Cournand catheter with no braiding was best, and that the end hole should be large enough to take an 035 wire in preference to anything thinner. The image above shows the injection into a major aortopulmonary collateral artery (MAPCA) coming off the R subclavian, perfusing the right upper zone and communicating with a central pulmonary artery system which supplies the rest of the lungs apart from the right base.
Entry to the MAPCA from the descending aorta (above) was easy but the image was surprising. It passes upwards to end as a small leash of true bronchial arteries plus an artery to the right base (arrowed above and clearly coming from the bronchial leash on the image below). It seems larger than its distal perfusion warrants. It gives rise to most of the right lower thoracic intercostal arteries, something I do not think I have seen ever before in a MAPCA. Odd though it may be, I suspect this vessel is the old distal right aortic arch. This would explain the intercostals. Can anyone show us a similar artery? If so lets write it up!
