Major aortopulmonary collateral artery coiling in tetralogy of Fallot: A critical intervention to modulate pulmonary circulation and enable effective surgical repair

Major aortopulmonary collateral arteries (MAPCAs) are nonregressed embryological connections present in patients with cardiac anomaly with compromised antegrade pulmonary flow such as tetralogy of Fallot. Depending on their angioarchitecture, they may be essential or nonessential and can affect the outcome of definite surgical repair in these patients in terms ranging from intraoperative difficulties to postoperative heart failure. Endovascular embolization of nonessential MAPCAs is a good option to manage these postoperative complications or for ease of doing surgery in a preoperative setting. Here is a case demonstrating preoperative endovascular embolization of nonessential MAPCAs with good surgical outcome.