Imaging and Transcatheter Treatments in PA/VSD/MAPCAs
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Angiography and transcatheter interventions play an integral role in the management of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collaterals (TOF/PA/MAPCAs). The role of angiography starts with a complete diagnostic investigation that delineates the anatomy of each source of pulmonary blood flow, as well as the vascular health of each segment of the lung. Transcatheter interventions are also used to eliminate unnecessary or potentially harmful sources of pulmonary blood flow, to maximize the health of the distal vasculature, and to optimize the anatomy after surgical repair has been completed. In addition, the majority of these patients will have a right ventricle-to-pulmonary artery conduit as part of their surgical repair, and this will require transcatheter interventions to treat conduit dysfunction in most patients. In this chapter, we will focus on the role of cardiac catheterization in the diagnostic evaluation of TOF/PA/MAPCAs and the role of transcatheter interventions as part of an integrated strategy to manage this complicated disease.