TITLE:
Unexpected Increase in Arterial to End-Tidal CO2 Gradient in a Child Undergoing Embolization of MAPCAs
AUTHORS:
Saifeldin A. Mahmoud, Khaled A. Sedeek, Patrick M. McQuillan
KEYWORDS:
Multiple Aorto-Pulmonary Collateral Arteries (MAPCAs), Pa-etCO2 Gradient, Ventilation-Perfusion (V/Q) Relationship
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.7 No.3,
March
29,
2017
ABSTRACT: A 17-month-old infant with multiple aorto-pulmonary collateral
arteries (MAPCAs) and pulmonary hypertension presented for diagnostic
catheterization. On the day of the procedure, the infant was asymptomatic with
oxygen saturation in the 90’s on 1.0 L/min O2 nasal cannula. His
parents denied any recent illness. During the procedure, one coil was
inadvertently embolized into the right lung resulting in markedly increased
pulmonary artery pressures. The Pa-etCO2 gradient increased to 25
mmHg from a baseline of 2 mmHg. Therapy was initiated to reduce the PaCO2.
The patient could not be weaned from mechanical ventilation due to elevated PA
pressures.