Major Aorto Pulmonary Collateral Arteries (MAPCA) with Tetralogy of Fallot and Pulmonary Artesia in Middle Age Adult: a Rare Finding.

A forty four years old male patient presented with headache and dizziness in our outpatient department. On examination, he had pulse rate of 96 /min, blood pressure of 122/80 mmHg, JVP was not raised. He had clubbing and cyanosis on General physical examination. On auscultation pansystolic murmur was heard all over the chest. His respiratory and abdominal examination was normal. There were no significant findings on electrocardiography and skiagram chest. Echocardiography revealed ventricular septal defect with overriding of aorta, pulmonary artery could not be visualised. On computrized tomography pulmonary angiography revealed Ventricular septal defect with overriding of aorta. The main and normally confluent right and left pulmonary arteries were not visualized. On left side there was large MAPCA arising from descending thoracic aorta at D8 level and dividing into upper and lower lobar arteries and segmental branches were seen. On right side there were three large MAPCAS seen arising from (i) proximal right subclavian artery (supplying the rt upper lobe), (ii) arch of aorta (at D5 level supplying right middle and lower lobes), (iii) descending thoracic aorta (at D7, D8 level supplying right lower lobe) respectively were seen. Inferior vena cava and pulmonary veins were normal. (Figure 1 and 2) Rest of examination was normal.