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Eur J Cardiothorac Surg 2006;29:643-644
© 2006 Elsevier Science NL

Editorial

MAPCAs, bronchials, monkeys, and men

Stanford University Medical Center, Stanford, CA 94305-5407, USA

^_* Corresponding author. Tel.: +1 650 7242925; fax: +1 650 7253846. (Email: fhanley@stanford.edu).

The first 20% of the full text of this article appears below.

In this edition of the journal, Norgaard et al. [1] make their case that the major aorto-pulmonary collateral arteries (MAPCAs) found in patients with pulmonary atresia with ventricular septal defect are in fact nothing more than dilated bronchial arteries. The authors are to be commended both for tackling the difficult subject of the origin of these unusual vessels, and for taking a very creative approach in their study design and analysis. Their findings, although far from conclusive, suggest some similarities between the ‘road maps’ of the large number MAPCAs that they evaluated, and those of normal bronchial arteries, with respect to site of origin, total number of arteries per patient, course and branching patterns, and destination within the lungs. These observations alone make this an interesting study.

It is a far cry, however, to say that just because these two categories of arteries have some, or even significant, similarities, that they are the same entity, or as specifically stated by the authors, MAPCAs are dilated and hypertrophied bronchial arteries. The story is much more complex than that.

MAPCAs and bronchial arteries are vessels that we find in fully developed individuals, and like all fully differentiated tissues, each arose developmentally from primordial tissue in the early embryo. It may well be that the one valid finding in the Norgaard study is that MAPCAs and bronchial arteries share a common primordial vascular origin, but I am getting ahead of myself. Let us . . . [Full Text of this Article]