Dysphagia and feeding outcomes in paediatric patients with major aortopulmonary collateral arteries undergoing pulmonary artery intervention

BACKGROUND: Major aortopulmonary collateral arteries represent a complex subgroup of CHD with unique cardiopulmonary physiology. While surgical outcomes have been well described, feeding and swallowing outcomes remain poorly understood. This study aimed to characterise dysphagia prevalence and functional feeding outcomes in these paediatric patients undergoing pulmonary artery intervention. METHODS: We conducted a retrospective chart review of paediatric patients with major aortopulmonary collateral arteries at a tertiary paediatric cardiac centre between January 1, 2020, and December 31, 2025. Swallowing outcomes were assessed using the Penetration-Aspiration Scale, and functional feeding outcomes were measured using the Pediatric Functional Oral Intake Scale. Descriptive statistics were used to summarise patient characteristics and feeding outcomes. Pre- and post-intervention outcomes were compared among patients with paired data. RESULTS: Nineteen patients were included. Genetic diagnoses were present in 58% of the cohort, most commonly 22q11.2 deletion syndrome. Prolonged intubation occurred in 53% of patients, and vocal fold motion impairment and necrotising enterocolitis were each observed in 42%. Among patients with paired data, median Penetration-Aspiration Scale increased from 3 pre-operatively to 6 post-operatively, and aspiration was observed in 50% post-operatively. Enteral tube use increased from 57% pre-operatively to 79% post-operatively among patients with paired data. Persistent oral aversion at six months was documented in 26% of the cohort. CONCLUSION: Patients with major aortopulmonary collateral arteries demonstrate high rates of dysphagia and enteral feeding dependence across the perioperative period. Preliminary findings highlight the need for early, multidisciplinary feeding evaluation to optimise developmental outcomes in this high-risk population.