Absent pulmonary valve syndrome with associated anomalies of the pulmonary blood supply

Anomalous origin of the right pulmonary artery from the ascending aorta accompanied by absent pulmonary valve syndrome and right-sided aortic arch: a rare case in adult congenital heart disease

We present a rare congenital heart disease in a 20-year-old man with anomalous origin of the right pulmonary artery from the ascending aorta, accompanied by absent pulmonary valve syndrome, and a right-sided aortic arch suspected initially in transthoracic echocardiography and subsequently confirmed by cardiac catheterisation and computed tomography angiography.

Unusual clinical presentation of rare adult survivors with a missing pulmonary valve associated with a missing left pulmonary artery

Tetralogy of Fallot with absent pulmonary valve syndrome is associated with absence of the left pulmonary artery in one-seventh of cases. Infants with this disorder commonly present very early in life with respiratory distress and heart failure. Because the pulmonary blood flow is primarily to the right lung only, severe respiratory distress occurs. Survival to late childhood without surgery is very rare due to clinical worsening in infancy. This report describes two adult natural survivors with this rare association who presented with extremely unusual unreported clinical features. The aneurysmally dilated main pulmonary artery was compressed on the left coronary ostium, causing angina in the first patient. The second patient had recurrent ventricular tachycardia originating from the dilated thinned out right ventricular outflow tract. Both patients had successful surgical correction with valved xenograft conduits.

A rare congenital cardiac anomaly in adulthood: tetralogy of Fallot with absent pulmonary valve syndrome

In approximately 3% to 6% of the patients with tetralogy of Fallot (TOF), the pulmonary valve leaflets are absent or only a rudimentary ridge of tissue is present. Some infants with the severe form of this syndrome die early during the newborn period due to severe respiratory distress, feeding intolerance, or cardiovascular compromise. Survival to adulthood of this combination is extremely unusual. In this article, we presented a case who was diagnosed in adult age with TOF having absent pulmonary valve syndrome. The patient with these findings underwent surgery, and complete repair was performed. Clinical symptoms resolved after surgery.

[A case of reoperation 24 years after repair of absent pulmonary valve syndrome with anomalous origin of the left pulmonary artery]

We experienced a case of a 38-year-old woman with a persistent cough, 24 years after repair of absent pulmonary valve syndrome with anomalous origin of the left pulmonary artery. The right pulmonary artery was massively dilated, thus it caused the compression of the bronchi, which was thought to result in her respiratory symptom. This dilatation of the right pulmonary artery seemed to have progressed because of the following two reasons. The first is the pulmonary hypertension caused by the late reconstruction of the left pulmonary artery. The second is residual pulmonary stenosis and regurgitation after the initial operation without a pulmonary valve insertion. We performed a reoperation consisting of reconstruction of the right ventricular outflow tract using a valved conduit and plication of the right pulmonary artery. Her postoperative course has been without any complications and satisfactory for the past 2 years.

Anomalous origin of one pulmonary artery from the ascending aorta: 36 years' experience from one centre

Anomalous origin of one pulmonary artery from the ascending aorta is an uncommon lesion with an uncertain outcome. We reviewed 16 consecutive children (9 males) presenting with this lesion over a 36 year period at a single institution. Median age at presentation was 2 days (range, birth to 3.2 years). The anomalous pulmonary was the right in 12 and the left in 4, all originating from the proximal ascending aorta, with no patient having stenosis at the origin of the anomalous pulmonary artery. Associated cardiac anomalies were noted in 9 patients. No intervention was attempted in 2 patients: one was deemed inoperable due to complex associated lesions and pulmonary vascular obstructive disease, while the other one died before repair. Surgical intervention was attempted in 14 patients, with 3 intraoperative deaths (21%). Of 11 operative survivors, 8 developed pulmonary arterial stenosis graded severe in 2, moderate in 1 and mild in 5. Patients with severe stenosis required surgical angioplasty, 1 after unsuccessful dilation combined with placement of an endovascular stent. One patient with moderate, and one with mild, stenosis underwent successful transcatheter balloon dilation. The remaining 4 patients with mild stenosis remain unchanged during follow-up. One patient had biopsy evidence of pulmonary vascular obstructive disease at 3.3 years of age. There were no late deaths, giving a total mortality of 25% (4/16).

CONCLUSION

While early diagnosis and repair of anomalous origin of one pulmonary artery from the ascending aorta is necessary, restenosis of the site of repair is common.

Magnetic resonance imaging of absent pulmonary valve syndrome

A neonate with absent pulmonary valve syndrome was examined by means of echocardiography and magnetic resonance imaging (MRI). MRI provided an excellent evaluation of the intracardial morphology, vessel anatomy, mediastinal structures, and shunt flow; and it was superior to echocardiography for detection of aortopulmonary collaterals and vessel abnormalities. This case report of an uncommon cardiac abnormality confirms that MRI is a useful complementary modality to echocardiography in neonates and is recommended for problems with central pulmonary vessels and their relation to tracheobronchial structures.

A rare case of tetralogy of Fallot with unusual blood supply to the left lung

We present a rare case of tetralogy of Fallot with absence of the leaflets of the pulmonary valve and anomalous blood supply of the left lung from the transverse aortic arch. Although embryologic considerations would suggest that the anomalous vessel is not the arterial duct, there was a good response to prostaglandin therapy.