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Nimal S, Palaniswamy G, Pillikunte Doddareddy N, Talacheru S, Jadhav S, Mareedu T, Parmar MP, Banur A. Hemoptysis Secondary to Anomalous Origin of Right Pulmonary Artery From Ascending Aorta in a Young Male: A Case Report. Cureus 2024; 16:e51634. [PMID: 38313938 PMCID: PMC10837743 DOI: 10.7759/cureus.51634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
We report a rare case of a 24-year-old male with a rare anatomic variant of patent ductus arteriosus (PDA). The patient presented with symptoms of productive cough with recurrent and severe bouts of hemoptysis and grade I dyspnea. There were no prior episodes reported. The patient was vitally stable with bilateral clubbing. On cardiopulmonary auscultation, a prominent parasternal heave, loud P2, and right lung crepitus were noted. A complete blood count revealed an elevated hemoglobin and RBC count. An ECG revealed sinus tachycardia and right ventricle (RV) strain. ECHO confirmed these findings, as dilated right atrium (RA) and RV, mild tricuspid valve regurgitation (TR), and severe pulmonary hypertension were noted. CT of the chest demonstrated multiple ground glass opacities, right lung consolidation, and volume loss suggestive of right-sided pneumonia with atelectasis. CT also proved the presence of PDA and an anomalous origin of the right pulmonary artery from the right ascending aorta, causing compression of the right main bronchus. We show the clinical and radiological findings and discuss the implications and approach to this rare congenital cardiovascular malformation, as well as how a patient-centered approach is necessary for its management.
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Affiliation(s)
- Simran Nimal
- Internal Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, IND
| | | | | | - Sahithi Talacheru
- Internal Medicine, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Shraddha Jadhav
- Internal Medicine, Teaching University Geomedi, Tbilisi, GEO
| | - Tanmayee Mareedu
- Internal Medicine, Mamata Academy of Medical Sciences, Hyderabad, IND
| | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education and Research Society, Vadodara, IND
| | - Anup Banur
- Pulmonology, S. S. Institute of Medical Sciences and Research Centre, Davanagere, IND
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Huang Q, Ling W, Wu Q, Guo S, Dang T, Ma H, Huang B, Chen C, Liu M, Qiu X, Weng Z. Anomalous origin of the fetal pulmonary artery. Front Pediatr 2023; 11:1204070. [PMID: 37456564 PMCID: PMC10338927 DOI: 10.3389/fped.2023.1204070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives This study aims to investigate the efficacy of prenatal ultrasonography in diagnosing the anomalous origin of the fetal pulmonary artery (AOFPA). Methods A total of 26 AOFPA cases were retrospectively analyzed from January 2014 to January 2023. The features of the AOFPA were characterized by comparing the prenatal ultrasonic data with the results of anatomical casting after pregnancy termination or postnatal imaging and surgical intervention. Missed diagnoses and misdiagnoses were expounded. Results Of the 26 AOFPA cases, there were 13 cases of pulmonary artery sling, 8 cases of anomalous origin of the unilateral pulmonary artery, and five cases of unilateral absence of the pulmonary artery; 17 cases received pathological anatomy and casting after pregnancy termination, and nine cases were confirmed by postnatal imaging and surgery. Nineteen cases were accurately prenatally diagnosed (19/26, 73.1%), and seven cases were missed or misdiagnosed (7/26, 26.9%). Conclusions Prenatal ultrasonography has a favorable diagnostic efficacy for anomalous origin of the fetal pulmonary artery. The absence of either the left or right pulmonary artery from the image of pulmonary artery bifurcation may indicate origin abnormalities of the pulmonary artery in fetuses, which signifies the necessity to detect the abnormal origin of the pulmonary artery on the affected side and other potential intracardiac malformation complications.
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Affiliation(s)
- Qiong Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tingting Dang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chunxia Chen
- Department of Imaging, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Chen C, Yang F, Zhao S. Anomalous origin of the right pulmonary artery from the descending aorta in a fetus. Echocardiography 2022; 39:1623-1626. [PMID: 36348157 DOI: 10.1111/echo.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Anomalous origin of the branches of the pulmonary artery to the aorta (AOPA) is a rare anomaly that accounts for .12% of all congenital heart defects. AOPA is usually characterized by the anomalous origin of one of the pulmonary arteries from the ascending aorta. We describe a 41-year-old pregnant woman in 24 + 0 weeks of gestation was diagnosed fetal AOPA by ultrasound. Further pathological examination revealed that the fetal right pulmonary artery originated from descending aorta. To the best of our knowledge, our study presented a very rare fetal case of fetal right pulmonary artery originating from descending aorta diagnosed by prenatal ultrasound diagnosis and confirmed by postnatal autopsy.
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Affiliation(s)
- Cheng Chen
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Fan Yang
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Sheng Zhao
- Department of Ultrasonography, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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Zhu Y, Jiang Q, Zhang W, Hu R, Dong W, Zhang H, Zhang H. Outcomes and occurrence of post-operative pulmonary hypertension crisis after late referral truncus arteriosus repair. Front Cardiovasc Med 2022; 9:999032. [PMID: 36237902 PMCID: PMC9551104 DOI: 10.3389/fcvm.2022.999032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Truncus arteriosus (TA) is a rare congenital heart disease with a high rate of early mortality. The occurrence of post-operative pulmonary hypertension crisis (PHC), known to be a common and life-threatening complication, increases due to the irreversible development of pulmonary vascular resistance with age. We sought to figure out the risk factors for PHC and describe the surgical outcomes of TA patients with late referral (repair <1 month excluded). Materials and methods We retrospectively reviewed patients after TA repair between 2009 and 2021 at Shanghai Children’s Medical Center. The occurrence of PHC was defined according to post-operative Pp/Ps ≥ 1 and clinical manifestations. Risk factors for PHC and mortality were conducted by multivariable analysis. Results A total of 98 patients were treated, including 55 males and 43 females. The median age at repair was 121 (69, 245) days. Post-operative PHC occurred in 22 (22.4%) patients with a median age of 186 (122, 293) days. By multivariable analysis, patients with the sum of Z-score of pre-operative bilateral pulmonary artery (PA) diameters (OR: 1.6, 95% CI: 1.2–2.3, P = 0.01) was more likely to experience PHC. Longer CPB duration contributed to early death (OR: 1.0, 95% CI: 1.0–1.0, P = 0.01). Total survival at 10 years was 81.4%. In 4.5 (2.9, 7.5) years of follow-up, twenty-six patients received 30 reinterventions. Valved reconstruction of RVOT most predicted reinterventions (OR: 4.2, 95% CI: 1.4–13.0, P = 0.01). Conclusion Surgical repair of TA patients with late referral has resulted in comparatively favorable early and mid-term outcomes. PHC occurred more commonly in patients with overextended bilateral PA pre-operatively. Meanwhile, valved reconstruction of RVOT would more likely lead to early reintervention.
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Affiliation(s)
- Yifan Zhu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Jiang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Dong
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Zhang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hao Zhang,
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Haibo Zhang,
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Repair of Anomalous Aortic Origin of Pulmonary Artery: Technique Matters. Ann Thorac Surg 2020; 111:1358. [PMID: 33212026 DOI: 10.1016/j.athoracsur.2020.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
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