Anomalous Origin of Left Pulmonary Artery Branch from the Aorta with Fallot's Tetralogy

Main pulmonary artery continuing as right pulmonary artery with trifurcation at its origin and aberrant origin of left pulmonary artery from ascending aorta in a case of tetralogy of Fallot

Anomalous origin of the left pulmonary artery from the ascending aorta is a rare cardiac malformation described with tetralogy of Fallot. Trifurcation of right pulmonary artery after origin from the main pulmonary artery has not been reported in literature yet.

Right Pulmonary Artery Originating from Ascending Aorta (Hemitruncus Arteriosus) with VACTERL Association in a Neonate: A Case Report

Vertebral, anal, cardiac, tracheo-esophageal fistula, renal and limb (VACTERL) association is defined as a condition including at least three of the above-mentioned anomalies in the same infant. Several cardiac defects that have been reported as a part of the VACTERL association are ventricular and atrial septal defects, hypoplastic left heart syndrome, transposition of the great arteries and tetralogy of Fallot. Anomalous origin of pulmonary artery (AOPA) from the ascending aorta is an unusual and critical cardiovascular anomaly, which frequently involves the right pulmonary artery (RPA). A male neonate was delivered by normal spontaneous vaginal delivery at 39 weeks and 3 days gestation, weighting 2660 gm. He was diagnosed with VACTERL association with five abnormalities: vertebral abnormalities, anal atresia, cardiovascular anomaly (right pulmonary artery originating from ascending aorta), tracheo-esophageal fistula and renal anomalies. AOPA origination from ascending aorta as part of the VACTERL association in a neonate is a rare congenital cardiovascular malformation. Here we present a rare case of RPA originating from the ascending aorta seen with VACTERL association in a neonate.

Left Pulmonary Artery from the Ascending Aorta: A Case Report and Review of Published Cases

The left pulmonary artery arising from the ascending aorta is an infrequent finding. It may be found isolated or with intracardiac anomalies. We present a new case of the left pulmonary artery arising from the ascending aorta and pool these findings with those of previously reported cases. Associated cardiac, extracardiac, and syndromic findings are discussed along with the implications of these in the evaluation and management of this condition.

Outcomes of Surgical Reimplantation for Anomalous Origin of One Pulmonary Artery From the Aorta

BACKGROUND

Anomalous origin of one pulmonary artery from the ascending aorta (AOPA) is a rare and potentially deadly anomaly. Little research, aside from case reports on APOA, has been published, especially for patients with late referrals.

METHODS

This study was a retrospective review of 57 patients with AOPA who underwent reimplantation of the pulmonary artery (PA) from 2009 to 2019. Two different reimplantation methods were used to correct the anomaly, including direct anastomosis in 36 patients and angioplasty with autologous tissue in 21 patients.

RESULTS

The median age at repair was 2.8 months (range, 8 days to 3.6 years). In-hospital death occurred in 2 patients (3.5%). Five patients (9.1%) with a median age of 9.3 months (range, 5.2 months to 3.6 years) experienced a pulmonary hypertensive crisis. Patients older than 4.9 months were more likely to have a pulmonary hypertensive crisis (P = .001). The 2-year freedom from postoperative PA stenosis rate was 75.3% in patients who underwent direct anastomosis and 46.8% in patients who underwent autologous tissue angioplasty (χ² = 4.878; P = .027). Angioplasty with autologous tissue (hazard ratio, 5.03; 95% confidence interval, 1.61 to 15.71; P = .005) and an innately smaller diameter of the aberrant PA (hazard ratio, 0.65; 95% confidence interval, 0.45 to 0.92; P = .015) were 2 independent risk factors for postoperative PA stenosis.

CONCLUSIONS

Surgical reimplantation of the PA in patients with AOPA has resulted in favorable early and midterm outcomes. Pulmonary hypertensive crisis occurs more commonly in patients who receive a diagnosis after the age of 4.9 months. Reimplantation with autologous tissue augmentation and an intrinsically smaller diameter in affected PAs are 2 independent risk factors for postoperative PA stenosis.

Hemitruncus Arteriosus in a 10-Day-Old Neonate with Patent Ductus Arteriosus and Thrombocytopenia

Hemitruncus arteriosus refers to an uncommon congenital cardiovascular abnormality. It usually presents in infancy and leads to the development of pulmonary hypertension, heart failure, and in severe cases maybe death. Herein, we reported hemitruncus arteriosus in a 10-day-old neonate with respiratory distress, patent ductus arteriosus, and thrombocytopenia.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases

OBJECTIVES

To improve the prenatal diagnosis for anomalous origin of pulmonary artery branches by comparing and analyzing different types of fetal echocardiography features.

METHODS

Between June 2012 and December 2018, fetal echocardiographic features were analyzed retrospectively from fetuses with a prenatal diagnosis of anomalous origin of pulmonary artery branch. The main points of identification were summarized.

RESULTS

A total of 12 fetuses were diagnosed, including anomalous origin of a pulmonary artery branch from the innominate artery and six cases with unilateral absence of pulmonary artery. The shared characteristic sonographic finding was the lack of confluence at the bifurcation of the main pulmonary artery. The differences between the two conditions are highlighted by the origin of the anomalous vessel. In fetuses with anomalous origin of one pulmonary artery branch, the affected pulmonary artery arose from the posterior wall of the ascending aorta as noted on three vessels and trachea view as well as the long axis of the left ventricular outflow tract. This is in contrast to fetuses with unilateral absence of pulmonary artery, where the origin of affected pulmonary artery arises from the base of the innominate artery via the ipsilateral patent arterial duct as evident on the three vessels and trachea view and the coronal view of innominate (brachiocephalic) artery.

CONCLUSION

(1) The main similarity is an absence of a confluence at the bifurcation of the main pulmonary artery. (2) The main distinguishing feature is the origin of the anomalous vessel from either the subclavian or directly from the aorta.

The surgical treatment of anomalous origin of one pulmonary artery from the ascending aorta

Objective

This study sought to summarize the clinical experience of surgical treatment of anomalous origin of pulmonary arteries from the ascending aorta (AOPA) in Fuwai hospital.

Methods

Fifty-two patients (28 males, 17.2 ± 27.2 months old and 8.7 ± 10.2 Kg weight) who have AOPA undertook surgical treatment between 1998 and 2017 were reviewed in this study, 47 out of 52 are anomalous origin of the right pulmonary artery (AORPA), among the rest of the patients are anomalous origin of left pulmonary artery (AOLPA). 27 out of 52 associate with simple cardiac abnormalities, 20 out of 52 associate with complex cardiac malformations, the remaining 5 patients without cardiac abnormalities. Among all patients who underwent surgical treatment, the direct end-to-side anastomosis strategy was applied in 26 patients, autologous pericardial-homograft patch and aortic flap were employed in 20 patients, and synthetic graft was used in 6 patients.

Results

No patient died during the perioperative period. 50 out of 52 patients were followed-up for 100.1 ± 70.9 months. The rate of pulmonary arterial free restenosis for 2 years, 5 years, and 10 years is 98.0, 96.0 and 92.0%, respectively.

Conclusions

The correct diagnosis and appropriate surgical treatment for AOPA could obtain excellent early and medium-term result.

Anomalous aortic origin of the pulmonary arteries: Case series and literature review

Anomalous origin of the pulmonary arteries from the ascending aorta is a rare, but severe clinical entity necessitating a scrupulous evaluation. Either the right or the left pulmonary arteries can arise directly from the ascending aorta while the other pulmonary artery retains its origin from the right ventricular outflow tract. Such a finding can be isolated or can coexist with several congenital heart lesions. Direct intrapericardial aortic origin, however, must be distinguished with origin through a persistently patent arterial duct. In the current era, clinical manifestations usually become evident in the newborn rather than during infancy, as used to be the case. They include respiratory distress or congestive heart failure due to increased pulmonary flow and poor feeding. The rate of survival has now increased due to early diagnosis and prompt surgical repair, should now be expected to be at least 95%. We have treated four neonates with this lesion over the past 7 years, all of whom survived surgical repair. Right ventricular systolic pressure was significantly decreased at follow-up. Our choice of treatment was to translocate the anomalous pulmonary artery in end-to-side fashion to the pulmonary trunk. Our aim in this report is to update an Italian experience in the diagnosis and treatment of anomalous direct origin of one pulmonary artery from the aorta, adding considerations on the lessons learned from our most recent review of the salient literature.

Prenatal diagnosis of anomalous origin of pulmonary artery

BACKGROUND

Anomalous origin of the pulmonary arteries is a rare congenital pulmonary vascular malformation that includes unilateral absence of the pulmonary artery (UAPA), anomalous origin of unilateral pulmonary artery (AOPA), and left pulmonary artery sling (LPAS).

METHODS

We analyze 15 cases of fetal pulmonary artery abnormalities from 2011 to 2017, detected via prenatal ultrasound at our center.

RESULTS

The 15 cases include UAPA (5), AOPA (6), and LPAS (4). Of the UAPA cases, 2 had pulmonary atresia and 3 had pulmonary artery stenosis. In 5 cases, the descending aorta issued collateral vessels to the left lung. Of the AOPA cases, 2 had left pulmonary artery abnormalities originating in the ascending aorta and 4 showed right pulmonary artery abnormalities originating in the ascending aorta. Of the LPAS cases, 2 were type IA, 1 was type IIA, and 1 was type IIB. Two of the LPAS were associated with right lung dysplasia.

CONCLUSION

Abnormal origin of the pulmonary artery has a characteristic ultrasonographic appearance. The branch of the pulmonary artery cross section can provide important clues to the diagnosis of abnormal pulmonary artery origin. Pulmonary artery abnormalities are often associated with pulmonary atresia or stenosis.

Anomalous Origin of the Left Pulmonary Artery: Hemi-Truncus Arteriosus

Hemi-truncus arteriosus is a rare congenital cardiovascular malformation. It usually presents in infancy and leads to development of progressive pulmonary vascular disease, heart failure, and death. We report a case of hemi truncus arteriosus in a 12-day-old neonate who was successfully managed at our institute.

Operative treatment of tetralogy of Fallot with concomitant correction of anomalous origin of the left pulmonary artery from Kommerell's diverticulum

Anomalies in development of the pulmonary valve, pulmonary trunk and peripheral pulmonary arteries are typical accompanying pathologies in patients with tetralogy of Fallot (ToF). Demanding for diagnostics and borderline for treatment is a condition colloquially called “discontinuous pulmonary arteries”, while the main branches are supplied with systemic blood from the ascending aorta, aortic arch or descending thoracic aorta.

We present a case of a one-year-old girl with ToF and anomalous origin of the left pulmonary artery (LPA) from Kommerell's diverticulum who underwent two-stage surgical therapy with the support of interventional cardiology.

We conclude that early diagnosis of discontinuous pulmonary artery is crucial for choosing the optimal operative strategy. In our opinion, simultaneous anatomic intracardiac correction with direct pulmonary reconstruction seems reasonable and effective, particularly when the result is achieved after joint efforts of cardiac surgery and interventional cardiology.

Tetralogy of Fallot and anomalous origin of the left pulmonary artery from the ascending aorta associated with absent right internal carotid artery

Anomalous origin of the left pulmonary artery from the ascending aorta is a rare cardiac malformation more commonly described with tetralogy of Fallot (TOF). The association of absent right carotid artery with TOF and anomalous left pulmonary artery from the ascending aorta has been rarely reported in the past. This case highlights the need for careful evaluation of the aortic arch and head vessels anatomy in patients with TOF because of the potential neurologic complications after surgery.