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Katewa A, Saxena S, Malhotra P, Rajesh VSP, Champaneri B, Surti J. Unilateral absence of pulmonary artery with absent pulmonary valve in tetralogy of Fallot. Indian J Thorac Cardiovasc Surg 2022; 38:637-643. [PMID: 36258824 PMCID: PMC9569396 DOI: 10.1007/s12055-022-01393-4] [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: 01/10/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 10/14/2022] Open
Abstract
The incidence of absent pulmonary valve (APV) in tetralogy of Fallot is 2.4 to 6.3%. About 1-3% of the patients with tetralogy of Fallot will have unilateral absence of pulmonary artery (UAPA). However, coexistence of APV with tetralogy of Fallot (TOF) and UAPA is extremely rare. This rare subset can present in two forms. In one group, the main pulmonary artery continues as either left or right pulmonary artery (UAPA) and there is true absence of contralateral pulmonary artery. The second group is termed as unilateral anomalous origin of pulmonary artery (UAOPA), in which the contralateral lung is supplied either by patent ductus arteriosus or a collateral from the aorta. There are a limited number of these cases in the literature. We present a rare case of TOF with APV and UAPA managed using a different surgical technique. Also, we have done contemporary literature review.
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Affiliation(s)
- Ashish Katewa
- Department of Cardio-Thoracic & Vascular Surgery, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
| | - Shivang Saxena
- Department of Cardio-Thoracic & Vascular Surgery, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
| | - Pulkit Malhotra
- Department of Cardio-Thoracic & Vascular Surgery, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
| | - Venuthurupalli S. P. Rajesh
- Department of Cardiac Anaesthesia, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
| | - Bhavik Champaneri
- Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
| | - Jigar Surti
- Department of Cardiac Anaesthesia, U N Mehta Institute of Cardiology and Research Center, Medicity, Asarwa, Ahmedabad, Gujarat 3800016 India
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Goldstein BH, Qureshi AM, Meadows JJ, Nicholson GT, Bauser-Heaton H, Petit CJ, Pater C, Kelleman MS, Morales DLS, Mery CM, Shashidharan S, Mascio CE, Mozumdar N, Aggarwal V, Agrawal H, Ligon RA, Christensen J, McCracken CE, Glatz AC. Impact of Treatment Strategy on Outcomes in Isolated Pulmonary Artery of Ductal Origin. Pediatr Cardiol 2021; 42:533-542. [PMID: 33394118 DOI: 10.1007/s00246-020-02511-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Isolated pulmonary artery (PA) of ductal origin (IPADO) is a rare cardiac defect which requires surgical repair, with or without preceding palliation. We sought to determine the impact of treatment strategy on outcomes. Retrospective study of consecutive patients with IPADO that underwent staged or primary repair from 1/05 to 9/16 at 6 Congenital Cardiac Research Collaborative centers. Patients with single ventricle physiology, major aortopulmonary collaterals, or bilateral IPADO were excluded. Primary outcome was isolated PA z-score at late follow-up. Secondary outcomes included PA symmetry index (isolated:confluent PA diameter) and reintervention burden. Propensity score adjustment was used to account for baseline differences. Of 60 patients in the study cohort, 26 (43%) underwent staged and 34 (57%) primary repair. The staged and primary repair groups differed in weight at diagnosis and presence of other heart disease but not in baseline PA dimensions. Staged patients underwent ductal stent (n = 16) or surgical shunt (n = 10) placement followed by repair at 210 vs. 21 days in the primary repair group (p < 0.001). At median follow-up of 4.5 years post-repair, after adjustment, isolated PA z-score (- 0.74 [- 1.75, - 0.26] vs. - 1.95 [- 2.91, - 1.59], p = 0.012) and PA symmetry index (0.81 [0.49, 1.0] vs. 0.55 [0.48, 0.69], p = 0.042) significantly favored the staged repair group. Freedom from PA reintervention was not different between groups (adjusted HR 0.78 [0.41, 1.48]; p = 0.445). A staged approach to repair of IPADO is associated with superior isolated PA size and symmetry at late follow-up. Consideration should be given to initial palliation in IPADO patients, when feasible.
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Affiliation(s)
- Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA.
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | - Colleen Pater
- The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School/Dell Children's Medical Center, University of Texas, Austin, TX, USA
| | | | | | | | - Varun Aggarwal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Hitesh Agrawal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | - Andrew C Glatz
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Edraki M, Ghasemzadeh B, Keshavarz K, Amirghofran A, Mohammadi H, Kheirandish Z, Amoozgar H, Nirooei E, Ajami G, Mehdizadegan N, Naghshzan A, Peiravian F, Cheriki S, Nobahkti MJ. Hidden pulmonary arteries in tetralogy of Fallot and pulmonary artery pressure in patients operated with a pulmonary artery. BMC Cardiovasc Disord 2021; 21:56. [PMID: 33509091 PMCID: PMC7845085 DOI: 10.1186/s12872-021-01877-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The absence of a pulmonary artery is a rare congenital anomaly that occurs isolated or with other congenital cardiac disorders, particularly tetralogy of Fallot (TOF); meanwhile, a hidden pulmonary artery might exist and originate from a closed ductus arteriosus (DA), which can be stented to reach the artery. Material and methods This prospective study describes cardiac catheterization of nine TOF patients diagnosed with the absence of the left pulmonary artery before the operation. The patients were stratified into three groups: group one, whose closed DA was found and connected to the hidden pulmonary artery with a stent; group two, whose hidden pulmonary arteries were found via the pulmonary vein angiography; and group three, for whom we could not find the remnant of the DA, or our attempt to stent the DA to the hidden pulmonary artery was not successful. We also evaluated outcomes of six other surgically-corrected TOF patients who were operated with the absent left pulmonary artery. Results The first group included the patients aged 1, 24, and 30 months, whose CT angiography 6–9 months after stenting showed acceptable left pulmonary artery diameter for surgical correction, and the pulmonary vein angiography of the second group showed a hidden left pulmonary artery with a suitable diameter for surgical correction. However, we were unable to find or stent the DA of group three patients, aged 12, 38, 60, and 63 months. Earlier Angiography might have increased the chance of access to the hidden vessel. Apart from these three groups, follow-ups of six other patients previously corrected with only the right pulmonary artery revealed pulmonary artery hypertension in all patients. Conclusion The concealed pulmonary artery might be found, and stenting of the closed DA to it might be performed to improve the diameter of the diminutive pulmonary artery. This procedure may allow TOF total surgical correction with two pulmonary arteries. Besides, pulmonary vein angiography can reveal the hidden pulmonary artery.
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Affiliation(s)
- Mohammadreza Edraki
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahram Ghasemzadeh
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kambiz Keshavarz
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Hamid Mohammadi
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kheirandish
- Pediatric Department, Kazeroon Azad University of Medical Sciences, Kazeroon, Iran
| | - Hamid Amoozgar
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Nirooei
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Mehdizadegan
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Naghshzan
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Farah Peiravian
- Pediatric Department, Kazeroon Azad University of Medical Sciences, Kazeroon, Iran
| | - Sirous Cheriki
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Nobahkti
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Avsar MK, Demir T, Demir HB. Absence of Left Pulmonary Artery in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome. J Card Surg 2014; 30:104-7. [DOI: 10.1111/jocs.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mustafa Kemal Avsar
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| | - Tolga Demir
- Department of Cardiovascular Surgery; Beylikduzu Kolan Hospital; Istanbul Turkey
| | - Hale Bolgi Demir
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
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Sivakumar K, Pavithran S, Coelho R. Unusual clinical presentation of rare adult survivors with a missing pulmonary valve associated with a missing left pulmonary artery. Pediatr Cardiol 2014; 34:1899-902. [PMID: 22864676 DOI: 10.1007/s00246-012-0438-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology and Cardiac Surgery, MIOT Hospital, 4/112, Mount Poonamalle Road, Chennai, 600089, Tamilnadu, India,
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