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Li W, Ma L, Xia S, Zou M, Chen W, Chen X. Early single-stage surgical revascularization of pulmonary artery in unilateral absence of a pulmonary artery. J Cardiothorac Surg 2021; 16:80. [PMID: 33849614 PMCID: PMC8045296 DOI: 10.1186/s13019-021-01481-3] [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: 11/19/2020] [Accepted: 04/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background This research aims to summarize the findings of the early single-stage revascularization of remnant pulmonary artery in unilateral absent intrapericardial pulmonary artery. Methods We retrospectively analyzed the medical records of 10 patients with unilateral absent pulmonary artery, in which 7 were right and 3 were left, the median age and mean weight at surgery was 4 months and 5.6 kg, respectively. The patients received operation from January 2009 to June 2020. Results Ten patients, 1 case associated with atrial septal defect, 2 cases with tetralogy of Fallot, and 1 case with aortopulmonary window. The mean diameter of the affected hilar pulmonary artery remnants was 3.14 ± 1.09 mm (1.6-5 mm), and the Z value was − 3.66 ± 1.86 (range, − 6.7 to − 1.75). All the patients received single-stage revascularization: tube graft interposition in 3 patients, autologous pericardial roll in 4, direct anastomosis in one, and main pulmonary artery flap angioplasty in the rest 3. No hospital deaths occurred. Mean follow-up in this cohort was 3.3 ± 1.9 years One case underwent percutaneous balloon dilatation due to new pulmonary artery stenosis. Nonetheless, the results were encouraging, symptoms have improved in all patients. The median Z value of the latest ipsilateral pulmonary artery diameter was − 1.88 (range, − 4.52 to − 1.35), a significantly improvement when compared to the preoperative value. The Z value of that in patients who using Gore-Tex tube increased relatively small. Conclusions Single-stage pulmonary artery revascularization is effective at restoring normal antegrade flow to the affected lung, resulting in improved diameter of the PA, regression of pulmonary hypertension, and patient’s symptoms. Revascularization by using the autologous tissue or autologous pericardium may obtain a preferred result. The new pulmonary artery stenosis certainly will need to be addressed in the long-term follow-up.
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Affiliation(s)
- Wenlei Li
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Li Ma
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Shuliang Xia
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Minghui Zou
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Weidan Chen
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Xinxin Chen
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China.
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Kawada K, Saiki H, Kemmochi M, Kuwata S, Takanashi M, Miyaji K, Senzaki H. Successful salvage of the left pulmonary artery in a neonate with isolated unilateral absence of the pulmonary artery. J Cardiol Cases 2020; 21:169-171. [PMID: 32373239 DOI: 10.1016/j.jccase.2019.12.004] [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: 07/05/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022] Open
Abstract
Isolated unilateral absence of the pulmonary artery (UAPA) is a congenital anomaly where involution of the extrapulmonary PA is insufficient and the intrapulmonary PA is only fed by the ductus arteriosus. Affected lung disorder causes complications years after ductus closure; thus, early diagnosis is of importance to avoid these complications. Here, we present the case of a male infant who was admitted to the neonatal intensive care unit because of transient tachypnea of the newborn and absence of the left PA (LPA) was indicated. Intensive echocardiography could detect neither the LPA nor the aortopulmonary collateral arteries to the left lung. Although the ductus was orthotopic with the right aortic arch, use of prostaglandin (PG) E1 unmasked the diagnosis of UAPA with bilateral ductus arteriosus. After ductal closure, delineation of the anatomy is not necessarily easy even with catheterization, whereas early use of PGE1 facilitates anatomical understanding by echocardiography, particularly early after birth. <Learning Objectives: While identification of disrupted pulmonary artery is often unsuccessful after ductal closure in the patients with unilateral absence of pulmonary artery, use of prostaglandin in the neonate with right aortic arch and large orthotropic right ductus arteriosus allowed successful recirculation of the disrupted pulmonary artery by reopening closed contralateral ductus arteriosus. Prostaglandin infusion early after birth delineated anatomical diagnosis of unilateral absence of pulmonary artery due to bilateral ductus, and it also made it possible to perform single stage uni-focalization.>.
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Affiliation(s)
- Kota Kawada
- Department of Neonatology, Kitasato University, Sagamiraha, Japan.,Kawada Pediatric Clinic, Shizuoka, Japan
| | - Hirofumi Saiki
- Department of Pediatrics and Pediatric Cardiology, Kitasato University, Sagamihara, Japan
| | - Manabu Kemmochi
- Department of Neonatology, Kitasato University, Sagamiraha, Japan
| | - Seiko Kuwata
- Department of Pediatrics and Pediatric Cardiology, Kitasato University, Sagamihara, Japan
| | - Manabu Takanashi
- Department of Pediatrics and Pediatric Cardiology, Kitasato University, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Thoracic and Cardiovascular Surgery, Kitasato University, Sagamihara, Japan
| | - Hideaki Senzaki
- Department of Pediatrics and Pediatric Cardiology, Kitasato University, Sagamihara, Japan
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Adán Lanceta V, Jiménez Olmos A, Martín de Vicente C, García Íñiguez JP. Isolated right pulmonary artery agenesis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Adán Lanceta V, Jiménez Olmos A, Martín de Vicente C, García Íñiguez JP. Agenesia aislada de la arteria pulmonar derecha. An Pediatr (Barc) 2017; 86:45-46. [DOI: 10.1016/j.anpedi.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/24/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
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Eltayeb O, Mongé MC, Popescu AR, Sarwark AE, Harris T, Backer CL. Discontinuous Pulmonary Artery. World J Pediatr Congenit Heart Surg 2016; 8:106-110. [PMID: 26993757 DOI: 10.1177/2150135115618871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the diagnosis and surgical repair of a five-month-old infant with a congenital discontinuous right pulmonary artery. Initial echocardiogram failed to show the right pulmonary artery and revealed systemic left pulmonary artery pressure based on the tricuspid regurgitation jet. Computed tomographic angiography confirmed the diagnosis of discontinuous right pulmonary artery. The right pulmonary artery appeared essentially normal in size, and there were no significant aortopulmonary collateral arteries. Using cardiopulmonary bypass and aortic transection, we created an anastomosis between the right and the main pulmonary arteries augmented anteriorly by a pericardial patch. Postoperative lung perfusion scan demonstrated balanced pulmonary blood flow to the lungs. Pulmonary hypertension resolved over three weeks in the postoperative period, an expected outcome in this age-group.
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Affiliation(s)
- Osama Eltayeb
- 1 Divisions of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael C Mongé
- 1 Divisions of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrada R Popescu
- 3 Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Anne E Sarwark
- 1 Divisions of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Tyler Harris
- 4 Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carl L Backer
- 1 Divisions of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Pulmonary artery resuscitation for isolated ductal origin of a pulmonary artery. J Thorac Cardiovasc Surg 2013; 148:2235-2244.e1. [PMID: 24503322 DOI: 10.1016/j.jtcvs.2013.11.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 11/13/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Ductal origin of a pulmonary artery (DOPA) is commonly misdiagnosed as agenesis of a pulmonary artery (PA), which may result in inadequate treatment. The objective is to describe the results of resuscitation of unilateral DOPA. METHODS This study is a retrospective review of all patients with unilateral DOPA who underwent PA resuscitation at Texas Children's Hospital from 1993 to 2012. Patients with other cardiac or contralateral lung anomalies were excluded. RESULTS Ten patients, median age 2 years (range, 3 days to 9 years), with unilateral DOPA were included. Symptoms were present in 6 patients. Cardiac catheterization was performed in all and showed a patent duct or a ductal stump in most patients and a small PA on wedge angiography of the pulmonary veins. Two patients underwent single-stage centralization. The other 8 underwent ductal stenting (n=2) or a systemic-to-PA shunt (n=6) as the first stage before centralization. The 2 patients with ductal stenting developed pulmonary edema. The 2 patients with a cryopreserved vein shunt developed early thrombosis requiring reintervention. Nine patients have undergone centralization. Six patients have required further interventional procedures. There have been no deaths. Symptoms and lung hypoplasia have improved in all patients. Median relative lung perfusion at follow-up was 26% (range, 12%-46%) with significant improvement in the size of the affected PA. CONCLUSIONS PA resuscitation is effective at restoring flow to the affected lung resulting in improved diameter of the PA, lung growth, and resolution of symptoms. PA resuscitation should be considered in all children with DOPA, including those beyond infancy.
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Batlivala SP, McElhinney DB, Pigula FA, Marshall AC. Isolated pulmonary artery arising from a duct: a single-center review of diagnostic and therapeutic strategies. J Thorac Cardiovasc Surg 2013; 148:2245-52. [PMID: 24521948 DOI: 10.1016/j.jtcvs.2013.11.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/07/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Isolated pulmonary artery of ductal origin (IPADO) is a rare disease with diverse presentations. Diagnostic and therapeutic approaches vary widely given the low incidence. Reporting additional cases may help inform medical decision making. METHODS We reviewed diagnostic data--including echocardiography, catheterization, and MRI--and outcomes for all patients with IPADO at our institution. RESULTS Thirty-seven patients who met inclusion criteria were identified. The mean age at diagnosis was 3 months (range, 1 day-45 years). In 11 patients, the duct supplying the IPADO was patent (ie, patent ductus arteriosis [PDA]); the duct had closed (ligamentum) in the other 26 patients. When performed, catheterization delineated the anatomy in 90% (100% if PDA) versus 54% with magnetic resonance imaging. Patients with a PDA were more likely to undergo intervention (100% vs 58%, P=.02) and had earlier first intervention (1 vs 20 months; P<.001). Patients diagnosed at age≤6 months were more likely to undergo intervention (86% vs 50%; P=.03) and unifocalization (81% vs 44%; P=.04), and had greater IPADO flow at follow-up (40% vs 14%; P<.001). Patients who underwent any intervention had greater IPADO flow than those without intervention (38% vs 0%). CONCLUSIONS Early IPADO diagnosis is important in long-term outcome. However, successful interventions can be performed on older patients. Diagnosis relies on angiography but magnetic resonance imaging may play an increasingly important role. Although initial intervention depends on individual factors, the ultimate goal should be early unifocalization.
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Affiliation(s)
- Sarosh P Batlivala
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Pediatric Cardiology, Batson Children's Hospital, Jackson, Miss; Department of Pediatrics, University of Mississippi Medical Center, Jackson, Miss.
| | - Doff B McElhinney
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Audrey C Marshall
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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McDevitt H, Stauthammer C, Leeder D, Hanson M, Olson J, Gruenstein D. Palliative balloon angioplasty in a cat with right pulmonary arterial branch stenoses and concurrent absence of the left pulmonary artery. J Vet Cardiol 2013; 15:211-6. [DOI: 10.1016/j.jvc.2013.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/08/2013] [Accepted: 03/03/2013] [Indexed: 11/25/2022]
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Left pulmonary artery thrombosis in a neonate with left lung hypoplasia. Case Rep Pediatr 2012; 2012:314256. [PMID: 23304599 PMCID: PMC3530762 DOI: 10.1155/2012/314256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Thrombotic events in neonates may origin from fetal life. A 4-day-old newborn infant with a family history of heterozygous type 1 protein C deficiency was diagnosed with left lung hypoplasia and left pulmonary artery thrombosis. Its source was prenatally closed ductus arteriosus. Surgical removal of the thrombus was performed.
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Clinical manifestations and long-term follow-up in pediatric patients living at altitude with isolated pulmonary artery of ductal origin. Pediatr Cardiol 2012; 33:775-81. [PMID: 22430374 PMCID: PMC3360790 DOI: 10.1007/s00246-012-0213-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
This study's aim was to define the clinical manifestations and long-term outcome of pediatric patients living at altitude with isolated pulmonary artery (PA) of ductal origin (IPADO). This was a retrospective cohort study of 17 consecutive cases of IPADO at a single center. All patients lived at modest altitude (median 2050 m [range 1700 m to 3050 m]). Fifteen children (88%) were symptomatic at presentation. High-altitude pulmonary edema was present in 2 patients (12%) at diagnosis, and only 1 patient had episodes of hemoptysis during follow-up. Fourteen patients (82%) demonstrated evidence of pulmonary arterial hypertension (PAH). Among 14 patients with PAH, 11 patients had surgical interventions. PAH resolved in 5 of 11 patients (45%) undergoing surgical rehabilitation. One patient died during follow-up, and 7 patients are receiving oral vasodilator therapies due to residual PAH; 14 patients remained asymptomatic. Our study showed that early intervention in patients with IPADO at modest altitude can potentially rehabilitate the isolated PA and reverse PAH. Whether surgery is indicated for patients with this disorder in the absence of PAH is unknown.
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