Continuous murmurs in tetralogy of Fallot and pulmonary atresia with ventricular septal defect

Tetralogy of fallot with anomalous origin of the right pulmonary artery from the ascending aorta and hypoplastic left pulmonary artery

A case of tetralogy of Fallot associated with anomalous origin of the right pulmonary artery from the ascending aorta and hypoplastic left pulmonary artery was successfully repaired. Following the simultaneous procedure with banding of the right pulmonary artery and replacement of modified Blalock-Taussig shunt to the left pulmonary artery at 34 days of age, the intracardiac repair was performed successfully at 1 year and 10 months of age. The patient was well 6 months postoperatively, without unilateral pulmonary hypertension.

Pulmonary atresia with ventricular septal defect and coronary artery fistula: a late presentation

A 41 year old man presented with cyanosis and progressive shortness of breath. Cardiac angiography showed absent central pulmonary arteries, ventricular septal defect, and a fistula between the left coronary artery and pulmonary artery. Most of the blood reaching the lungs came through this fistula. An attempt at surgical palliation was unsuccessful.

Congenital extracardiac shunts with tetralogy of Fallot

Congenital extracardiac shunts in tetralogy of Fallot may significantly alter the history and clinical findings and also have significant management implications. An unusual variant of severe tetralogy of Fallot in a 54-year-old man enabled long survival with minimal symptoms. The patient had pulmonary valvular and infundibular stenosis, a large ventricular septal defect, an overriding aorta, and large volume systemic-to-pulmonary artery shunting from his right internal mammary and accessory internal mammary arteries to his right pulmonary artery.

Variant of tetralogy of fallot with absent pulmonary valve leaflets and origin of one pulmonary artery from the ascending aorta

Absent pulmonary valve leaflets and anomalous origin of a pulmonary artery from the ascending aorta have been reported as separate lesions associated with tetralogy of Fallot but not in combination. The clinical, radiologic and pathologic findings are presented in three patients with this previously undescribed combination. A search of the literature for similar cases revealed 233 patients with absent pulmonary valve leaflets and 56 patients with anomalous origin of a pulmonary artery from the ascending aorta; these cases are reviewed. Although 17 patients with absent pulmonary valve leaflets and tetralogy of Fallot also had absence of the proximal portion of the left pulmonary artery, none had an anomalously arising pulmonary artery from the ascending aorta. In the reviewed cases, anomalous origin of the right pulmonary artery from the ascending aorta was more frequent than that of the left pulmonary artery (44 compared with 12 cases, respectively), but the latter was more often associated with tetralogy of Fallot.

Pulmonary atresia or severe stenosis and coronary artery-to-pulmonary artery fistula

Five patients have had the common features of pulmonary atresia or severe stenosis associated with a septal defect and a coronary artery-to-pulmonary artery (CA-PA) fistula. Four had pulmonary valvular atresia, and one had severe pulmonary stenosis. In all five, the CA-PA fistula contributed the principal component of the pulmonary blood flow. Cyanosis, continuous murmur, right ventricular hypertrophy, and decreased or normal pulmonary vascularity were frequent clinical manifestations, but angiocardiography was required to establish the diagnosis. The fistula was a side-to-side communication between the left coronary artery and the main pulmonary artery in each of the five patients. The dilated proximal coronary artery connecting the aortic root with the pulmonary artery gave a unique angiocardiographic appearance distinguishing it from truncus arteriosus or aorticopulmonary window. It is suggested that this unique angiocardiographic appearance be called an "aorticopulmonary tunnel." The surgical repair of this anomaly is closely related to that for severe tetralogy of Fallot and should involve a comparable risk and achieve a comparable result.

Pulmonary atresia with cyanosis. Report of two cases with ventricular septal defect and increased pulmonary blood flow

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Management of pulmonary atresia

Based on experience with 48 patients, a new simple classification of pulmonary atresia, according to pulmonary artery development is suggested. The need for extensive investigation including biplane aortography and right ventricular angiocardiography is emphasized. Adequate display of the anatomy is required to plan the surgical management. Early palliative procedures are advised for hypoxia and later radical correction is possible in a large number of these patients.

Aortography in Fallot's tetralogy and variants

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