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Seth R, Yadav A, Jain Y, Gupta A. N-Butyl cyanoacrylate embolization of an extremely rare variant of sequestration complex - a high-flow left-to-left shunt between systemic artery and pulmonary vein. Indian J Thorac Cardiovasc Surg 2024; 40:361-364. [PMID: 38681718 PMCID: PMC11045699 DOI: 10.1007/s12055-023-01659-5] [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: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 05/01/2024] Open
Abstract
A 19-year-old female presented with hemoptysis. Computed tomography (CT) pulmonary angiography revealed aberrant vessels from descending thoracic aorta, draining into pulmonary veins (left-to-left shunt). She was managed by transcatheter embolization of the aberrant vessels using N-butyl cyanoacrylate (NBCA) with balloon occlusion. A systemic artery to pulmonary vein fistula is one of the least common congenital anomalies. Most of the reported cases have been managed by surgery. Only a few patients have been treated by transcatheter embolization, using coils or vascular plugs as the embolizing agents. To our knowledge, this is the first case of its kind that was managed by glue embolization. Favorable post-procedure results have led us to believe that glue embolization can be considered a suitable alternative to thoracotomy in such patients. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01659-5.
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Affiliation(s)
- Raghav Seth
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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2
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Ebihara M, Fujimori S, Suzuki S, Yotsumoto T, Kikunaga S, Ohtsuka R, Matsuyama S. Anomalous systemic arterial supply to the left basal lung with a calcified abnormal vessel: a case report. Surg Case Rep 2022; 8:121. [PMID: 35729289 PMCID: PMC9213598 DOI: 10.1186/s40792-022-01469-8] [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: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anomalous systemic arterial supply to the normal basal segment of the left lower lobe is a congenital abnormality of the lung, frequently and is generally diagnosed at a young age. Surgery is generally recommended if symptoms such as blood sputum or fever are observed. Resection of the abnormal artery is often performed at an early age, with only few reports of surgery being performed at an older age. In addition, to the best of our knowledge, there are no reports on surgical treatment of abnormal calcified vessels to date. Herein, we have presented a case in which a calcified aberrant vessel of lung was resolved surgically. Case presentation A 65-year-old female, previously diagnosed with anomalous systemic arterial supply to the left normal basal segment of the left lung lower lobe of lung was under observation on the basis of being asymptomatic. The patient presented to the emergency room with the chief complaint of blood in the sputum and she was referred to our hospital for a surgery. Computed tomography showed circumferential calcification of the intima of the abnormal vessel, which might have contributed to incomplete resection of the artery if automatic sutures were used. Thus, the abnormal vessel was ligated and dissected using pledgeted 4–0 polypropylene sutures and vessel clips under open thoracotomy followed by left lower lobectomy. The patient was discharged seven days after surgery without any serious surgical complications. Conclusions Vascular congenital anomalies of the lung are often operated at a young age presenting due to the associated symptoms. However, even if the disease is discovered incidentally and does not cause any symptoms or calcification in the aberrant artery, early surgical intervention is important due to the possibility of calcification occuring in the future. This can help minimize the degree of surgical invasion.
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Miller JR, Lancaster TS, Abarbanell AM, Manning PB, Eghtesady P. Anomalous Systemic Artery to the Left Lower Lobe: Literature Review and a New Surgical Technique. World J Pediatr Congenit Heart Surg 2018; 9:326-332. [PMID: 29692233 DOI: 10.1177/2150135118755986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anomalous systemic arterial supply to the basal segments of the left lower lobe without coexisting pulmonary artery connection is a rare anomaly. Most feel treatment is necessary; however, the ideal strategy is unclear. Treatments described include embolization, pulmonary resection, or anastomosis to the native pulmonary artery. We recently encountered an infant with this anomaly and present a literature review summarizing all recent reports. Additionally, we describe a novel surgical technique to create a tension-free anastomosis utilizing segmental aortic translocation that we employed in our patient due to a large distance between the anomalous vessel and native left pulmonary artery.
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Affiliation(s)
- Jacob R Miller
- 1 Section of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital/Washington University School of Medicine, St Louis, MO, USA
| | - Timothy S Lancaster
- 1 Section of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital/Washington University School of Medicine, St Louis, MO, USA
| | - Aaron M Abarbanell
- 1 Section of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital/Washington University School of Medicine, St Louis, MO, USA
| | - Peter B Manning
- 1 Section of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital/Washington University School of Medicine, St Louis, MO, USA
| | - Pirooz Eghtesady
- 1 Section of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital/Washington University School of Medicine, St Louis, MO, USA
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Dell'Amore A, Giunta D, Campisi A, Congiu S, Dolci G, Barbera NA, Agosti R, Buia F. Uniportal thoracoscopic resection of intralobar and extralobar pulmonary sequestration. J Vis Surg 2018; 4:63. [PMID: 29682473 DOI: 10.21037/jovs.2018.03.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/02/2018] [Indexed: 11/06/2022]
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS.
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Affiliation(s)
- Andrea Dell'Amore
- Department of Cardiothoracic Surgery, S. Orsola University Hospital, Bologna, Italy
| | - Domenica Giunta
- Department of Cardiothoracic Surgery, S. Orsola University Hospital, Bologna, Italy
| | - Alessio Campisi
- Department of Cardiothoracic Surgery, S. Orsola University Hospital, Bologna, Italy
| | - Stefano Congiu
- Department of Cardiothoracic Surgery, S. Orsola University Hospital, Bologna, Italy
| | - Giampiero Dolci
- Department of Cardiothoracic Surgery, S. Orsola University Hospital, Bologna, Italy
| | | | - Roberto Agosti
- Department of Pathology, S. Orsola University Hospital, Bologna, Italy
| | - Francesco Buia
- Department of Radiology, S. Orsola University Hospital, Bologna, Italy
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Kim DW, Jeong IS, Kim JH, Kim YH, Cho HJ. Operation for an anomalous systemic arterial supply to the left lower lobe using an anastomosis procedure in an infant. J Thorac Dis 2018; 10:E301-E303. [PMID: 29850173 DOI: 10.21037/jtd.2018.04.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An anomalous systemic arterial supply to a normal lung is a rare congenital anomaly, and then for which no standard treatment has been established. We present the case of a 7-month-old girl who had a continuous murmur at the trunk. She was diagnosed the anomalous systemic arterial supply to the left lower lobe, we decided to perform an end-to-side anastomosis between the abnormal systemic artery and left pulmonary artery. After 3 years, the patient showed the normal lung perfusion of the operation lobe.
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Affiliation(s)
- Do Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Ja Hae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Yun Hyeon Kim
- Department of Radiology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Hospital and Medical School, Gwangju, Korea
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Thakur S, Goh SSC, Sharma R, Hardikar A. Anomalous systemic arterial supply to the left lower lobe without evidence of pulmonary sequestration. ANZ J Surg 2016; 88:510. [PMID: 26923779 DOI: 10.1111/ans.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sameer Thakur
- Tasmanian Cardiothoracic Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | - Rajiv Sharma
- Tasmanian Cardiothoracic Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ashutosh Hardikar
- Tasmanian Cardiothoracic Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Jariwala P, Ramesh G, Sarat Chandra K. Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: closure with vascular plugs & coil embolization. Indian Heart J 2015; 66:95-103. [PMID: 24581104 PMCID: PMC4054825 DOI: 10.1016/j.ihj.2013.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/28/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022] Open
Abstract
A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as1 anomalous supply by normal systemic artery [internal mammary artery]2 and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.
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Affiliation(s)
- Pankaj Jariwala
- Indo-US Superspeciality Hospitals, Shyam Karan Road, Anand Bagh, Ameerpet, Andhra Pradesh 500016, India.
| | - G Ramesh
- Nizam's Institute of Medical Science, Punjagutta, Andhra Pradesh 500082, India
| | - K Sarat Chandra
- Indo-US Superspeciality Hospitals, Shyam Karan Road, Anand Bagh, Ameerpet, Andhra Pradesh 500016, India
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Hwang JH, Kim EY, Park SY. Aberrant Bronchial Artery to Non-Sequestrated Left Upper Lobe in Massive Hemoptysis. Tuberc Respir Dis (Seoul) 2015; 78:380-4. [PMID: 26508929 PMCID: PMC4620335 DOI: 10.4046/trd.2015.78.4.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/10/2015] [Accepted: 07/10/2015] [Indexed: 11/24/2022] Open
Abstract
Systemic arterial supply from the descending thoracic aorta to the basal segment of the left lower lobe without a pulmonary arterial supply is a rare congenital anomaly within the spectrum of sequestration lung disease. The most common pattern of anomalous systemic artery to the lung arises from the descending thoracic aorta and feeds the basal segments of the left lower lobe. We report an extremely rare case of a 29-year-old woman who underwent a successful left upper lobectomy for the treatment of recurrent massive hemoptysis from anomalous bronchial arterial supply to the lingular segment of left upper lobe.
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Affiliation(s)
- Joo Hee Hwang
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Eun Young Kim
- Department of Radiology, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Yong Park
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
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Journal Club: Comparison of assessment of preoperative pulmonary vasculature in patients with non-small cell lung cancer by non-contrast- and 4D contrast-enhanced 3-T MR angiography and contrast-enhanced 64-MDCT. AJR Am J Roentgenol 2014; 202:493-506. [PMID: 24555585 DOI: 10.2214/ajr.13.10833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to prospectively and directly compare the capabilities of non-contrast-enhanced MR angiography (MRA), 4D contrast-enhanced MRA, and contrast-enhanced MDCT for assessing pulmonary vasculature in patients with non-small cell lung cancer (NSCLC) before surgical treatment. SUBJECTS AND METHODS A total of 77 consecutive patients (41 men and 36 women; mean age, 71 years) with pathologically proven and clinically assessed stage I NSCLC underwent thin-section contrast-enhanced MDCT, non-contrast-enhanced and contrast-enhanced MRA, and surgical treatment. The capability for anomaly assessment of the three methods was independently evaluated by two reviewers using a 5-point visual scoring system, and final assessment for each patient was made by consensus of the two readers. Interobserver agreement for pulmonary arterial and venous assessment was evaluated with the kappa statistic. Then, sensitivity, specificity, and accuracy for the detection of anomalies were directly compared among the three methods by use of the McNemar test. RESULTS Interobserver agreement for pulmonary artery and vein assessment was substantial or almost perfect (κ=0.72-0.86). For pulmonary arterial and venous variation assessment, there were no significant differences in sensitivity, specificity, and accuracy among non-contrast-enhanced MRA (pulmonary arteries: sensitivity, 77.1%; specificity, 97.4%; accuracy, 87.7%; pulmonary veins: sensitivity, 50%; specificity, 98.5%; accuracy, 93.2%), 4D contrast-enhanced MRA (pulmonary arteries: sensitivity, 77.1%; specificity, 97.4%; accuracy, 87.7%; pulmonary veins: sensitivity, 62.5%; specificity, 100.0%; accuracy, 95.9%), and thin-section contrast-enhanced MDCT (pulmonary arteries: sensitivity, 91.4%; specificity, 89.5%; accuracy, 90.4%; pulmonary veins: sensitivity, 50%; specificity, 100.0%; accuracy, 95.9%) (p>0.05). CONCLUSION Pulmonary vascular assessment of patients with NSCLC before surgical resection by non-contrast-enhanced MRA can be considered equivalent to that by 4D contrast-enhanced MRA and contrast-enhanced MDCT.
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Mondal TK, Chen K, Jansen JW. Anomalous systemic vessel to the lung with hypoplastic left heart syndrome in a fetus. Pediatr Dev Pathol 2013; 16:214-6. [PMID: 23387835 DOI: 10.2350/12-11-1270-cr.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report a case of a fetus with hypoplastic left heart syndrome in addition to an anomalous vessel extending from the descending thoracic aorta to the basal segments of the lower left lung without sequestration. The concurrence of these 2 congenital abnormalities is extremely rare and unreported in the existing literature. The anomalous vessel to the left lung may cause increased pulmonary vascular resistance, which has implications for the long-term management of hypoplastic left heart syndrome via the Fontan procedure.
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Affiliation(s)
- Tapas K Mondal
- Tapas K. Mondal, McMaster Children's Hospital, McMaster University Division of Cardiology, Department of Pediatrics 1280 Main Street West, Hamilton ONL8S 4K1, Canada.
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Kubota S, Nakano K, Kodera K, Asano R, Kataoka G, Tatsuishi W. Mitral valve plasty in an adult patient without a right superior vena cava. Gen Thorac Cardiovasc Surg 2012; 60:569-71. [PMID: 22945860 DOI: 10.1007/s11748-012-0001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 04/15/2011] [Indexed: 11/28/2022]
Abstract
Persistent left superior vena cava without a right superior vena cava is an extremely rare condition. We report the case of a 65-year-old woman with this condition who underwent mitral valve plasty. During cardiac catheterization, the asymptomatic patient with mitral valve prolapse syndrome was found to have a persistent left superior vena cava without a right superior vena cava. During mitral valve plasty, cardiopulmonary bypass was established using bicaval drainage through the persistent left superior vena cava and the right atrium. A cannula was inserted into the persistent left superior vena cava to provide a large surgical field in the left atrium. We selected a technique that involved direct insertion of an L-shaped cannula into the persistent left superior vena cava and obtained a clear view of the surgical field. Proper assessment of the right superior vena cava is necessary when a persistent left superior vena cava is suspected.
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Affiliation(s)
- Sayaka Kubota
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, Nishiogu 2-1-10, Arakawa-Ku, Tokyo 116-8567, Japan.
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Anomalous systemic arterial supply from the celiac trunk to the basal segments of the right lower lobe without sequestration in a child with a patent ductus arteriosus. Pediatr Cardiol 2011; 32:851-2. [PMID: 21487795 DOI: 10.1007/s00246-011-9965-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
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13
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Singhi AK, Nicholson I, Francis E, Kumar RK, Hawker R. Anomalous Systemic Arterial Supply to Normal Basal Segment of the Left Lung. Heart Lung Circ 2011; 20:357-61. [DOI: 10.1016/j.hlc.2011.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 02/10/2011] [Accepted: 02/14/2011] [Indexed: 11/16/2022]
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Canyigit M, Gumus M, Kilic E, Erol B, Cetin H, Hasanoglu HC, Arslan H. Aneurysm of an Anomalous Systemic Artery Supplying the Normal Basal Segments of the Left Lower Lobe: Endovascular Treatment with the Amplatzer Vascular Plug II and Coils. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S126-30. [DOI: 10.1007/s00270-010-9827-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/08/2010] [Indexed: 12/01/2022]
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