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Matoq AA, Kernizan D, Radtke W. Transcatheter recanalisation for absent intra-pericardial pulmonary arteries. Cardiol Young 2024:1-5. [PMID: 38577776 DOI: 10.1017/s1047951124000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Unilateral absence of intra-pericardial pulmonary artery is a rare congenital malformation. If untreated, it can lead to morbidity and mortality in adulthood. Early intervention and restoration of physiologic pulmonary blood flow is necessary. Transcatheter stenting as initial intervention has been rarely reported. We present transcatheter recanalisation and stenting of the obliterated ductus in two newborns with unilateral absence of intra-pericardial pulmonary artery with cross-sectional imaging, procedural details, angiography, and follow up to surgical repair. We believe that such procedure promotes ipsilateral pulmonary vasculature growth to facilitate unifocalization surgery at a later age.
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Affiliation(s)
- Amr A Matoq
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Wolfgang Radtke
- Nemours Cardiac Center, Alfred I DuPont Hospital for Children, Wilmington, DE, USA
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Li T, Ling Y, Xiong Z, An Q. Case report: Reconstruction of the long-gap unilateral absence of right pulmonary artery with contralateral pulmonary artery flap and autologous pericardial graft. Front Cardiovasc Med 2023; 10:1071111. [PMID: 36970362 PMCID: PMC10031123 DOI: 10.3389/fcvm.2023.1071111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
Unilateral absence of pulmonary artery (UAPA) is a rare type of congenital abnormality that may coexist with other congenital abnormalities or present as an isolated lesion, the latter form can be asymptomatic. Surgical procedure is usually carried out when UAPA was diagnosed with significant symptoms, and the aim of surgery is to restore the pulmonary flow distribution. The right-side UAPA is a considerable challenge for surgeons to process surgery, however, technical description of this type of UAPA are limited. Here we described a rare case of a two-month girl with absence of right pulmonary artery, we presented a technique that reconstructs this long-gap UAPA with contralateral pulmonary artery flap and autologous pericardial graft.
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Cui H, Yang Y, Qiu H, Cen J, Wen S, Zhuang J, Chen J. Pulmonary artery reconstruction and correction of tetralogy of Fallot combined with the absence of the mediastinal left pulmonary artery. J Card Surg 2022; 37:2285-2291. [PMID: 35526149 DOI: 10.1111/jocs.16588] [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: 02/10/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tetralogy of Fallot (TOF) is the most common deformity combined with the unilateral absence of the mediastinal pulmonary artery (UAMPA), and its treatment strategy remains controversial. In this study, we analyzed the effect of bilateral pulmonary reconstruction in patients with TOF combined with UAMPA. METHODS This was a single-center, retrospective review of 1713 patients with TOF between January 2009 and November 2021. Overall, eight patients were diagnosed with TOF combined with UAMPA. Among them, seven underwent surgery: three underwent one-stage TOF correction with bilateral pulmonary artery reconstruction; three patients underwent bilateral pulmonary artery reconstruction, followed by two-stage TOF correction after several months; and one patient underwent two procedures of left pulmonary artery reconstruction, and the ventral septal defect remained open. The left pulmonary arteries were reconstructed with a Goretex conduit in three cases, direct anastomosis in two cases, and the modified autologous tissue extension technique in two cases. RESULTS All seven patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation of >97%. During follow-up echocardiography, we noted that the left pulmonary arteries reconstructed with a Goretex conduit or direct anastomosis had thrombosis or stenosis. However, those reconstructed using the modified autologous tissue extension technique was unobstructed. CONCLUSIONS In patients with TOF and UAMPA, if there is a pulmonary artery confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of the pulmonary artery extension technique and autologous tissue for bilateral pulmonary reconstruction could reduce the incidence of anastomotic stenosis.
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Affiliation(s)
- Hujun Cui
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongchao Yang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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4
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Nakamura M, Kanno K, Nishioka M. Primary pulmonary artery reconstruction for functional single ventricle with absent central pulmonary artery and bilateral patent ductus arteriosus. Gen Thorac Cardiovasc Surg 2021; 70:541-546. [PMID: 34792738 DOI: 10.1007/s11748-021-01734-x] [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: 07/29/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate and discuss the outcomes of creating a single systemic-pulmonary shunt and reconstruction of the pulmonary artery continuity in patients with a single functional ventricle, absent central pulmonary artery, and bilateral patent ductus arteriosus. METHODS Six infants diagnosed with a functional single ventricle, absent central pulmonary artery, and bilateral patent ductus arteriosus were treated by creating a single systemic-pulmonary shunt and reconstructing the pulmonary artery continuity (primary operation) between January 2010 and September 2020. Pulmonary artery continuity was ensured using the remnant pulmonary artery and an autologous pericardial patch in five patients and a rolled autologous pericardium in one patient. RESULTS All patients eventually underwent total cavopulmonary connection. Two patients underwent intrapulmonary artery septation before Glenn or total cavopulmonary connection procedure. The median follow-up period was 9.02 years (interquartile range, 3.90-9.53). No late deaths were observed. CONCLUSIONS Our strategy of establishing a single systemic-pulmonary shunt with reconstruction of the pulmonary artery continuity was useful for treating patients with a functional single ventricle with absent central pulmonary artery and bilateral patent ductus arteriosus. This procedure helped accomplish pulmonary artery growth and ensured an appropriate volume load after total cavopulmonary connection.
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Affiliation(s)
- Makoto Nakamura
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center, Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa, 901-1193, Japan.
| | - Kazuyoshi Kanno
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center, Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa, 901-1193, Japan
| | - Masahiko Nishioka
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center, Children's Medical Center, 118-1, Arakawa, Haebaru-cho, Okinawa, 901-1193, Japan
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5
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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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Khoshhal S, Al‐Mutairi M, Morsy M, Kreary N, Alnajjar A, Abo‐Haded H. Effectiveness of stenting and subsequent re-implantation of disconnected pulmonary artery to restore the pulmonary hemodynamics. Pediatr Investig 2021; 5:65-68. [PMID: 33778430 PMCID: PMC7984012 DOI: 10.1002/ped4.12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/10/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Early intervention in patients with congenitally disconnected pulmonary artery improves long-term outcome. CASE PRESENTATION We present 3 cases of isolated disconnected pulmonary artery in the absence of associated structural heart disease during a period of 3 years. CONCLUSION Transcatheter stenting of the feeding ductus arteriosus re-established pulmonary artery flow and growth. Successful surgical repair was achieved, and normal perfusion and complete function of the ipsilateral lung were regained.
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Affiliation(s)
- Saad Khoshhal
- Pediatric Cardiology teamPediatric DepartmentFaculty of MedicineTaibah UniversityMadinahSaudi Arabia
| | - Mansour Al‐Mutairi
- Pediatric Cardiology DepartmentMadinah Cardiac CenterMadinahSaudi Arabia
| | - Mohamed Morsy
- Pediatric Cardiology DepartmentMadinah Cardiac CenterMadinahSaudi Arabia
- Pediatric DepartmentFaculty of MedicineSohag UniversitySohagEgypt
| | - Nasser Kreary
- Pediatric Cardiology DepartmentMadinah Cardiac CenterMadinahSaudi Arabia
| | | | - Hany Abo‐Haded
- Pediatric Cardiology teamPediatric DepartmentFaculty of MedicineTaibah UniversityMadinahSaudi Arabia
- Pediatric Cardiology UnitPediatric DepartmentFaculty of MedicineMansoura UniversityMansouraEgypt
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Jain S, Yadav T, Kumar P, Goyal JP. Recurrent croup in a young child: look beyond airways disease. BMJ Case Rep 2021; 14:e236605. [PMID: 33619150 PMCID: PMC7903105 DOI: 10.1136/bcr-2020-236605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/03/2022] Open
Abstract
We reported here a boy aged 5 years who presented for the evaluation of recurrent croup since infancy. On chest examination, breath sounds were reduced throughout the right lung field with a shifting of the trachea and cardiac apex to the right side. The chest radiograph showed a small right lung with decreased vascularity, hyperinflated left lung and mediastinum shifted towards the right side. Flexible bronchoscopy revealed tracheomalacia with left bronchomalacia due to external pulsatile compression. In CT angiogram, the right pulmonary artery (PA) was absent with dilated left PA. Echocardiography did not show any features of pulmonary arterial hypertension (PAH). Since the child was growing well, and there was no limitation of activity and evidence of PAH, he was managed conservatively and kept on follow-up. Though unilateral absent PA is a rare condition, it should be suspected in children with unilateral hypoplastic lung.
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Affiliation(s)
- Saurav Jain
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Prawin Kumar
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
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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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9
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Congenital isolated unilateral agenesis of pulmonary arteries in adults: case series and review. Indian J Thorac Cardiovasc Surg 2020; 37:144-154. [PMID: 33584030 DOI: 10.1007/s12055-020-01032-w] [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: 04/21/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
Congenital, isolated unilateral agenesis of pulmonary arteries (UAPA) has a bimodal clinical presentation. It is either diagnosed in early infancy or during adulthood. Early diagnosis and timely surgical correction at infancy prevent the development of irreversible pulmonary hypertension and enable prolonged survival. Though surgical intervention is a conclusive method of treatment, its outcome depends upon the reversibility of pulmonary hypertension and the adequacy of the pulmonary artery dimension. Adults with UAPA can be asymptomatic (diagnosed incidentally) or symptomatic. They may present clinically with myriads of symptoms like exertional dyspnea, recurrent lung infection, hemoptysis, and atypical chest pain. For cases where definitive surgical treatment is not feasible, interventional and medical management should be carried out as part of palliative therapy. A retrospective analysis of 22 cases of UAPA in adults published in the literature from the years 2017-2020 are presented here, along with our institutional case.
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Commentary: Isolated unilateral absence of pulmonary artery, a rare disease with diverse presentations. JTCVS Tech 2020; 3:348-349. [PMID: 34317926 PMCID: PMC8305742 DOI: 10.1016/j.xjtc.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
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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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Calabri G, Clemente A, Santoro G. Repeat percutaneous recanalizations of a discontinuous pulmonary artery: A very "lucky" vessel. Ann Pediatr Cardiol 2020; 13:163-166. [PMID: 32641893 PMCID: PMC7331843 DOI: 10.4103/apc.apc_142_19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/15/2019] [Accepted: 12/18/2019] [Indexed: 01/11/2023] Open
Abstract
Pulmonary artery (PA) discontinuity with ductal origin of a major pulmonary branch is a rare congenital anomaly that can be diagnosed as an isolated lesion or in association with major cardiac malformations. Arterial duct (AD) closure results in complete disappearance of the dependent PA, thus leading to the misdiagnosis of “congenital PA absence.” Neonatal AD transcatheter recanalization is considered a cost-effective approach in view of later, lower-risk surgical recruitment of the disconnected PA. However, repeat percutaneous recanalizations of a completely occluded PA, the first one as native duct-dependent lesion and the second one several months after its surgical reimplantation, have so far never been reported in the literature. This paper reports on a neonate who serendipitously received at a few weeks of age the diagnosis of “congenital” absence of the right PA. She was successfully submitted to transcatheter AD recanalization and then surgical recruitment of the dependent PA about 8 months later. However, complete occlusion of the reconnected PA was diagnosed some few months after the surgical repair. This vessel was once again recruited by percutaneous approach and it is still patent and in catch-up growth after 6 months from the second recanalization procedure.
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Affiliation(s)
- Giovanbattista Calabri
- Pediatric Cardiology, "Meyer" Pediatric Hospital, University of Florence, Florence, Italy
| | - Alberto Clemente
- "Ospedale del Cuore", Tuscany-CNR Foundation "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", Tuscany-National Council of Research Foundation "G. Monasterio", Massa, Italy
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13
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Abstract
Disconnection of a pulmonary artery needs early surgical treatment in order to support the growth of the vessel. However, owing to the high rate of re-stenosis after traditional surgical reconstruction, we developed a hybrid approach involving the creation of pulmonary artery continuity by using autologous or heterologous tissue supported by stent implantation.
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14
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Wu SJ, Downing T, Mascio C, Gillespie MJ, Dori Y, Rome JJ, Glatz AC. Reintervention Burden and Vessel Growth After Surgical Reimplantation of a Pulmonary Artery During Childhood. Pediatr Cardiol 2018; 39:390-397. [PMID: 29098350 DOI: 10.1007/s00246-017-1767-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/28/2017] [Indexed: 11/26/2022]
Abstract
Children requiring reimplantation of a branch pulmonary artery (PA) are at risk for postoperative stenosis and impaired growth of the reimplanted PA. Outcomes and risk factors for reintervention and impaired growth are incompletely described. We reviewed data on patients who underwent reimplantation of a branch PA between 1/1/99 and 5/1/15 at a single center. The primary outcome was reintervention to treat postoperative stenosis. The secondary outcome was "catch-up" growth (faster diameter growth of the affected PA compared with the unaffected PA from the preoperative to follow-up measurements.). Twenty-six patients were identified with a total follow-up of 102.2 patient-years (median 2.5 years). Diagnoses included LPA sling (n = 12) and isolated PA of ductal origin with (n = 7) or without (n = 7) tetralogy of Fallot (ToF). All had primary repair of the anomalous PA. Seventeen (65%) had reintervention with median time to first reintervention of 69 (range 1-1005) days and median of 1.5 (range 1-6) reinterventions. 94% of reinterventions were transcatheter (53% balloon and 41% stent angioplasty). Patients with reintervention were younger (hazard ratio 0.75 per log-day, p = 0.02) and lower weight (hazard ratio 0.18 per log-kg, p = 0.02) at initial repair. Of the 18 with PA growth data, 8 (44%) had catch-up growth. There were no identified differences between those who did and did not demonstrate catch-up growth. Despite a practice of primary reimplantation and aggressive postoperative reintervention, these results suggest that changes in strategy are needed or that there are intrinsic patient factors that have more influence on longer-term reimplanted PA growth.
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Affiliation(s)
- Stephan J Wu
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Tacy Downing
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Nicklaus Children's Hospital, Miami, FL, USA
| | - Christopher Mascio
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 6th Floor Main Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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15
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Seedat F, Kalla IS, Feldman C. Unilateral absent pulmonary artery in an adult - A diagnostic and therapeutic challenge. Respir Med Case Rep 2017; 22:238-242. [PMID: 28951831 PMCID: PMC5604951 DOI: 10.1016/j.rmcr.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 12/01/2022] Open
Abstract
Unilateral absent pulmonary artery (UAPA) is a congenital abnormality rarely diagnosed in adults. UAPA has a myriad of clinical presentations and pulmonary hypertension is present in a quarter of all cases. Isolated UAPA commonly affects the right pulmonary artery and occurs as a result of abnormal development of the sixth aortic arch segment. Due to its rarity, it remains a diagnostic and therapeutic challenge. We describe a case of UAPA in an adult presenting with severe pulmonary hypertension. We describe the appropriate diagnostic approach to a patient with pulmonary hypertension and illustrate the importance of a detailed evaluation to determine the underlying aetiology, particularly in rare causes. Furthermore, we review the clinical presentation, diagnosis and management challenges of UAPA in adults.
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Affiliation(s)
- Faheem Seedat
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ismail S Kalla
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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16
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Abstract
Tetralogy of Fallot with absent pulmonary valve syndrome (TOF/APV) is a rare congenital malformation. Although pulmonary artery (PA) anomalies have been observed in TOF, its association with disconnected PA is extremely rare. We report successful stenting of the disconnected left PA in a 3-year-old boy with TOF/APV followed by surgical reimplantation. The significance of this transcatheter intervention for guidance during surgery and the importance of visualizing a ductal stump on angiography as an indicator of disconnected PA are discussed.
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17
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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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18
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Taniguchi H, Saito J, Abo H, Masaki Y, Tsuda T, Furuse H, Suzuki K. Isolated Unilateral Absence of the Pulmonary Artery. Am J Respir Crit Care Med 2015; 192:518-9. [PMID: 26278797 DOI: 10.1164/rccm.201502-0209im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Junko Saito
- 2 Department of Diagnostic Radiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hitoshi Abo
- 2 Department of Diagnostic Radiology, Toyama Prefectural Central Hospital, Toyama, Japan
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19
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Pourmoghadam KK, Schwartz MC, DeCampli WM, O'Brien MC. Novel Approach to Construct Absent Intrapericardial Branch Pulmonary Arteries. Ann Thorac Surg 2015; 100:738-40. [PMID: 26234859 DOI: 10.1016/j.athoracsur.2015.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 01/22/2015] [Accepted: 03/03/2015] [Indexed: 11/26/2022]
Abstract
Unilateral or bilateral absence of branch pulmonary arteries is a rare congenital heart defect. Various reconstructive techniques have been previously described, each with its inherent limitations. We present a novel technique of constructing a branch pulmonary artery that maintains potential for growth.
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Affiliation(s)
- Kamal K Pourmoghadam
- The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida; The University of Central Florida College of Medicine, Orlando, Florida.
| | - Matthew C Schwartz
- The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida; The University of Central Florida College of Medicine, Orlando, Florida
| | - William M DeCampli
- The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida; The University of Central Florida College of Medicine, Orlando, Florida
| | - Michael C O'Brien
- The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida
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20
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Babu B, Caldarone CA. Management of tetralogy of Fallot with unilateral absence of pulmonary artery: an overview. World J Pediatr Congenit Heart Surg 2014; 5:70-9. [PMID: 24403358 DOI: 10.1177/2150135113506597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot with unilateral absence of pulmonary artery (PA) is a rare congenital anomaly that has been reported in isolated case reports and small case series. There is no well-defined treatment algorithm for these patients, and repair has been associated with high mortality, although survival is improving in the more recent era. Recent reports suggest strict case selection criteria based on PA dimensions and size of the left ventricle.
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Affiliation(s)
- Balram Babu
- Department of Cardiothoracic Surgery, Apollo Hospitals, Bangalore, Karnataka, India
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21
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Bockeria LA, Makhachev OA, Khiriev TK, Podzolkov VP, Zelenikin MA, Kim AI, Zaets SB. Repair of congenital heart defects associated with single pulmonary artery. Asian Cardiovasc Thorac Ann 2014; 23:157-63. [PMID: 24855279 DOI: 10.1177/0218492314536568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experience with complete repair of congenital heart defects associated with unilateral absence of a pulmonary artery is limited. The aim of this retrospective study was to present our surgical experience of this complex category of patients, to analyze immediate results of surgical interventions, and to suggest a rational surgical strategy. METHODS Of 37 patients with a single pulmonary artery who underwent complete repair of associated heart defects, the left or right pulmonary artery was absent in 32 and 5, respectively. The most frequent heart defects were tetralogy of Fallot (n = 25) and ventricular septal defect (n = 8). The median age of these patients was 7.1 years. Preoperative examinations included echocardiography, cardiac catheterization and angiocardiography, with quantitative assessment of the single pulmonary artery. In-hospital parameters of surgical outcome were analyzed. RESULTS Recorded hospital mortality was 2.7% (1/37). The single death was in a patient with tetralogy of Fallot, agenesis of the left pulmonary artery, and a small diameter of the contralateral pulmonary artery (Nakata index 174 mm(2)·m(-2)). The right-to-left ventricular systolic pressure ratio after complete tetralogy of Fallot repair in patients who survived the operation was 0.58 ± 0.11. CONCLUSIONS Complete repair of congenital heart defects in patients with unilateral absence of a pulmonary artery is associated with a relatively low risk. If the hilar artery is of adequate size, surgical intervention should attempt restoration of the communication between the disconnected hilar artery and the pulmonary trunk, in addition to repairing the heart defects.
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Affiliation(s)
- Leo A Bockeria
- Bakoulev Center for Cardiovascular Surgery, Moscow, Russia
| | | | | | | | | | - Aleksey I Kim
- Bakoulev Center for Cardiovascular Surgery, Moscow, Russia
| | - Sergey B Zaets
- Bakoulev Center for Cardiovascular Surgery, Moscow, Russia
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22
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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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23
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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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24
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Noonan PME, Ramchandani B, Barron DJ, Stumper O. Catheter rehabilitation of occluded aberrant pulmonary artery. Interact Cardiovasc Thorac Surg 2013; 17:210-2. [PMID: 23529755 DOI: 10.1093/icvts/ivt108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 10-year old girl underwent a CT angiogram to investigate right lung hypoplasia. This showed a normal bronchial tree, lung parenchyma and pulmonary venous drainage, but an absent right pulmonary artery. Cardiac catheterization with pulmonary vein wedge injections identified a disconnected hypoplastic right pulmonary artery system supplied by an occluded right-sided ductus arteriosus. Transcatheter recanalization of the ductus re-established right pulmonary artery flow and growth. Ultimately, this allowed for complete surgical repair and restoration of normal perfusion of the right lung, leading to complete functional rehabilitation.
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25
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Bockeria LA, Podzolkov VP, Makhachev OA, Alekyan BG, Khiriev TK, Zelenikin MA, Shatalov KV, Zaets SB. Palliative surgical treatment of congenital heart defects associated with unilateral absence of the pulmonary artery. Interact Cardiovasc Thorac Surg 2012; 16:286-92. [PMID: 23211214 DOI: 10.1093/icvts/ivs503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Experience with the palliative treatment of congenital heart defects (CHDs) associated with unilateral absence of the pulmonary artery (UAPA) is limited. There is a description of 32 interventions in the available literature. The aim of this retrospective study was to present our experience with palliative interventions in patients with cyanotic CHDs associated with UAPA and to suggest a rational surgical strategy. METHODS Twenty-nine patients were subjected to palliative interventions. All of them had the following cyanotic CHDs with agenesis of the left pulmonary artery: tetralogy of Fallot (n = 26) or double outlet right ventricle (n = 3). Twenty patients were subjected to a single and 9 to multiple staged palliative operations. Patients were grouped according to the type of initial palliation to assess the clinical and haemodynamic results of each surgical intervention: Group 1: systemic-to-pulmonary shunts (n = 13); Group 2: transluminal balloon pulmonary valvuloplasty (n = 5); Group 3: palliative reconstruction of the right ventricular outflow tract (n = 11). The median age of patients at the initial palliative intervention was 2.6 years. Twenty-three of 27 discharged patients were followed up for a median period of 3 years. RESULTS Hospital mortality in our series reached 7% (2 of 29 patients). Both lethal outcomes occurred after palliative reconstruction of the right ventricular outflow tract was performed as a sole intervention. The assessment of angiographic parameters has shown that palliative reconstruction of the right ventricular outflow tract provided more significant and uniform enlargement of the pulmonary artery than systemic-to-pulmonary shunts or transluminal balloon pulmonary valvuloplasty. Fifty-nine percent of patients (17 of 29 patients) were subjected to complete repair of CHDs during the follow-up. CONCLUSIONS Palliative surgical treatment of CHDs associated with UAPA can be performed with a relatively low risk. Systemic-to-pulmonary artery shunt and transluminal balloon pulmonary valvuloplasty are methods of choice in patients with non-severe hypoplasia of the single pulmonary artery. The intravascular intervention is indicated more in patients with a prevailing valvular component of the pulmonary stenosis. Palliative reconstruction of the right ventricular outflow tract is a more favourable procedure for patients with a severe hypoplasia of the single pulmonary artery.
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Affiliation(s)
- Leo A Bockeria
- Bakoulev Center for Cardiovascular Surgery, Moscow, Russia
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26
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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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Fagan T, Kay J, Carroll J, Neubauer A. 3-D guidance of complex pulmonary artery stent placement using reconstructed rotational angiography with live overlay. Catheter Cardiovasc Interv 2011; 79:414-21. [DOI: 10.1002/ccd.23229] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 05/08/2011] [Indexed: 11/11/2022]
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