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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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Abstract
BACKGROUND Tetralogy of Fallot is a common congenital cardiac malformation. A rare subgroup includes unilateral absence of the pulmonary artery, either the left or the right main branch. The literature lacks an established treatment for these cases, and surgical options carry certain mortality and morbidity. PATIENTS AND METHODS There were five patients who had single pulmonary artery and received surgical treatment among the 126 patients with the diagnosis of Tetralogy of Fallot, who were admitted to our institution between July, 2010 and November, 2011. All the patients were male. Ages ranged between 12 months and 8 years. The mean body mass index was 17.1 plus or minus 3.4 kilograms per square metre. Pulmonary artery Nakata index, Nakata index Z-score, and the McGoon index were used for the quantitative assessment of the pulmonary artery and to determine the surgical strategy. RESULTS Urgent modified Blalock-Taussig shunt operations were performed in two patients with very low oxygen saturation and haemodynamic instability. These patients are scheduled for corrective procedures on an elective basis. There was one patient who received an elective shunt procedure; however, the post-operative course was complicated with the overflow phenomenon and the patient underwent total correction with a check-valved patch used to close the ventricular septal defect. The patient required extracorporeal membrane oxygenator support in the post-operative period. There were two patients who underwent total correction of the pathology uneventfully. Mortality did not occur. Mean durations of hospital stay and follow-up were 14 plus or minus 13.4 days and 184.5 plus or minus 89.3 days, respectively. CONCLUSION Our modest series with Tetralogy of Fallot with unilateral absent pulmonary artery indicates the feasibility of surgical correction in patients with appropriate unilateral pulmonary artery size and palliative procedures when the pulmonary artery size is smaller than that predicted for the age. Multi-centre long-term data of larger series are warranted in order to establish a treatment protocol.
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Bockeria LA, Podzolkov VP, Makhachev OA, Zelenikin MA, Alekian BG, Ilyin VN, Gadjiev AA, Shatalov KV, Kakuchaya TT, Khiriev TK, Zaets SB. Surgical correction of tetralogy of Fallot with unilateral absence of pulmonary artery. Ann Thorac Surg 2007; 83:613-8. [PMID: 17257996 DOI: 10.1016/j.athoracsur.2006.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 08/08/2006] [Accepted: 08/19/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tetralogy of Fallot with unilateral absence of the pulmonary artery is a rare congenital heart defect that still represents a surgical challenge. The purpose of this study is to summarize our experience of surgical treatment of this complex lesion. METHODS From 1983 to 2003, 27 patients with tetralogy of Fallot and unilateral absence of the left (n = 25) or right (n = 2) pulmonary artery underwent different surgical interventions. The age of patients ranged from 40 days to 37 years (median, 5.3 years). Pulmonary arterial Nakata index and Nakata index Z-score were used for the quantitative assessment of the contralateral pulmonary artery. Twenty patients underwent various palliative procedures, namely Blalock-Taussig or Gore-Tex shunt, transluminal balloon pulmonary valvuloplasty, and reconstruction of right ventricular outflow tract without ventricular septal defect closure. At a median interval of 3.6 years after palliation, 13 patients underwent complete repair of tetralogy of Fallot. In the other 7 patients, complete repair was performed as a primary intervention. RESULTS Hospital mortality after palliation and after a complete repair was the same and reached 5%. Sixteen patients with the Nakata index greater than 200 mm2/m2 and Z-score greater than -4 survived after a complete repair. One of 4 patients with Nakata index less than 200 mm2/m2 and Z-score less than -4 died after surgery. CONCLUSIONS Majority of patients with tetralogy of Fallot and unilateral absence of the pulmonary artery require palliative intervention as a first step of surgical treatment. Nakata index greater than 200 mm2/m2 and Nakata index Z-score greater than -4 are criteria for a successful complete repair.
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Affiliation(s)
- Leo A Bockeria
- Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
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Pastor Menchaca E, Cabrera Duro A, Aramendi Gallardo J, Rodrigo Carbonero D, Alcibar Villa J, Galdeano Miranda J, Latorre García J. [Tetralogy of Fallot with absence of the left pulmonary branch. Surgical correction]. An Pediatr (Barc) 2005; 62:485-6. [PMID: 15871838 DOI: 10.1157/13074630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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MORGAN J, PITMAN R, GOODWIN JF, STEINER RE, HOLLMAN A. Anomalies of the aorta and pulmonary arteries complicating ventricular septal defect. BRITISH HEART JOURNAL 1998; 24:279-92. [PMID: 14475964 PMCID: PMC1017885 DOI: 10.1136/hrt.24.3.279] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Forty-one well-studied thoracic arterial arch anomalies are related to cases previously reported in the literature and presented with simplified drawings in an attempt to provide a workable understanding of these anomalies.
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POOL PE, VOGEL JH, BLOUNT SG. Congenital unilateral absence of a pulmonary artery. The importance of flow in pulmonary hypertension. Am J Cardiol 1998; 10:706-32. [PMID: 13972174 DOI: 10.1016/0002-9149(62)90248-5] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
An ontogenetic theory is proposed to explain the absence of a primary division of the pulmonary trunk on the basis of an error in the septation of the truncus arteriosus, and the two common varieties of the syndrome are discussed in detail. It is suggested that:
Both lateral pulmonary arteries are present in this syndrome, but one of them arises anomalously from the systemic circulation.
The aberrant origin of one lateral pulmonary artery derives from the dorsal shifting of one of the two ridges responsible for the septation of the truncus arteriosus. The sixth arch on the side of the dorsorotated truncal ridge then becomes incorporated into the newly formed ascending aorta.
The combination of tetralogy of Fallot, right aortic arch, and absent left primary pulmonary division results from a single primordial error: a dorsorotation of the left ridge extending throughout the truncoconus.
The initial portion of the aberrant (systemic) pulmonary artery may obliterate postnatally, thus impairing maturation of the terminal portion. This would explain the frequent failure to demonstrate the artery by angiography and, occasionally, at dissection.
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YACOUB MH, BELCHER JR, PATTINSON JN. UNILATERAL PULMONARY ARTERY HYPOPLASIA ASSOCIATED WITH CONGENITAL CARDIAC ANOMALIES. ACTA ACUST UNITED AC 1996; 59:102-12. [PMID: 14283434 DOI: 10.1016/s0007-0971(65)80018-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sreeram N, Asante-Korang A, Ladusans E. Distal ductal origin of the right pulmonary artery: prospective diagnosis and primary repair in infancy. Int J Cardiol 1992; 35:272-4. [PMID: 1572750 DOI: 10.1016/0167-5273(92)90190-e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Absence of the proximal segment of the right pulmonary artery was diagnosed by echocardiography in two neonates. In both a right-sided duct communicated with the right pulmonary artery at the hilum of the lung. Successful surgical repair was undertaken at seven months and 10 weeks, respectively
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Affiliation(s)
- N Sreeram
- Heart Clinic, Royal Liverpool Children's Hospital, UK
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Abstract
Ventilation and perfusion radionuclide lung scans, using krypton 81m and technetium-99m macroaggregates, were performed together with a variety of other imaging procedures in 18 children aged between 1 week and 13 years in whom radiology had shown a small lung. Radionuclide scans provided an assessment of regional ventilation and perfusion unobtainable by other means, and 4 main categories of disturbed function could be seen in the radiological small lung--namely, absence of ventilation and perfusion, absent perfusion with preserved ventilation, generalised or segmental decreases in ventilation, and perfusion and segmental perfusion defects in areas of decreased ventilation. The clinical history and other imaging procedures, including fluoroscopy and penetrated mediastinal views, enabled a firm diagnosis to be made in each of these 18 patients. In 3 main pulmonary arteries were absent, 2 had lung aplasia, 2 had lobar aplasia, 9 had varying degrees of pulmonary hypoplasia (two with additional sequestrated segments), 1 had lobar emphysema, and 1 had post-infective lung mal-development (MacLeod's syndrome).
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Mancebo A, Wanner A. Lung tumor in a patient with congenital unilateral hypoplasia of the pulmonary artery. Chest 1975; 68:846-7. [PMID: 1192873 DOI: 10.1378/chest.68.6.846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The occurrence of an undifferentiated carcinoma in the affected lung of a cigarette smoker with asymptomatic congenital hypoplasia of the right pulmonary artery is reported.
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Asfaw I, Thorns NW, Arbulu A. Interventricular septal defects from penetrating injuries of the heart. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)41570-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nasrallah A, Williams RL, Nouri S. ABSENT PULMONARY VALVE IN TETRALOGY OF FALLOT: CLINICAL AND ANGIOGRAPHIC CONSIDERATIONS WITH REVIEW OF THE LITERATURE. CARDIOVASCULAR DISEASES 1974; 1:392-399. [PMID: 15215956 PMCID: PMC287507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Antoine Nasrallah
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77025
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Ruschhaupt DG, Thilenius OG, Ranniger K. Pulmonary atresia with aneurysmal systemic-pulmonary arterial anastomosis: an angiographic study. Am Heart J 1970; 80:396-400. [PMID: 5452311 DOI: 10.1016/0002-8703(70)90104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bankl H. [Congenital heart defects in autopsy statistics. Incidence, malformation correlation, survival time and causes of death]. ARCHIV FUR KREISLAUFFORSCHUNG 1970; 62:118-51. [PMID: 4257554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Quiroga C, Rudhe U. Pulmonary vascular disparity in Fallot's anomaly and in simple pulmonary valve stenosis. ACTA RADIOLOGICA: DIAGNOSIS 1969; 8:423-32. [PMID: 5402887 DOI: 10.1177/028418516900800507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Darke CS, Lewtas NA. Selective bronchial arteriography in the demonstration of abnormal systemic circulation in the lung. Clin Radiol 1968; 19:357-67. [PMID: 5716977 DOI: 10.1016/s0009-9260(68)80074-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Nagao GI, Daoud GI, McAdams AJ, Schwartz DC, Kaplan S. Cardiovascular anomalies associated with tetralogy of Fallot. Am J Cardiol 1967; 20:206-15. [PMID: 4951346 DOI: 10.1016/0002-9149(67)90079-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Porstmann W, El-Sallab RA, David H. Pseudo-aplasia of the Right Pulmonary Artery Associated with Right-sided Aortic Arch. BRITISH HEART JOURNAL 1967; 29:527-32. [DOI: 10.1136/hrt.29.4.527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Winship WS, Beck W, Schrire V. Congenital "absence" and anomalous origin of the main pulmonary arteries. Variations of the same congenital defect. Heart 1967; 29:34-42. [PMID: 6018317 PMCID: PMC459114 DOI: 10.1136/hrt.29.1.34] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Dixon LM, Franklin RB, Gorczyca CA. Congenital unilateral absence of a pulmonary artery. A report of three cases. Am J Cardiol 1966; 18:754-60. [PMID: 5921401 DOI: 10.1016/0002-9149(66)90094-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hastreiter AR, D'Cruz IA, Cantez T, Namin EP, Licata R. Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies. BRITISH HEART JOURNAL 1966; 28:722-39. [PMID: 5332779 PMCID: PMC490086 DOI: 10.1136/hrt.28.6.722] [Citation(s) in RCA: 225] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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WU C, BALCON R, KURTZMAN RS, WENDT VE. Absent left pulmonary artery, right-sided aortic arch and patent ductus arteriosus with right to left shunt. Am J Cardiol 1964; 14:702-8. [PMID: 14218853 DOI: 10.1016/0002-9149(64)90062-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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CZARNECKI SW, HOPEMAN AR, CHILD PL. Tetralogy of Fallot with Aortic Origin of the Left Pulmonary Artery: Radiographic and Angiocardiographic Considerations. ACTA ACUST UNITED AC 1964; 46:97-101. [PMID: 14195417 DOI: 10.1378/chest.46.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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OAKLEY C, GLICK G, McCREDIE RM. Congenital absence of a pulmonary artery. Report of a case, with special reference to the bronchial circulation and review of the literature. Am J Med 1963; 34:264-71. [PMID: 13939333 DOI: 10.1016/0002-9343(63)90061-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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HEINTZEN P, TESKE I. [Unilateral agenesis of the pulmonary artery]. ARCHIV FUR KREISLAUFFORSCHUNG 1960; 32:263-91. [PMID: 14400756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TORNER-SOLER M, BALAGUER-VINTRO I, CARRASCO-AZEMAR J. Cardiac dextroposition: Hypoplasia of the right pulmonary artery with right venous pulmonary drainage into the inferior vena cava. Am Heart J 1958; 56:425-30. [PMID: 13571120 DOI: 10.1016/0002-8703(58)90281-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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ANDERSON RC, CHAR F, ADAMS P. Proximal Interruption of a Pulmonary Arch (Absence of One Pulmonary Artery): Case Report and a New Embryologic Interpretation. ACTA ACUST UNITED AC 1958; 34:73-86. [PMID: 13561876 DOI: 10.1378/chest.34.1.73] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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SCHNEIDERMAN LJ. Isolated congenital absence of the right pulmonary artery: a caution as to its diagnosis and a proposal for its embryogenesis; report of a case with review. Am Heart J 1958; 55:772-80. [PMID: 13533260 DOI: 10.1016/0002-8703(58)90018-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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STEINBERG I. Congenital absence of a main branch of the pulmonary artery; report of three new cases associated respectively with bronchiectasis, atrial septal defect and Eisenmenger's complex. Am J Med 1958; 24:559-67. [PMID: 13520757 DOI: 10.1016/0002-9343(58)90296-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MULLER BOTHA G. Obstructive emphysema due to chronic inhaled foreign body in the bronchus. THE BRITISH JOURNAL OF TUBERCULOSIS AND DISEASES OF THE CHEST 1958; 52:134-40. [PMID: 13523166 DOI: 10.1016/s0366-0869(58)80081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tetralogy of fallot with absent left pulmonary artery: Report of a case with anomalous development of the right hilar vasculature and nonfunctioning right lung. Am Heart J 1958. [DOI: 10.1016/0002-8703(58)90050-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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PATTINSON JN, EMANUEL RW. The aorta and pulmonary arteries in Fallot's tetralogy. BRITISH HEART JOURNAL 1957; 19:201-5. [PMID: 13413005 PMCID: PMC479615 DOI: 10.1136/hrt.19.2.201] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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GUNNING AJ. An unusual cause of a continuous murmur simulating persistent ductus arteriosus and associated with other congenital cardiac defects. Thorax 1957; 12:34-6. [PMID: 13422395 PMCID: PMC1019295 DOI: 10.1136/thx.12.1.34] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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