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Mohamed Irshad MR, Raja J, Mahajan S. RVOT pseudoaneurysm post biventricular repair for tetralogy of Fallot with single pulmonary artery. Indian J Thorac Cardiovasc Surg 2024; 40:83-85. [PMID: 38125321 PMCID: PMC10728407 DOI: 10.1007/s12055-023-01558-9] [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: 04/18/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 12/23/2023] Open
Abstract
Pseudoaneurysm of the right ventricular outflow tract (RVOT), post repair for tetralogy of Fallot (TOF), is a rare occurrence with few cases reported in literature. TOF with single pulmonary artery is in itself a rare occurrence. RVOT pseudoaneurysm in a case of TOF with single pulmonary artery has not been reported to the best of our knowledge. RVOT pseudoaneurysm is a catastrophic complication which has very few symptoms and has to be picked up early to avoid dire consequences. We have reported such a rare occurrence to highlight the importance of looking out for such complications in rare presentations where anatomy is altered. Supplementary information The online version contains supplementary material available at 10.1007/s12055-023-01558-9.
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Affiliation(s)
- M. R. Mohamed Irshad
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
| | - Sachin Mahajan
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
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2
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Malani SK, Kashyap P, Nalawade D. A rare case of unilateral agenesis of left pulmonary artery presenting as severe pulmonary arterial hypertension. Glob Cardiol Sci Pract 2023; 2023:e202315. [PMID: 37575286 PMCID: PMC10422877 DOI: 10.21542/gcsp.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 08/15/2023] Open
Abstract
A 26-year-old young male patient presented with progressive dyspnea over the previous 2 years. The patient also had pulmonary hypertension. Computed tomography (CT) pulmonary angiography showed absence of the left pulmonary artery, and conventional pulmonary and aortic root angiograms showed ipsilateral lung receiving collaterals from the left internal mammary artery and thyrocervical trunk.
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3
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Ghosh A, Sahu AK, Goel PK, Singh SD. Isolated unilateral pulmonary artery atresia with contralateral pulmonary artery branch stenosis: A "window" for intervention. Ann Pediatr Cardiol 2023; 16:154-158. [PMID: 37767172 PMCID: PMC10522155 DOI: 10.4103/apc.apc_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 02/04/2023] [Indexed: 09/29/2023] Open
Abstract
Adult presentation of unilateral pulmonary artery atresia in association with contralateral branch pulmonary stenosis is rare. We present the case of a quadragenarian, who manifested with right ventricular failure and hemoptysis. This report discusses the diagnostic workup and therapeutic options along with a brief overview of the concerned literature.
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Affiliation(s)
- Anindya Ghosh
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankit Kumar Sahu
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pravin K. Goel
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shiv Dayal Singh
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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4
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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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5
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Haifa GZ, Wardoyo S. Surgical management in tetralogy of Fallot with rare unilateral pulmonary anomalies: A literature review. Asian Cardiovasc Thorac Ann 2021; 30:226-236. [PMID: 34486383 DOI: 10.1177/02184923211039732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot with unilateral pulmonary anomalies such as the unilateral absence of pulmonary artery or unilateral pulmonary agenesis is an extremely rare complex congenital heart anomaly. There is no established surgical algorithm for tetralogy of Fallot with concomitant unilateral pulmonary anomalies. This condition is still challenging, especially in the surgical field. In this review we also present our experiences in our center, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. This literature review aimed to discuss systematic treatment options and hoped to help the decision-making process when surgeons face these rare anomalies.
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Affiliation(s)
- Ghitha Z Haifa
- Training Program of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Indonesia, 364090Cipto Mangunkusumo General Hospital, Indonesia
| | - Suprayitno Wardoyo
- Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, 95338Universitas Indonesia, 218394Cipto Mangunkusumo General Hospital, Indonesia
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6
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Mingjun T, Minjuan Z. Analysis of Ultrasonic Features Based on Absence of Pulmonary Artery. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
According to clinical features and ultrasonic imaging features of patients with absence of pulmonary artery, it is necessary to analyze ultrasonic imaging features of absence of pulmonary artery to provide clinical basis for improving the diagnostic value and prognosis. The data and
color Doppler echocardiography of 45 patients with absence of pulmonary artery are collected, who are confirmed by cardiac catheterization, CTA and operation, and the clinical features and ultrasonic imaging features are studied. The research results show that 57% of the patients have left
absence of pulmonary artery and 91% of them have other cardiovascular malformations, where ASD/PFO is the most common, PDA and VSD are the second. Patients with UAPA have changes of pulmonary artery, the incidence of pulmonary artery abnormalities in multiple malformations, changes of ASD/PFO,
PDA and VSD are mainly pulmonary hypertension. The ejection fraction of patients with UAPA is normal. The main manifestation of pulmonary hypertension is the increase of right cardiac volume load, and the main manifestation of pulmonary stenosis is the increase of collateral circulation. Pulmonary
hypertension and its associated cardiovascular malformations may be related to the prognosis of patients. Ultrasound doctors should understand such diseases to improve the diagnosis rate and the prognosis.
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Affiliation(s)
- Tian Mingjun
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Zheng Minjuan
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
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7
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Koizumi J, Iwase T, Tsuji S, Goto T, Oyama K, Kin H. Intrapulmonary artery septation for unilateral absence of the pulmonary artery. Asian Cardiovasc Thorac Ann 2021; 30:477-479. [PMID: 33926269 DOI: 10.1177/02184923211013998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a seven-month-old boy with tetralogy of Fallot and an absent left pulmonary artery. Due to the diminutive size of the left pulmonary artery, we performed a native tissue left pulmonary artery reconstruction and intrapulmonary artery septation procedure with a left modified Blalock-Taussig shunt. After confirming left pulmonary artery growth, the patient underwent tetralogy of Fallot repair, removal of septation patch, and division of the Blalock-Taussig shunt. Nine months post-surgery, we confirmed his balanced lung perfusion (R/L ratio 6:4). The intrapulmonary artery septation procedure would be suitable for both the resuscitation and reconstruction of the hypoplastic absent pulmonary artery.
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Affiliation(s)
- Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Iwate Prefecture, Japan
| | - Tomoyuki Iwase
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Iwate Prefecture, Japan
| | - Shigeto Tsuji
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Iwate Prefecture, Japan
| | - Takuya Goto
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Iwate Prefecture, Japan
| | - Kotaro Oyama
- Department of Pediatric Cardiology, Iwate Medical University Hospital, Iwate Prefecture, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Iwate Prefecture, Japan
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8
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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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Ramamurthy HR, Walavalkar V, Siddaiah S, Maheshwari S. A comprehensive study of congenital unilateral absence of branch pulmonary artery associated with other congenital heart defects and ipsilateral non-unifocalizable major aorto-pulmonary collateral arteries: A single-center retrospective study. Ann Pediatr Cardiol 2021; 14:139-145. [PMID: 34103851 PMCID: PMC8174626 DOI: 10.4103/apc.apc_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/20/2020] [Accepted: 12/13/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Congenital unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly with the complete absence of intrapericardial segment of one of the branch pulmonary arteries. Sixty percent are associated with other congenital heart defects (CHD) that often need correction. Aim To analyze the data of patients with UAPA and ipsilateral non-unifocalizable major aortopulmonary collateral arteries (MAPCAs) associated with other CHD to identify the commonly associated CHD, their management strategies and outcomes. Materials and Methods Retrospective data of patients admitted for congenital UAPA with other CHD was compiled from hospital records from 2002 to 2015. The associated CHD were categorized as group I with the decreased pulmonary flow and group II with increased pulmonary flow to the unaffected contralateral pulmonary artery. The determinants of their management were analyzed. Results Sixty-five patients of UAPA and ipsilateral non-unifocalizable MAPCAs associated with other CHD were identified. Group I had 41 patients and Group II had 24. The most common CHD associated with UAPA was tetralogy of Fallot (TOF) in 31 patients (47.7%). Fifty-three patients underwent surgery, 48 (73.8%) underwent single lung corrective surgery, 5 (7.6%) palliative surgery and 12 (18.4) received no surgery. Four operated patients died in the immediate postoperative period. The lowest Mc Goon ratio and Nakata index to undergo corrective surgery were 1.0 and 87.4 mm2/m2. A follow-up of 21 patients was done, among which 11 patients who underwent single-stage corrective surgery, all are in NYHA class II and saturating above 95%. Conclusions Congenital UAPA is a rare anomaly and associated with a variety of CHDs, TOF being the most common. Single lung corrective surgery in patients with ipsilateral non-unifocalizable MAPCAs has good immediate and long term survival.
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Affiliation(s)
- Harpanahalli Ravi Ramamurthy
- Department of Pediatric Cardiology & Grown Up Congenital Heart Diseases, Army Hospital (Research & Referral), New Delhi, India
| | - Varsha Walavalkar
- Department of Pediatric and Grown-Up Congenital Heart Diseases, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Satheesh Siddaiah
- Department of Pediatric and Grown-Up Congenital Heart Diseases, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Sunita Maheshwari
- RXDX Healthcare and Teleradiology Solutions, Bengaluru, Karnataka, India
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10
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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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11
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Stefanelli G, Meli M, Nardelli R, Chiurlia E, Weltert L. Outcome at 26 Years After Repair of Fallot's Tetralogy With Absent Left Pulmonary Artery. World J Pediatr Congenit Heart Surg 2020; 11:661-663. [PMID: 32853077 DOI: 10.1177/2150135120932509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report long-term outcome after two-stage, "one lung repair" in a four-year-old boy with tetralogy of Fallot and congenital absence of the left pulmonary artery. The operation was carried out two years after a palliative aortopulmonary central shunt and was uneventful. Twenty-six years later, the patient is in excellent clinical condition, with normal peripheral oxygen saturation. A recent radionuclide lung scan and cardiac magnetic resonance imaging show the pulmonary flow entirely directed into the right lung. In selected cases, the long-term prognosis of patients with tetralogy of Fallot and true absence of left pulmonary artery after "one lung repair" may be excellent.
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Affiliation(s)
| | - Marco Meli
- Department of Cardiac Surgery, 18614Cardiology Hesperia Hospital, Modena, Italy
| | - Rosaria Nardelli
- Department of Cardiac Surgery, 18614Cardiology Hesperia Hospital, Modena, Italy
| | - Emilio Chiurlia
- Department of Cardiac Surgery, 18614Cardiology Hesperia Hospital, Modena, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, 47291European Hospital, Roma, Italy
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12
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Yang T, Sun J, Xu H, Yan J, Li S, Wang Q, Zhang J. Surgical Management of Tetralogy of Fallot with Unilateral Absence of the Pulmonary Artery. Pediatr Cardiol 2019; 40:1026-1034. [PMID: 31049646 DOI: 10.1007/s00246-019-02109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
Tetralogy of Fallot with unilateral absence of the pulmonary artery (UAPA) is a rare congenital heart disease. The aim of the present study was to examine the surgical strategy for Tetralogy of Fallot with UAPA by summarizing our experience of its treatment. We retrospectively evaluated 17 patients admitted to our hospital for treatment between 2006 and 2017. All patients were diagnosed with absence of the left pulmonary artery. The Nakata Index (NI), NI Z score, and McGoon ratio of the existing pulmonary artery were calculated. All patients were divided into one-stage complete repair (group A) or palliative procedure (group B) groups according to these criteria and surgical treatments. There were nine treated patients in group A, with a mean NI of 595.6 ± 690.32 mm2/m2 (169.3-2433 mm2/m2) and a mean NI Z score of - 1.57 ± 3.02 (- 4.60 to 5.27). There were eight treated patients in group B, with a mean NI of 107.61 ± 49.49 mm2/m2 (53.15-216.39 mm2/m2) and a mean NI Z score of - 6.27 ± 1.56 (- 8.22 to - 3.54). The mean follow-up time in group A was 5.58 ± 3.42 years (1-11.7 years), while that in group B was 5.4 ± 3.42 years (0.6-12.1 years). No hospital deaths occurred and the follow-up results were good in both groups. In conclusion, development of a single existing pulmonary artery can be evaluated using the NI and the NI Z score. These evaluations can be used to select complete repair or palliative procedures for patients and achieve good results.
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Affiliation(s)
- Tengjiao Yang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jing Sun
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Haitao Xu
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jun Yan
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Qiang Wang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jing Zhang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China.
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13
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Anomalous left pulmonary artery: rare case, uncertain embryology and off-pump approach. Indian J Thorac Cardiovasc Surg 2018; 35:226-229. [PMID: 33061012 DOI: 10.1007/s12055-018-0770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022] Open
Abstract
Left pulmonary artery from descending aorta, left-sided arch and patent ductus arteriosus is a rare congenital anomaly. Only one such case has been reported before, which was repaired in the neonatal period and the authors suggested that current theories of embryology failed to explain such a combination. Early and often bilateral pulmonary vascular disease is common with such defects. We present an 8-month-old baby, with this anatomy, who was repaired using an off-pump approach, to minimize the risk of postoperative pulmonary hypertensive crisis and propose a "modified ontogenic theory" to explain the embryology.
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Katewa A, Anand K, Sahu B. One-Stage Repair of Tetralogy of Fallot and Pseudoaneurysm of the Ascending Aorta After Central Shunt. World J Pediatr Congenit Heart Surg 2018; 11:NP132-NP135. [PMID: 29614910 DOI: 10.1177/2150135117750566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudoaneurysm of the ascending aorta following a central aortopulmonary shunt is a rare and potentially fatal complication. Loss of pulmonary artery continuity is another complication following an aortopulmonary shunt. We report an unusual combination of these two complications following an aortopulmonary shunt performed in a child with tetralogy of Fallot. This was managed successfully along with intracardiac repair of tetralogy of Fallot incorporating only the left pulmonary artery.
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Affiliation(s)
- Ashish Katewa
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
| | - Kanwaljeet Anand
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
| | - Balswaroop Sahu
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
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