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Verma M, Pandey NN, Ramakrishnan S, Jagia P. Anomalous origin of one pulmonary artery from aorta: Evaluation on computed tomography angiography. J Card Surg 2022; 37:483-491. [PMID: 35018673 DOI: 10.1111/jocs.16229] [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: 12/26/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
AIM The present study sought to evaluate the morphology and associated cardiovascular anomalies in patients with anomalous origin of one pulmonary artery from aorta (AOPA) on CT angiography. MATERIALS AND METHODS A retrospective search of the departmental database from January 2014 to September 2021 was conducted to identify patients diagnosed with AOPA on CT angiography. The subtype of AOPA, site of origin, and associated cardiovascular abnormalities were assessed. RESULTS AOPA was identified in 27 patients (19 males, mean age: 8.8 years). Anomalous origin of the right pulmonary artery from aorta (AORPA) was observed in 17/27 (63%) patients, while anomalous origin of the left pulmonary artery (AOLPA) was seen in 10/27 (37%) patients. The proximal and distal subtypes were observed in 24/27 (88.9%) and 3/27 (11.1%) patients respectively. AOPA was associated with other cardiac anomalies in 92.6% (25/27) patients. Patent arterial duct (11/17; 64.7%) was the most frequently anomaly associated with AORPA, while tetralogy of Fallot (10/10; 100%) was the most commonly anomaly associated with AOLPA. The anomalous pulmonary artery was contralateral to the aortic arch in 23/27 (85.2%) patients. Right-sided aortic arch was observed in only 2/17 (11.8%) patients with AORPA and 8/10 (80%) patients with AOLPA. In 2/10 (20%) patients, AORPA was associated with aortopulmonary window and aortic arch anomaly. CONCLUSION AOPA is rare and frequently associated with other cardiovascular anomalies like patent arterial duct, tetralogy of Fallot, and right-sided aortic arch. CT angiography helps in providing exact anatomical delineation and identifying associated anomalies, thus aiding preoperative planning of surgical management.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Alhawri K, Alakhfash A, Alqwaee A, HassabElnabi M, Ahmed F, Alhawri M, Nasser B, Alhoobani M, Mazzesi G, Alsaeedi A, Almesned A. Anomalous right pulmonary artery from aorta, surgical approach case report and literature review. J Card Surg 2021; 36:2890-2900. [PMID: 34047395 PMCID: PMC8361962 DOI: 10.1111/jocs.15618] [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: 04/17/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anomalous origin of one pulmonary artery from the aorta is a rare congenital anomaly affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. Early surgical treatment has been proven safe with excellent results. The surgical approach and technique is challenging and should be decided ahead before the patient to surgery. Different techniques were described including direct reimplantation, conduit interposition, aortic ring flap. AIM We present a neonate with anomalous origin of the right pulmonary artery from the aorta and discuss the surgical technique and complications in the literature.
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Affiliation(s)
- Khaled Alhawri
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia.,Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
| | - Ali Alakhfash
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia.,Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
| | | | | | - Fazel Ahmed
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia
| | - Mohammed Alhawri
- International University of Malaya Wales, Kuala Lumpur, Malaysia
| | - Bana Nasser
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia
| | | | - Giusseppe Mazzesi
- Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
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Jiang Q, Zhang W, Hu R, Zhu Y, Hu J, Gu M, Zhang H. Outcomes of Surgical Reimplantation for Anomalous Origin of One Pulmonary Artery From the Aorta. Ann Thorac Surg 2020; 111:1351-1357. [PMID: 32971061 DOI: 10.1016/j.athoracsur.2020.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anomalous origin of one pulmonary artery from the ascending aorta (AOPA) is a rare and potentially deadly anomaly. Little research, aside from case reports on APOA, has been published, especially for patients with late referrals. METHODS This study was a retrospective review of 57 patients with AOPA who underwent reimplantation of the pulmonary artery (PA) from 2009 to 2019. Two different reimplantation methods were used to correct the anomaly, including direct anastomosis in 36 patients and angioplasty with autologous tissue in 21 patients. RESULTS The median age at repair was 2.8 months (range, 8 days to 3.6 years). In-hospital death occurred in 2 patients (3.5%). Five patients (9.1%) with a median age of 9.3 months (range, 5.2 months to 3.6 years) experienced a pulmonary hypertensive crisis. Patients older than 4.9 months were more likely to have a pulmonary hypertensive crisis (P = .001). The 2-year freedom from postoperative PA stenosis rate was 75.3% in patients who underwent direct anastomosis and 46.8% in patients who underwent autologous tissue angioplasty (χ2 = 4.878; P = .027). Angioplasty with autologous tissue (hazard ratio, 5.03; 95% confidence interval, 1.61 to 15.71; P = .005) and an innately smaller diameter of the aberrant PA (hazard ratio, 0.65; 95% confidence interval, 0.45 to 0.92; P = .015) were 2 independent risk factors for postoperative PA stenosis. CONCLUSIONS Surgical reimplantation of the PA in patients with AOPA has resulted in favorable early and midterm outcomes. Pulmonary hypertensive crisis occurs more commonly in patients who receive a diagnosis after the age of 4.9 months. Reimplantation with autologous tissue augmentation and an intrinsically smaller diameter in affected PAs are 2 independent risk factors for postoperative PA stenosis.
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Affiliation(s)
- Qi Jiang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingjun Gu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Anomalous origin of right pulmonary artery: diagnosis, treatment, and follow-up in an adult patient. Cardiol Young 2020; 30:1199-1201. [PMID: 32624062 DOI: 10.1017/s1047951120001729] [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: 11/05/2022]
Abstract
Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. We present the case of a 43-year-old man with an anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta. Reimplantation of the right pulmonary artery was carried out successfully, with favourable evolution in the medium-term follow-up. It is the first described case that receives corrective treatment in adulthood with a favourable evolution.
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Dong S, Yan J, Xu H, Duan Y, Liu C. The surgical treatment of anomalous origin of one pulmonary artery from the ascending aorta. J Cardiothorac Surg 2019; 14:82. [PMID: 31029153 PMCID: PMC6487052 DOI: 10.1186/s13019-019-0904-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/01/2019] [Indexed: 12/26/2022] Open
Abstract
Objective This study sought to summarize the clinical experience of surgical treatment of anomalous origin of pulmonary arteries from the ascending aorta (AOPA) in Fuwai hospital. Methods Fifty-two patients (28 males, 17.2 ± 27.2 months old and 8.7 ± 10.2 Kg weight) who have AOPA undertook surgical treatment between 1998 and 2017 were reviewed in this study, 47 out of 52 are anomalous origin of the right pulmonary artery (AORPA), among the rest of the patients are anomalous origin of left pulmonary artery (AOLPA). 27 out of 52 associate with simple cardiac abnormalities, 20 out of 52 associate with complex cardiac malformations, the remaining 5 patients without cardiac abnormalities. Among all patients who underwent surgical treatment, the direct end-to-side anastomosis strategy was applied in 26 patients, autologous pericardial-homograft patch and aortic flap were employed in 20 patients, and synthetic graft was used in 6 patients. Results No patient died during the perioperative period. 50 out of 52 patients were followed-up for 100.1 ± 70.9 months. The rate of pulmonary arterial free restenosis for 2 years, 5 years, and 10 years is 98.0, 96.0 and 92.0%, respectively. Conclusions The correct diagnosis and appropriate surgical treatment for AOPA could obtain excellent early and medium-term result.
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Affiliation(s)
- Shuo Dong
- 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 District, Beijing, 100037, People's Republic of China.,38 Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, 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 District, Beijing, 100037, People's Republic of China. .,38 Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, 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 District, Beijing, 100037, People's Republic of China.,38 Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yabing Duan
- 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 District, Beijing, 100037, People's Republic of China.,38 Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Chun Liu
- 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 District, Beijing, 100037, People's Republic of China.,38 Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
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Bu H, Gong X. Image diagnosis: An anomalous origin of right pulmonary artery from the ascending aorta. J Cardiovasc Comput Tomogr 2018; 14:e37-e39. [PMID: 30594440 DOI: 10.1016/j.jcct.2018.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, PR China.
| | - Xueyang Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, PR China.
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Gupta A, VanLoozen D, Polimenakos AC, Murdison KA. Restoring Fetal Circulation as a Means of Bridging Treatment Prior to Surgical Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta with Persistent Pulmonary Hypertension of the Newborn. Pediatr Cardiol 2018; 39:848-851. [PMID: 29500505 DOI: 10.1007/s00246-018-1849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/24/2018] [Indexed: 11/27/2022]
Abstract
Anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital anomaly. Even more rarely reported is its presence in conjunction with persistent pulmonary hypertension of the newborn (PPHN). We present a case of a full-term infant, initially thought to have PPHN and later found to have anomalous origin of the right pulmonary artery from the ascending aorta. We discuss our management concept which included use of PgE1 infusion to restore fetal circulation prior to surgical treatment in this unique clinical scenario.
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Affiliation(s)
- Aamisha Gupta
- Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, 1446 Harper Street, Augusta, GA, 30912, USA
| | - Dennis VanLoozen
- Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, 1446 Harper Street, Augusta, GA, 30912, USA
| | - Anastasios C Polimenakos
- Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta University, 1446 Harper Street, Augusta, GA, 30912, USA
| | - Kenneth A Murdison
- Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, 1446 Harper Street, Augusta, GA, 30912, USA.
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Pallangyo P, Lyimo F, Nicholaus P, Mtolera M. Anomalous Origin of the Right Pulmonary Artery From the Ascending Aorta in a 10-Month-Old Child: A Case Report From Tanzania. J Investig Med High Impact Case Rep 2016; 4:2324709616648992. [PMID: 27231696 PMCID: PMC4871194 DOI: 10.1177/2324709616648992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/13/2022] Open
Abstract
Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital deformity associated with poor quality of life and reduced life expectancy. Without a corrective surgery, less than one third of cases will live to see their sixth month. We report a case of a 10-month-old male child from Tanzania who presented with a 6-month history of recurrent respiratory tract infections, mild effort intolerance, and failure to thrive.
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Affiliation(s)
- Pedro Pallangyo
- The Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | | | | | - Maria Mtolera
- Muhimbili National Hospital, Dar es Salaam, Tanzania
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