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Alakhfash AA, Alqwaiee A, Alakhfash GA, Alhajjaj A, Almesned AA. Pulmonary hypertension associated with congenital heart disease; clinical decision scenario. Respir Med Case Rep 2020; 31:101286. [PMID: 33294357 PMCID: PMC7683341 DOI: 10.1016/j.rmcr.2020.101286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/18/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is one type under group 1 PH. Undiagnosed or delayed diagnosis of significant CHD might lead to significant PAH and at the end might lead to Eisenmenger syndrome. We could expect the degree of PAH in patients with CHD by proper clinical assessment as well as by the basic assessment tools including the chest x-ray (CXR), ECG, and transthoracic echocardiography (TTE). We are presenting a three and half years old child with a delayed/missed diagnosis of large patent ductus arteries (PDA) who present with significant PAH. Clinical evaluation, CXR, ECG, TTE, as well as cardiac catheterization data are presented, with a review of the current guidelines regarding the management of pediatric patients with PAH-CHD.
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Key Words
- APW, Aortopulmonary window
- BPD, Bronchopulmonary dysplasia
- CHD, Congenital Heart Disease
- Congenital heart defects
- PAH, Pulmonary arterial hypertension
- PCW, pulmonary capillary wedge
- PDA closure
- PDA, Patent ductus arteriosus
- PH, Pulmonary hypertension
- PVR, pulmonary vascular resistance
- Pulmonary arterial hypertension
- Qp, pulmonary blood flow
- Qs, Systemic blood flow
- SVR, Systemic vascular resistance
- VSD, Ventricular septal defect
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Affiliation(s)
- Ali A Alakhfash
- Consultant Pediatric Cardiologist, Prince Sultan Cardiac Center-Qassim, Saudi Arabia
| | - Abdullah Alqwaiee
- Consultant Pediatric Cardiologist, Prince Sultan Cardiac Center-Qassim, Saudi Arabia
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Morosetti D, Di Stefano C, Mondillo M, Pensabene MC, De Corato L, Bizzaglia M, Di Martino A, Floris R. Right-sided aortic arch with mirror image branching and situs solitus: a case of a 79 years old woman. Radiol Case Rep 2019; 14:1246-1251. [PMID: 31462948 PMCID: PMC6706679 DOI: 10.1016/j.radcr.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/21/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022] Open
Abstract
Right aortic arch with mirror image branching (RAMI) is a rare congenital defect of the aorta. The exact incidence of RAMI in the general population is unclear. In RAMI the first branch arising from the arch is the left innominate artery, followed by the right carotid artery and right subclavian arteries. We report a case of an adult female patient with RAMI discovered as an incidental finding during radiological investigations for suspected pulmonary embolism in emergency department. No other congenital malformations were reported. It is important to recognize congenital variants of the aortic arch, as they can have relevant implications for patients’ prognosis and management. Therefore, being aware of these conditions is key to avoid any mistakes or surgical and endovascular complications.
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Key Words
- ALSA, Aberrant Left Subclavian Artery
- CHD, Congenital Heart Disease
- CT, Computed Tomography
- Congenital vascular anomalies
- Incidental finding
- LCCA, Left Common Carotid artery
- LIA, Left Innominate Artery
- LSA, Left Subclavian Artery
- MR, Magnetic Resonance
- RAA, Right Aortic Arch
- RAMI
- RAMI, Right aortic arch with mirror image branching
- RCCA, Right Common Carotid artery
- RSA, Right Subclavian Artery
- Right aortic arch
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Affiliation(s)
- Daniele Morosetti
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Carla Di Stefano
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Mariateresa Mondillo
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Maria Claudia Pensabene
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Laura De Corato
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Mirko Bizzaglia
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Arezia Di Martino
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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