Partial Anomalous Left Pulmonary Artery: New Evidence on the Development of the Pulmonary Artery Sling

Clinical and angiographic data of a child with a unique form of partial anomalous left pulmonary artery are reported. Because the anomalous pulmonary artery does not run posterior to the trachea, this malformation is not associated with airway obstruction, as are all other forms of anomalous left pulmonary artery described to date. This case strengthens our understanding of the development of the pulmonary artery sling.     

Univentricular Heart With Bridging Bronchus and Sling Left Pulmonary Artery

A bridging bronchus (BB) is a rare congenital heart anomaly. Frequently, BB also is complicated with congenital cardiac malformation, especially with sling (retrotracheal) left pulmonary artery (SLPA). This report presents a patient who underwent a Norwood procedure for a complex congenital heart disease with BB and SLPA.     

Origin of an Anomalous Left Coronary Artery from a Left Hilar Pulmonary Artery

Anomalous coronaries arising in nontruncal regions of the pulmonary artery are exceedingly rare. We report an autopsy case of an anomalous left coronary artery that arose from the distal pulmonary artery at the hilum of the left lung in an infant with complex congenital heart disease. To the best of our knowledge, this is the first such report. This previously unknown coronary malformation led to a fatal intraoperative complication during a pulmonary angioplasty procedure.     

Anomalous Origin of Left Pulmonary Artery from the Aorta with Partial Anomalous Pulmonary Venous Return

Anomalous origin of left pulmonary artery (AOLPA) from the aorta is a rare congenital cardiac malformation. We report a case of AOLPA from the aorta with partial anomalous pulmonary venous return (PAPVR) in a 3.2 kg infant. Surgical correction was performed with direct anastomosis of AOLPA to the main pulmonary artery with subsequent baffling of the anomalous right pulmonary veins to the left atrium and patch augmentation of the left pulmonary artery performed at 1-month of life. Recurrent stenosis of the proximal left pulmonary artery was treated with stent placement at 17-months. Pulmonary hypertension has persisted at 30-month follow up.     

Asymptomatic Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly of the coronary arteries which usually presents with heart failure in early infancy. We describe the unusual occurrence of this in an older child with no signs of cardiac ischemia. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants

The electrocardiogram of an infant with anomalous left coronary artery from the pulmonary artery (ALCAPA, Bland-White-Garland syndrome) usually shows typical signs of an anterolateral myocardial infarction, manifested by abnormal Q waves in leads I, avL, V5, and V6, as well as by transient ST changes in these leads. Because 20–45 % of such patients do not show abnormal Q waves, the diagnosis should be strongly suspected if there is an abnormal R wave progression in the chest leads.     

Anomalous Origin of Left Pulmonary Artery from Aorta with Atrial Septal Defect

Anomalous origin of left pulmonary artery (ALPA) from aorta with atrial septal defect (ASD) is a rare congenital cardiac malformation. We report a case of ALPA from the aorta with ASD in a 1.8-kg baby. Repair was needed at an early age due to progressive congestive heart failure. Surgical correction was performed with cardiopulmonary bypass for closure of ASD and direct anastomosis of the ALPA onto the main pulmonary artery.     

Hoarseness as the Initial Clinical Presentation of Anomalous Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly that, if left untreated, will most often result in severe myocardial ischemia and significant morbidity and mortality. We report an unusual presentation of this defect in a 2-month-old infant who had an initial complaint of a “hoarse cry.” We theorize that impingement of the recurrent laryngeal nerve due to dilatation of the pulmonary artery was the most likely etiology of the patient's symptoms. This case serves as an important reminder that serious congenital heart disease may present with any number of complaints and unusual findings.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in a Premature Infant with Preserved Left Ventricular Function

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare condition. The majority of cases present with impaired left ventricular function. We report on a premature infant who was diagnosed at a gestational age near term with ALCAPA during routine cardiac examination. The patient showed no signs of myocardial ischemia and is doing well after corrective surgery. This is the youngest patient reported with ALCAPA and preserved myocardial function.     

Tetralogy of Fallot with Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta and Hypoplastic Left Pulmonary Artery

A case of tetralogy of Fallot associated with anomalous origin of the right pulmonary artery from the ascending aorta and hypoplastic left pulmonary artery was successfully repaired. Following the simultaneous procedure with banding of the right pulmonary artery and replacement of modified Blalock-Taussig shunt to the left pulmonary artery at 34 days of age, the intracardiac repair was performed successfully at 1 year and 10 months of age. The patient was well 6 months postoperatively, without unilateral pulmonary hypertension.     

Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery Confirmed by 320-Slice Computed Tomography

Anomalous origin the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare congenital coronary abnormality that may be difficult to diagnose by echocardiography. Most patients present with a potentially fatal illness leading to sudden cardiac death during infancy. This report describes a 15-year-old girl who had 15-year history of cardiac murmur but with no clinical symptoms. Echocardiographic examination was normal, but a 320-slice computed tomographic (CT) scan showed the anomalous origin of the left coronary artery form the pulmonary artery. This case demonstrates that the 320-slice CT scan is a sensitive and reliable technique for establishing the diagnosis of ALCAPA in both symptomatic and asymptomatic patients when it cannot be visualized by echocardiography.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Children: 15 Years Experience

This study aimed to illustrate the experience of treating children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The clinical data for 19 children with ALCAPA admitted to Beijing Anzhen Hospital from August 1993 to June 2009 were reviewed. According to the data, 47.4% (9/19) of the patients had a misdiagnosis of endocardial fibroelastosis, and 15.8% (3/19) had a misdisgnosis of dilated cardiomyopathy. Electrocardiography showed abnormal Q waves with T wave inversion in leads I, avL, and V4-V6 of 18 patients, especially in lead avL. The ratio of proximal right coronary artery diameter to aotic root diameter exceeded 0.20 for 15 of 16 patients. Apical ventricular aneurysm or aneurysmal dilation (52.6%,10/19), enhanced echogenicity of papillary muscles (84.2%, 16/19), and increased coronary collaterals (78.9%, 15/19) were detected frequently during echocardiography. A total of 18 patients underwent cardiac surgery including left coronary artery (LCA) ligation for 1 patient (5.6%), LCA ligation plus coronary artery bypass grafting for 1 patient (5.6%), Takeuchi operation for 7 patients (38.9%), and LCA reimplantation for 9 patients (50.0%). Five patients died in the hospital, and the remainder were asymptomatic during a follow-up period of 6 to 166 months. Their abnormal Q waves gradually regressed, and left ventricular systolic function and size returned to normal with alleviation of mitral insufficiency. The clinical features of ALCAPA are helpful for determining an accurate diagnosis. This anomaly can be treated successfully by several types of operations with good prognosis.     

Neonatal Right Lung Emphysema Due to Pulmonary Artery Sling

Pulmonary artery sling is a rare variant of vascular ring where the left pulmonary artery arises from the right and loops behind the trachea or right bronchus causing airway compression. A 40-day-old infant had been mechanically ventilated since birth for severe hypercapnia and right lung emphysema. Left pulmonary artery reimplantation was successfully performed.     

婴幼儿肺动脉吊带畸形5例

目的探讨小儿先天性肺动脉吊带畸形(PAS)的临床诊断方法。方法回顾性分析北京儿童医院2006年1月-2007年5月收治5例婴幼儿PAS资料,采用X线胸片、超声心动图、CT、支气管镜等方法综合检查,其中4例有手术资料。结果5例中超声心动图检出3例;由临床和超声疑诊为PAS,高速CT确诊,诊断符合率100%。结论婴儿早期即出现反复呼吸困难、喘鸣、肺部感染应考虑先天性PAS可能。高速CT、超声心动图可明确诊断。