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.     

A Case of Anomalous Origin of the Pulmonary Arteries: Right Pulmonary Artery from the Descending Aorta and the Left Pulmonary Artery from the Ascending Aorta

A 3-month-old girl classified as having persistant truncus arteriosus underwent surgical correction of the anomalous origin of the pulmonary arteries; the right pulmonary artery from the descending aorta and the left pulmonary artery from the ascending aorta. The patient died on the fourth postoperative day. The definite diagnosis and choice of surgical strategies should be further examined.     

单侧肺动脉起源于升主动脉的外科治疗

目的 探讨单侧肺动脉起源于升主动脉(AOPA)的外科治疗方法.方法 2006年5月-2008年8月共8例AOPA患儿接受外科治疗.男女各4例;年龄1～96个月;体质量4～24 kg.7例为右肺动脉起源于主动脉,同时并动脉导管未闭、肺动脉高压,其中4例并卵圆孔未闭.1例左肺动脉起源于主动脉,同时并法洛四联症型肺动脉闭锁.病例术前均经心血管增强CT确诊.其中7例右肺动脉起源于主动脉的病例,在体外循环心脏停跳下,游离并切断右肺动脉,将切断的右肺动脉直接吻合于主肺动脉.1例左肺动脉起源异常,由于并法洛四联症型肺动脉闭锁,肺动脉发育较差,因此游离左肺动脉后采用7 mm Goretex管道行中央分流.结果 本组患儿均成活,术后恢复顺利,手术效果良好.术后1个月超声复查右肺动脉与主肺动脉吻合口流速(1.71±0.24)m/s,压差(1.60±0.45)kPa,均未见明显狭窄.结论 AOPA肺动脉高压产生快,应早期诊断,早期手术治疗,近期手术效果良好.但仍需远期观察,以评估手术效果.     

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.     

A Simple and Feasible Technique for Repair of Anomalous Origin of the Left Pulmonary Artery from the Ascending Aorta

Anomalous origin of the left pulmonary artery from the ascending aorta is a rare congenital cardiac malformation and the direct reimplantation technique has been the strategy of choice, although postoperative restenosis across the anastomosis site is frequently observed. In the described case, a simple and feasible technique was used with satisfactory results at 20-month follow-up.     

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.     

Origin of the Main Pulmonary Artery from the Left Coronary Artery in Complex Pulmonary Atresia

We describe a 22-year-old woman with a history of unrepaired pulmonary atresia with ventricular septal defect. This woman was interesting in that her main pulmonary artery and right pulmonary artery arose from the left main coronary artery. She developed significant pulmonary hypertension in addition to isolation of the left pulmonary artery following ductal closure, subsequent to which the majority of her pulmonary blood flow was coronary dependent.     

Autologous Right Pulmonary Artery Tissue for Repair of Left Pulmonary Artery Originating from Left Patent Ductus Arteriosus in a Patient With Tetralogy of Fallot and Absent Pulmonary Valve

Left pulmonary artery (PA) originating from patent ductus arteriosus is an exceptionally rare variant of tetralogy of Fallot with absent pulmonary valve. We described an alternative technique for the repair of discontinuous left PA with the use of the redundant pulmonary artery tissue as material for the conduit in a 3-year-old boy.     

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.     

Early Detection of Anomalous Origin of Left Coronary Artery from the Right Pulmonary Artery After Successful Repair of Critical Coarctation of the Aorta

Left ventricular (LV) function is impaired by increased afterload in neonates with severe coarctation of the aorta, which may result in endocardial fibroelastosis. Repair of the coarctation usually solves the problem, with LV function normalizing after a few weeks. This report describes a patient who underwent successful repair of critical coarctation with normalization of LV function despite signs of endocardial fibroelastosis but with persisting elevation of cardiac troponin T. Cardiac catheterization showed the rare coincidence of anomalous origin of left coronary artery from the right pulmonary artery (ALCAPA) and coronary sinus orifice atresia with left superior vena cava.     

Postductal Origin of the Left Carotid,Left Subclavian,and Aberrant Retroesophageal Right Innominate Arteries in Truncus Arteriosus with Interrupted Aortic Arch

A neonate presented to the C.S. Mott Children's Hospital at the University of Michigan with truncus arteriosus and interrupted left aortic arch, with associated postductal origin of the left carotid, left subclavian, and aberrant retroesophageal right innominate arteries. In addition, the patient was diagnosed with DiGeorge syndrome. This unique anomaly has not been previously reported. The anatomy, pathophysiology, embryology, and successful surgical management of this anomaly are reviewed in this report.     

Asthma-like Attacks Resulting from the Isolated Congenital Left Pulmonary Artery Agenesis with Right Main Bronchus Stenosis

A 5-year-old girl with isolated congenital left pulmonary artery agenesis suffered from recurrent attacks of dyspnea and right-sided pneumonia due to the stenosis of the right main bronchus. The division of ligamentum of the ductus arteriosus and suspension of the right pulmonary artery resulted in the disappearance of symptoms. It is notable that the compression of contralateral bronchus by the remaining pulmonary artery can cause respiratory symptoms in patients with isolated unilateral pulmonary artery agenesis.     

Single Doppler Detection of Left to Right Shunt through the Ductus Arteriosus

ABSTRACT. Forty-two infants and children were examined with unguided continuous and pulsed Doppler echocardiography before and/or after surgical closure of ductus arteriosus or in connection with cardiac catheterization. Presence or absence of diastolic reverse flow in the main pulmonary artery was evaluated for sensitivity and specificity to detect left to right ductus shunt. Diastolic reverse flow was detected in 15 of 16 patients with such a shunt and in 3 of 38 patients without a left to right ductus shunt. This corresponds to 94% sensitivity and 92% specifcity. It is concluded that the accuracy of a single Doppler system in diagnosing patent ductus arteriosus is comparable to the results obtained with a Doppler interfaced to M-mode or cross-sectional echocardiography.