Absence of the left pulmonary artery: A report of six cases with autopsy findings in three

Abstract

Three cases have been presented in which an absent left pulmonary artery was demonstrated at post-mortem examination. The findings in three living patients, presumed to have an absent left pulmonary artery, are also briefly reported. The literature has been reviewed, and eleven cases of absent right or left pulmonary artery briefly commented upon. 1. 1. The principal anatomic features are as follows: 1.1. (a) Absence of the central or heart-end of the left pulmonary artery with persistence of a normal intrapulmonary portion. This anomaly has been associated with a variety of cardiac malformations. Both in our own series and those in the literature, there is a high incidence of an aortic arch on the side opposite to the absent pulmonary artery. However, at least two of our living cases show the arch and the apparently absent artery on the same side. 1.2. (b) An anomalous obliterated vessel running from the left innominate artery to the hilus of the left lung, continuous with patent, normally distributed, elastic intrapulmonary arteries. Evidence has been presented to show that the closed part of the vessel is an obliterated left ductus arteriosus. Almost certainly, the ductus portion may, on occasion, remain patent, as judged from the cases in the literature, whether there is an absent right or left pulmonary artery. 1.3. (c) A normally developed but small left lung, the size possibly secondary in part to the decreased blood flow. 2. 2. The embryologic aspects of the anomaly have been discussed. 3. 3. The physiologic and diagnostic aspects of absence of one or other branch of the pulmonary artery have been discussed and the importance of such absence in surgical operations involving occlusion of one branch of the pulmonary artery was emphasized.