Aorta-pulmonary septal defect and aortic origin of the right pulmonary artery with interruption of the aortic arch: a clinical analysis of 5 cases

Abstract

Objective Reviewing the experience in the diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of the aortic arch. Methods Reviewed clinical data from medical records for5 patients (4 boys and 1 girl, age from 1 to 18 years on admission) who had been treated in Wuhan Asia Heart Hospital between 2005 and 2009. Results All cases had type A interruption of the aortic arch ( according to Celoria and Patron's Classification) , type Ⅱ aorta-pulmonary septal defect( according to Mori Classification) and aortic origin of right pulmonary artery complicated with interruption of the aortic arch. Large patent ductus arteries were observed in all cases,and no cardiac abnormality such as ventricular septal defect was found. All patients received echocardiography and spiral CT examination, and 3 of them over 10 years of age received cardiac catheterization and angiography for the evaluation of the pulmonary artery pressure. Two patients, at the age of 14 and 18 years, had severe pulmonary hypertension and declined to receive the operation. One of the 2 cases had hemoptysis and was given prostacyclin ( Iloprost solution for inhalation, a drug for pulmonary artery hypertention ) for reducing the pulmonary pressure. The patient now has an improved cardiac fu0ction without recurrent hemoptysis. One 14-year-old case gave up the operation because of the financial problem and failed to communicate with us after discharge. Radical surgery was performed in the remaining three cases, one had serious infection in the lung and died 11 days after the operation, in one case ( 2 years old) pulmonary artery hypertension has been persisted even though drug therapy was given for a long time and was found at a poor cardiac function 18 months after the operation. One patient recovered well under routine drug therapy and has been followed-up. Conclusion Aorta-pulmonary septal defect and aortic origin of right pulmonary artery with interruption of the aortic arch ( with intact ventricular septum) are different from the classic triad of inter ruption of the aortic arch, consisted of the interruption of the aortic arch, patent ductts arteriosus and ventricular septal defect.It should be considered as a special kind of cardiovascular malformation syndrome. Echocardiography can be used for the preliminary diagnosis of aorta-pulmonary septal defect and aortic origin of right pulmonary artery with interruption of the aortic arch. The final diagnosis and decision for surgery should be based on the combined information from cardiac catheterization,cardiovascular angiography and spiral CT examination. Pulmonary artery pressure and resistance are the most important factors,because they have great effects on the duration of surgery and the outcome. A radical operation is necessary for all cases, but the mortality rate is high. The prognosis would be great if only the patient can survive successfully during the peri-operative period, a period with a poor cardiac function, potential lung infection and the pulmonary artery hypertension. Key words: Aortapulmonary sepial defect; Heart defects, congenital; Cardiac surgical procedures