Anterior Pulmonary Artery Research Articles

Mobilization and division of the truncus anterior pulmonary artery during robot-assisted right upper lobectomy. Surgeon self-assists by retracting the lung posteriorly and controlling the camera. The pre-vascular plane is identified, and the tissue above the pulmonary artery is divided with a bipolar energy device. Prior to placing the vascular stapler, the truncus anterior branch of the pulmonary artery is mobilized

Mobilization and division of the truncus anterior pulmonary artery during robot-assisted right upper lobectomy. Surgeon self-assists by retracting the lung posteriorly and controlling the camera. The pre-vascular plane is identified, and the tissue above the pulmonary artery is divided with a bipolar energy device. Prior to placing the vascular stapler, the truncus anterior branch of the pulmonary artery is mobilized

Computational fluid dynamics investigation of the novel hybrid comprehensive stage II operation

BackgroundThe hybrid comprehensive stage 2 (HCS2) procedure is a novel palliative operation applicable to a select subset of single ventricle patients with adequate native antegrade aortic flow to the upper body. Flow to the descending aorta, through the pulmonary outlet and ductal arch, is influenced by a stented intrapulmonary baffle connecting the branch pulmonary arteries. We used computational fluid dynamics (CFD) to elucidate the hemodynamic characteristics of this reconstruction. MethodsWe used multiscale CFD analysis of a synthetic, patient-derived HCS2 anatomic configuration with unsteady laminar flow conditions and a non-Newtonian blood model to quantify the resultant hemodynamics. The 3-dimensional CFD model was coupled to a 0-dimensional lumped parameter model of the peripheral circulation to determine the required boundary conditions. ResultsFor the specific anatomy studied, the intrapulmonary baffle did not obstruct flow from the pulmonary trunk to ductal arch as long as the distance between the anterior pulmonary artery wall and baffle wall exceeded ∼7 mm. Vortex shedding off of the baffle wall did not develop, because of the short distance to the ductal arch. The stented baffle experienced significantly uneven “inward” loading from the systemic side. Pulmonary outlet flow separation distal to the baffle produced a low-speed recirculation region. ConclusionsHemodynamic patterns in this complex anatomy are generally favorable. Low flow recirculation could be mitigated by preoperative shape optimization. Calculated inward stresses on the pulmonary baffle can be used in the future to study baffle stent deformation, which is expected to be small.

Atrioventricular Groove Patch Plasty as Part of Konno Operation After Arterial Switch Operation

Aortic insufficiency sometimes occurs after arterial switch operation for transposition of the great arteries. Left ventricular outflow tract enlargement by Konno operation and right ventricular outflow tract reconstruction are necessary during the aortic valve replacement in case of small aortic annulus. A vertical incision from the anterior pulmonary artery to the right ventricular outflow tract in Konno operation can be applied if the coronary anatomy is Shaher type 1, 2, 6, and 8. However, a vertical incision jeopardizes the coronary artery which traverses on the right ventricular outflow tract in Shaher type 3a, 3c, 3d, 4, 5c, 7c, and 9. In this difficult situation, atrioventricular groove patch plasty as part of Konno operation is a choice of surgery.

A Model of Pediatric End-Stage Lung Failure in Small Lambs

One in five children with end-stage lung failure (ESLF) die while awaiting lung transplant. No suitable animal model of ESLF exists for the development of artificial lung devices for bridging to transplant. Small lambs weighing 15.7 ± 3.1 kg (n = 5) underwent ligation of the left anterior pulmonary artery (PA) branch, and gradual occlusion of the right main PA over 48 hours. All animals remained hemodynamically stable. Over seven days of disease model conditions, they developed pulmonary hypertension (mean PA pressure 20 ± 5 vs. 33 ± 4 mm Hg), decreased perfusion (SvO2 66 ± 3 vs. 55 ± 8%) with supplemental oxygen requirement, and severe tachypneic response (45 ± 9 vs. 82 ± 23 breaths/min) (all p < 0.05). Severe right heart dysfunction developed (tricuspid annular plane systolic excursion 13 ± 3 vs. 7 ± 2 mm, fractional area change 36 ± 6 vs. 22 ± 10 mm, ejection fraction 51 ± 9 vs. 27 ± 17%, all p < 0.05) with severe tricuspid regurgitation and balloon-shaped dilation of the right ventricle. This model of pediatric ESLF reliably produces pulmonary hypertension, right heart strain, and impaired gas exchange, and will be used to develop a pediatric artificial lung.

Video-assisted thoracic surgery experience of calcified lymph nodes for lingular sparing lobectomy.

Video-assisted thoracic surgery (VATS) is commonly used for posterior, superior and lingular segmentectomy. Segmental resections involving the left upper lobe are the following: upper division (S1+2 and S3) (lingular sparing lobectomy), apicoposterior segmentectomy (S1 + S2), and lingulectomy (S4 + S5). Lingular sparing lobectomy is still a challenge for more technical demanding and more anatomic variations, especially when facing calcified lymph nodes. A 73 years old woman was admitted for founding a ground glass opacity (GGO) during the screening test (1.0 cm × 1.0 cm). Her pulmonary function result was forced expiratory volume in 1 second (FEV1): 1.51 L (54.7% predicted). She was a non-smoker, with negative bronchoscopy findings. She received general anesthesia with double-lumen endotracheal intubation and right lung ventilation. Right lateral decubitus position was chosen. The first 1.5-cm incision was selected in the 8th intercostal space in the midaxillary line, and was used for the camera. A 4-cm long incision was made in the 4th intercostal space in the preaxillary line. A third 1.5-cm incision was performed in the 9th intercostal space in the postaxillary line for assistant. Pulmonary ligament and the entire left hilum were mobilized. The superior pulmonary vein has usually three major tributaries. The superior branch drains the apicoposterior segments and frequently blocks the access to the apicoposterior arteries. The middle branch drains the anterior segment, and the lowermost branch drains the lingula. The lingular vein must be preserved. The apicoposterior and anterior segment vein was transected with a vascular stapler. Anterior pulmonary artery and anterior bronchus were then divided and stapled. The upper lobe bronchus splits immediately into the lingular bronchus and a common stem. All these segmental bronchi have short course and a calcified lymph node located between the apicoposterior pulmonary artery and apicoposterior bronchus. These situations make the dissection and identification very difficult. Following many failure attempts of trying take the calcified lymph node out. Staple the left apicoposterior pulmonary artery together with the apicoposterior bronchi is completed. And left upper division (S1+2 and S3) was taken out after stapling lung tissue above the level of lingular segment with a 60-mm green linear stapler. Mediastinal lymph nodes of level 9, 7, 4L and 5 were cleared afterwards. Pathology was confirmed with adenocarcinoma (ancinar component dominant). There were no complications and the patient was discharged 6 days postoperatively. Staple the left apicoposterior pulmonary artery together with the apicoposterior bronchi is a safe and feasible way when facing the difficult dissection of the calcified lymph nodes during segmentectomy.

Thoracoscopic Needle Aspiration Biopsy for a Centrally Located Solitary Pulmonary Nodule

Thoracoscopic needle aspiration is a good alternative for a centrally-located solitary pulmonary nodule (SPN) suspected of being lung cancer without severe pleural adhesion. The authors report the technique of thoracoscopic needle aspiration biopsy in a SPN just in the medial aspect of the truncus anterior pulmonary artery and the right upper lobe bronchus.

Transfer Technique of an Anomalous Coronary Artery From the Anterior Pulmonary Artery

We describe a simple rerouting technique for an anteriorly situated anomalous left coronary artery from the pulmonary artery (ALCAPA), extending the left main coronary trunk with autologous aortic and pulmonary tissue. This technique is reproducible. It provides a tension-free aortocoronary anastomosis and a full potential for future growth.

A new operation for ventricular septal defect with aortic incompetence

Two boys, 10 years of age, with ventricular septal defect and severe aortic insufficiency were treated using a new method. An autograft of anterior pulmonary artery wall and the adjacent leaflet and subpulmonary muscle was excised. The excised pulmonary artery segment was used to replace the prolapsed right coronary cusp, and the autograft muscle was used to close the ventricular septal defect. The right ventricular outflow tract and pulmonary valve were repaired using an autologous pericardial patch with an autologous single cusp. The results in both cases were satisfactory.

Tetralogy of Fallot with anomalous coronary artery: double outflow technique

A new technique to repair tetralogy of Fallot with an anomalous coronary artery crossing the right ventricular outflow tract is described, together with intermediate term follow-up. Using a pedicled flap of the anterior pulmonary artery wall as the floor, and a vascular or prosthetic patch as the roof, a composite conduit with the potential for growth is constructed. Together with the native outflow tract, this provides unobstructed egress from the right ventricle to the branch pulmonary arteries. Since 1990, 4 infants aged 2-weeks to 6-months have undergone primary repair using this technique. Intermediate term follow-up shows adequate durability of the repair.

Pulmonary blood flow regulation in an aquatic snake.

Regulation of pulmonary blood flow was studied during voluntary diving in the aquatic file snake, Acrochordus granulatus. Measurements of pressure and blood flow in pulmonary and systemic vessels indicate that blood flow completely bypasses the lung for significant periods during prolonged and quiescent submergence (greater than 30 minutes). When the lung is ventilated, pulmonary blood flow increases to 36 milliliters per minute per kilogram of body mass (measured in the anterior pulmonary artery), and the cardiac output largely bypasses the systemic circulation. These reciprocating patterns of preferential blood flow reflect inverse relations between flow and vascular resistance, with the result that systemic and pulmonary arterial pressures remain virtually constant throughout repetitive dive cycles. Neuropharmacological studies of freely diving snakes and isolated, perfused lung preparations show that pulmonary blood flow is regulated by an interplay of adrenergic vasodilatation and cholinergic vasoconstriction within the densely innervated lung vasculature. The patterns of blood circulation shown by diving Acrochordus reflect an unusual lability of intracardiac shunts.

Rules for diagnosis of arterioventricular discordances and spatial identification of ventricles. Crossed great arteries and transposition of the great arteries.

Rules are presented for the diagnosis of arterioventricular discordances and the spatial position of the ventricles in these cardiopathies by means of angiocardiography and the position of cardiac catheters. Because these rules are based on previous anatomo-embryological findings, the normal development of the conus and the truncus is briefly analysed. The probable morphogenesis of this group of truncoconal cardiopathies is discussed. The fundamental process required to establish the diagnosis of these cardiopathies is as follows: 1) The truncoconal morphology is identified in the lateral projection. a) The anterior position of the pulmonary artery and its infundibulum with respect to the aorta and its infundibulum is characteristic of crossed great arteries with arterioventricular concordance or discordance. b) The anterior position of the aorta and its infundibulum with respect to the pulmonary artery and its infundibulum is characteristic of transposition of the great arteries with arterioventricular concordance or discordance. 2) Once the truncoconal morphology is identified, the use of the anteroposterior projection allows the establishment of the differential diagnosis between arterioventricular concordances and discordances, and of the spatial location of the ventricles in these entities. a) An anterior pulmonary artery directed from right to left, emerging from an infundibulum placed on the left side (anatomically right ventricle on the left) or an anterior pulmonary artery directed from left to right, arising from an infundibulum located to the right (anatomically right ventricular placed on the right), is the specific image of discordant crossed great arteries. b) An anterior pulmonary artery directed from right to left emerging from an infundibulum placed on the right side (anatomically right ventricle on the right side) or the anterior pulmonary artery directed from left to right arising from a left-sided infundibulum (anatomically right ventricle placed on the left side) is characteristic of concordant crossed great arteries. c) An anterior aorta placed to the right of the pulmonary artery and emerging from a left-sided infundibulum (anatomically right ventricle placed on the left side) or an anterior aorta placed to the left of the pulmonary artery and arising from an infundibulum placed on the right side (anatomically right ventricle placed on the right) is characteristic of discordant transposition of the great arteries. d) An anterior aorta placed to the right of the pulmonary artery emerging from a right-sided infundibulum (anatomically right ventricle placed on the right) or an anterior aorta placed to the left of the pulmonary artery arising from an infundibulum placed on the left (anatomically right ventricle placed on the left) is the specific picture of concordant transposition of the great arteries...

Transposition of the great arteries with posterior aorta, anterior pulmonary artery, subpulmonary conus and fibrous continuity between aortic and atrioventricular valves

A newly recognized type of complete d-transposition of the great arteries is presented. The aortic valve was posterior and inferior to the pulmonary valve in 4 postmortem cases. Deficiency of the subaortic muscular conus permitted tenuous aortic-tricuspid fibrous continuity in 3 of 4 cases and tenuous aortic-mitral fibrous continuity in all by means of a high ventricular septal defect. The crista supraventricularis (parietal band) was entirely above the morphologically left ventricle and was much shorter than normal (average length 3 mm, normal average length 7 mm). The morphogenesis of these transpositions cannot be explained by the straight truncal septum hypothesis because the truncal septum in these cases was spiral, not straight. These new findings can readily be explained by the conal growth hypothesis, and they indicate the desirability of a literal (accurate) definition of transposition of the great arteries: aorta arising above the morphologically right ventricle and pulmonary artery originating above the morphologically left ventricle. Malpositions of the great arteries include transposition, double-outlet right ventricle, double-outlet left ventricle and anatomically corrected malposition (“transposition”). Transposition of the great arteries is a relation, not an entity. It is 3 different entities in terms of conal malformations (on the basis of these 4 cases plus a control study of 100 unselected autopsy cases of transposition, accurately defined): (1) subaortic conus with pulmonary-mitral fibrous continuity, 92 percent; (2) subaortic and subpulmonary (bilateral) conus without semilunar-atrioventricular fibrous continuity, 8 per cent; and (3) markedly foreshortened subpulmonary conus with tenuous aortic-atrioventricular fibrous continuity, as in these 4 cases, much less than 1 percent.