Origin Of Pulmonary Artery Branch Research Articles

Outcomes of repair of anomalous origin of pulmonary artery branch from aorta ascendens with autologous tissue: a rare condition revisited.

Anomalous origin of pulmonary artery branch from ascending aorta (APA) in the presence of two separate semilunar valves is an uncommon entity necessitating early diagnosis and surgery to prevent development of irreversible pulmonary vascular disease. We evaluated our experience with the technique and outcome of 11 patients with this condition. Between January 2000 and December 2019, 11 patients were diagnosed with APA. Echocardiographic data were collected from the records, including the site of origin of the anomalous pulmonary artery, additional defects, pulmonary artery pressures, and biventricular function. Intraoperative charts were reviewed for the details of the surgical procedure and cardiopulmonary bypass. Post-operative data included survival, ventilatory support, and duration of hospital stay. After discharge, children were reviewed at 1 month, 3 months, 6 months, and then at yearly intervals. Of the 11 patients, females were more than males (7:4) with a median age of 6 months (15 days-28 years) and median weight of 5.7 kg (1.8-40 kg). Nine patients underwent direct re-implantation of anomalous pulmonary artery branch to main pulmonary artery. The survival rate was 88.8% in our series. On follow-up, no re-operations or re-interventions were required and all surgically corrected patients were in stable clinical condition. Early- and midterm outcomes of children who underwent surgery for APA is convincing. Early direct re-implantation of the anomalous branch pulmonary artery to main pulmonary artery without any graft material is the optimal surgical strategy for these patients.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases.

To improve the prenatal diagnosis for anomalous origin of pulmonary artery branches by comparing and analyzing different types of fetal echocardiography features. Between June 2012 and December 2018, fetal echocardiographic features were analyzed retrospectively from fetuses with a prenatal diagnosis of anomalous origin of pulmonary artery branch. The main points of identification were summarized. A total of 12 fetuses were diagnosed, including anomalous origin of a pulmonary artery branch from the innominate artery and six cases with unilateral absence of pulmonary artery. The shared characteristic sonographic finding was the lack of confluence at the bifurcation of the main pulmonary artery. The differences between the two conditions are highlighted by the origin of the anomalous vessel. In fetuses with anomalous origin of one pulmonary artery branch, the affected pulmonary artery arose from the posterior wall of the ascending aorta as noted on three vessels and trachea view as well as the long axis of the left ventricular outflow tract. This is in contrast to fetuses with unilateral absence of pulmonary artery, where the origin of affected pulmonary artery arises from the base of the innominate artery via the ipsilateral patent arterial duct as evident on the three vessels and trachea view and the coronal view of innominate (brachiocephalic) artery. (1) The main similarity is an absence of a confluence at the bifurcation of the main pulmonary artery. (2) The main distinguishing feature is the origin of the anomalous vessel from either the subclavian or directly from the aorta.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch from the aorta and unilateral absence of pulmonary artery by echocardiography

Objective To improve the prenatal diagnosis and differential diagnosis ability for anomalous origin of one pulmonary artery branch from the aorta (AOPA) and unilateral absence of pulmonary artery (UAPA) by comparing and analyzing different types of fetal echocardiography features. Methods Fetal echocardiographic features were analyzed retrospectively in fetus with prenatal diagnosis of UAPA or AOPA between June 2012 and December 2018, and the different types of fetal echocardiography characteristics and main points of identification were summarized. Results A total of 6 fetuses with AOPA and 6 fetuses with UAPA were diagnosed.Among the 6 fetuses with AOPA, 5 cases were anomalous origin of right pulmonary artery from the aorta (AORPA), including 3 cases with isolated AORPA and 2 cases combined with Berry syndrome, and 1 case was anomalous origin of left pulmonary artery from the aorta (AOLPA) with an absent pulmonary valve. All 6 cases of AOPA had proximal form. Among the 6 fetuses with UAPA, 4 cases were isolated unilateral absence of right pulmonary artery, 1 case was isolated unilateral absence of left pulmonary artery and 1 case was unilateral absence of left pulmonary artery combined with tetralogy of Fallot (TOF). The main common characteristic sonographical findings included: there was no confluence at the bifurcation of the main pulmonary artery on multiple views, and the affected pulmonary branch was not attached to the main pulmonary artery. The different characteristic sonographical findings in fetus included: the affected pulmonary artery of AOPA arosed from the right posterior or left posterior portion of the ascending aorta on three vessels and trachea view (3VT) and long axial view of left ventricle, and 3VT and the coronary view of brachiocephalic trunk artery showed that the abnormal origin of pulmonary artery branch of UAPA connected with the root of brachiocephalic trunk artery by the ipsilateral vertical arterial duct (DA), and color Doppler flow imaging showed that the blood flow of the affected pulmonary artery branch was isolated in the pulmonary field. Conclusions AOPA and UAPA have many similarities in the characteristics of fetal echocardiography. 3VT and long axial view of left ventricle are the best views for displaying proximal AOPA, 3VT and the coronary views of the root of brachiocephalic trunk artery are the best views for displaying UAPA. Key words: Echocardiography; Fetus; Unilateral absence of pulmonary artery; Anomalous origin of one pulmonary artery branch from the aorta

The prenatal diagnosis, classification and outcome of anomalous origin of pulmonary artery from ascending aorta

Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis, classification and outcome of abnormal origin of pulmonary artery from ascending aorta (AOPA). Methods From January 2014 to June 2018, 18 cases of AOPA diagnosed by echocardiography in 43 966 fetuses from Shaanxi Fetal Congenital Heart Disease Diagnostic Center were retrospectively analyzed. The echocardiographic features, pathological and anatomical classification, genetic characteristics and outcome of postnatal echocardiography were summarized. Results Abnormal origin of pulmonary artery branches could be demonstrated by color Doppler imaging system in 18 cases. Ten cases (55.6%) of right pulmonary artery abnormalities originated from ascending aorta (AORPA), in which 6 cases (60%) were distal pulmonary artery abnormalities, 4 cases (40%) were proximal pulmonary artery abnormalities. Eight cases (44.4%) of left pulmonary artery abnormalities originated from ascending aorta (AOLPA), including 7 cases (87.5%) of distal pulmonary artery abnormalities and 1 case (12.5%) of proximal pulmonary artery abnormalities. Twelve AOPAs were associated with other intracardiac malformations with 6 right ventricular double outlet (DORV) accompanying with pulmonary stenosis, 3 tetralogy of fallots(TOF), 2 atrioventricular septal defects(AVSD), 1 single ventricle with single atrium, and 1 Berry syndrome, and no casese were associated with extracardiac malformations.Amniocentesis karyotype analysis and gene chip detection in 5 cases showed normal results. Four of 18 cases were born, in which 3 cases died and 1 case was progressively suffered with right pulmonary artery atresia, 10 cases were inducted of labor (4 autopsy) and following-up was lost in 4 cases. Conclusions Incidence of AOLPA and distal type in fetal AOPA is higher than that in child and adult from references, DORV is abnormal type mostly associated with intracardiac malformation. AOPA has no obvious genetic result for less cases. The main risk after AOPA birth is pulmonary infection. Echocardiography is of great value for AOPA in prenatal diagnosis, outcome observation and surgical planning after birth. Key words: Ultrasonography, prenatal; Fetus; Abnormal origin of pulmonary artery from ascending aorta

Anomalous Origin of One Pulmonary Artery From the Ascending Aorta: From Diagnosis to Treatment in Angola.

Anomalous origin of one pulmonary artery is a rare congenital heart disease in which one pulmonary artery branch originates from the ascending aorta. To describe the experience of a cardiothoracic center in an African country to repair anomalous origin of one pulmonary artery in the context of Portugal-Angola collaboration. Between March 2011 and March 2015, four consecutive patients with anomalous origin of pulmonary artery branch underwent surgical correction. The mean age was 1.6 months. The mean weight was 4 kg. All had right pulmonary artery branch originating from the ascending aorta. All patients underwent direct implantation of right pulmonary branch to main pulmonary artery. Two patents had patent ductus arteriosus and one had atrial septal defect. Two patients had pulmonary hypertension. There was no registration of death. The mean cardiopulmonary bypass time was 75.5 ± 4.5 minutes, mean aortic cross-clamping time was 40 ± 5.6 minutes, and mean duration of the postoperative intensive care unit stay was 6.8 ± 5.7 days. At discharge, one patient had residual gradient of 25 mm Hg, the remainder had no significant gradient. The mean follow-up time was 11 months (5-28 months). One week after discharge, one patient presented operative wound dehiscence. At the last follow-up, all patients were alive, and no significant residual gradient or stenosis at site of anastomosis was observed. No reintervention was required. Anomalous origin of one pulmonary artery is a rare but potentially treatable lesion if operated early in life. Direct implantation was a good technique with good short-term results.

A Different Therapeutic Strategy for Severe Tetralogy of Fallot with Origin of the Left Pulmonary Artery from the Ascending Aorta: Stenting of the Right Ventricular Outflow Tract before Complete Repair

The origin of pulmonary artery branches (particularly the left pulmonary artery) from the ascending aorta is a rare condition. We detected prominent hypoplasia of the main and right pulmonary arteries in a 3.5-month-old 3.7 kg female infant who had tetralogy of Fallot with origin of the left pulmonary artery in the ascending aorta. In order to ensure the development of the right pulmonary artery, a stent was put in that extended from the right ventricular outflow tract to the right pulmonary artery. During follow-up, after the patient's right pulmonary artery had developed sufficiently, a complete repair surgery was done. It is common practice for patients with abnormal origin of the left pulmonary artery to perform the complete repair using the direct reimplantation technique. However, we think that another possibility is to implant the stent in patients with hypoplastic pulmonary artery and branches in the early stages, wait for a short period of time and perform the complete repair surgery before permanent pulmonary hypertension develops.

Use of autogenous aortic and main pulmonary artery flaps for repair of anomalous origin of the right pulmonary artery from the ascending aorta

in patients with origin of the right (RPA) or left pulmonary artery from the ascending aorta, the RPA or, much less commonly, the left pulmonary artery arises from the ascending aorta in the presence of separate aortic and pulmonary valves and without the interposition Of ductal tissue. 1" 2 The RPA usually originates from the right posterior aspect of the ascending aorta. 3 Physiologically, the alteration creates a large left-to-right shunt. The contralateral lung is therefore subjected to the entire right ventricular output in addition to flow contributed by associated anomalies, such as patent ductus arteriosus, aortopulmonary septal defect, atrial septal defect, or ventricular septal defect, which have been present in greater than 60% of previous reports. 1 4 Without early operation the natural history of this condition is dismal, with a mortality rate of approximately 70% at 6 months of age and 80% at I year of age. 5 Armer and associates 6 reported the first successful anatomic repair of anomalous origin of the RPA from the ascending aorta with interposition of a polyester fiber graft between the RPA and the main pulmonary artery (MPA). The first successful primary repair was reported by Kirkpatrick, Girod, and King. 7 Traditionally, primary repair is generally reserved for those patients in whom the RPA originates from the posterior aspect of the aorta in close proximity to the MPA. s When the RPA arises from the right lateral aspect of the aorta, the right hilum is often mobilized medially to allow apposition of the RPA and MPA without tension. Alternatively, an interposition synthetic graft is placed either anterior or posterior to the aorta 5, 9 We propose a modified native tissue repair that reduces tension on the RPA-MPA anastomosis. The ascending aorta, proximal aortic arch vessels, the MPA, and both branch pulmonary arteries are widely mobilized. As soon as cardiopulmonary bypass has been established, the RPA is temporarily clamped or snared. The patent ductus arteriosus, if present, is doubly ligated and divided. After crossclamping of the aorta, the anterior aortic circumference is incised transversely at the level of the RPA origin (Fig. 1). Under direct vision, the remaining aortic circumference is transected, with a generous cuff of posterior aortic wall left around the RPA origin (Fig. 2). Alternatively, the posteromedial aspect of the aortic wall can be left intact. Utmost care should be taken to avoid compromise of the left

Origin of pulmonary artery branch from ascending aorta: Primary surgical repair in infancy

1. Surgical repair of origin of a pulmonary artery branch from the ascending aorta should be performed as early as possible in order to prevent death from congestive heart failure or the development of irreversible pulmonary vascular obstructive disease. 2. Deep hypothermic circulatory arrest greatly facilitates surgical repair of this lesion in infancy, as is illustrated by the three cases reported herein. 3. Direct anastomosis of the ectopic pulmonary artery branch to the main pulmonary artery is the surgical technique of choice. 4. Origin of the RPA or the LPA from the ascending aorta results from origin of the RPA or LPA from the aortic sac, instead of from the confluent sixth arches. Typically, the RPA has failed to migrate leftward because of abnormal development of the wall of the aortic sac, abnormal development of the sixth arches, or both. 5. Origin of the RPA or the LPA from the ascending aorta should be distinguished from origin of the "RPA" or of the "LPA" from the innominate artery or from the aortic arch via a PDA or a collateral artery.