Narrowing Of Pulmonary Arteries Research Articles

Oral Prostacyclin Therapy for Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is characterized by vascular remodeling and cellular proliferation that leads to narrowing and obstruction of small pulmonary arteries. The arteriopathy is clinically manifest as increased pulmonary vascular resistance and elevation of pulmonary arterial pressures. PAH is considered a progressive vasculopathy that ultimately leads to right heart failure and death. Although there is no cure for PAH, current pharmacological therapies have improved morbidity, and in some cases, mortality. The current 3-year survival for patients with PAH managed with state-of-the-art multiple drug therapy remains troubling at ≈58%.1 This is slightly better than in the 1980s, when there were no approved treatments. Article see p 624 In PAH endothelial dysfunction and platelet activation causes an imbalance of arachidonic acid metabolites with reduced prostacyclin levels and increased thromboxane A2 production. Prostacyclin has both vasodilatory and antiproliferative affects on vascular smooth muscle and inhibits platelet aggregation. Prostacyclin synthase levels are decreased in pulmonary arteries of patients with PAH.2 An imbalance between these two arachidonic acid metabolites favoring thromboxane A2 plays an important role in the pathogenesis of PAH.3 This imbalance is addressed by the exogenous administration of prostanoids as therapy in advanced PAH. Epoprostenol was the first prostacyclin used in the treatment of PAH. Intravenous epoprostenol improves hemodynamics, functional capacity, and survival.4–7 The second-generation prostanoid, Treprostinil, which has a considerably longer half-life (4.5 hours versus 4–6 minutes for epoprostenol),8 can be administered subcutaneously, intravenously, or by inhalation, and also improves pulmonary hemodynamics, symptoms, exercise capacity, and survival in PAH.9–11 Prostacyclin remains a mainstay of PAH therapy and is the only therapy with a proven survival …

Transesophageal Echocardiographic Imaging of Aortic Valve Replacement Using Autologous Glutaraldehyde-Treated Pericardium

Transesophageal Echocardiographic Imaging of Aortic Valve Replacement Using Autologous Glutaraldehyde-Treated Pericardium

Sarcoidosis with Major Airway, Vascular and Nerve Compromise

The present report describes a 60-year-old Caucasian woman who presented with progressive dyspnea, cough and wheeze. A computed tomography scan of the chest showed innumerable bilateral inflammatory pulmonary nodules with bronchovascular distribution and a mediastinal and hilar infiltrative process with calcified lymphadenopathy leading to narrowing of lobar bronchi and pulmonary arteries. An echocardiogram revealed pulmonary hypertension. Bronchoscopy showed left vocal cord paralysis and significant narrowing of the bilateral bronchi with mucosal thickening and multiple nodules. Transbronchial biopsy was compatible with sarcoidosis. Despite balloon angioplasty of the left lower lobe and pulmonary artery, and medical therapy with oral corticosteroids, her symptoms did not significantly improve. To the authors' knowledge, the present report describes the first case of pulmonary sarcoidosis resulting in major airway, vascular and nerve compromise due to compressive lymphadenopathy and suspected concurrent granulomatous infiltration. Its presentation mimicked idiopathic mediastinal fibrosis.

P139 Survival of Idiopathic Pulmonary Arterial Hypertension BMPR2 Mutation Carriers Vs BMPR2 Non Carriers

IntroductionIdiopathic pulmonary arterial hypertension (IPAH) is a devastating condition charactericed by the narrowing and obliteration of small pulmonary arteries, leading to elevated pulmonary arterial pressure and ultimately to right heart...

Inhibition of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) reverses experimental pulmonary hypertension.

Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by the progressive narrowing and occlusion of small pulmonary arteries. Current therapies fail to fully reverse this vascular remodeling. Identifying key pathways in disease pathogenesis is therefore required for the development of new-targeted therapeutics. We have previously reported tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) immunoreactivity within pulmonary vascular lesions from patients with idiopathic PAH and animal models. Because TRAIL can induce both endothelial cell apoptosis and smooth muscle cell proliferation in the systemic circulation, we hypothesized that TRAIL is an important mediator in the pathogenesis of PAH. We demonstrate for the first time that TRAIL is a potent stimulus for pulmonary vascular remodeling in human cells and rodent models. Furthermore, antibody blockade or genetic deletion of TRAIL prevents the development of PAH in three independent rodent models. Finally, anti-TRAIL antibody treatment of rodents with established PAH reverses pulmonary vascular remodeling by reducing proliferation and inducing apoptosis, improves hemodynamic indices, and significantly increases survival. These preclinical investigations are the first to demonstrate the importance of TRAIL in PAH pathogenesis and highlight its potential as a novel therapeutic target to direct future translational therapies.

T6 TRAIL is a potential novel therapeutic target in pulmonary arterial hypertension

Introduction and ObjectivesPulmonary Arterial Hypertension (PAH) is a life threatening disease characterised by the progressive narrowing and occlusion of small pulmonary arteries, driven by the dysregulated growth of vascular cells....

The triad of bridging bronchus malformation associated with left pulmonary artery sling and narrowing of the airway: the legacy of Wells and Landing

Although noted in the 19th century, it was not until 1938 that Scheid published the combination of left pulmonary artery sling and narrowing of the airway due to annular tracheal cartilages. Unaware of these prior descriptions, and without a precise preoperative diagnosis, Willis Potts in Chicago performed the first successful sling repair in 1953. In 1976, Cohen and Landing described Scheid's combination of left pulmonary artery sling and stenosis caused by complete tracheal rings, and the term "ring-sling complex" was introduced by Berdon in 1984. Four years later, Wells and Landing noted characteristic tracheobronchial malformations associated with these lesions and proposed a classification that has been confirmed to be clinically relevant in recent cross-sectional imaging studies.

Cardiac magnetic resonance imaging predicts cardiac catheter findings for great artery stenosis in children with congenital cardiac disease

To assess the cardiac catheterisation findings of all children in whom cardiac magnetic resonance imaging found great artery stenosis. We conducted a retrospective analysis of all 45 consecutive children with congenital cardiac disease who were undergoing cardiac catheterisation for intervention on cardiac magnetic resonance-defined great vessel stenosis, between January, 2006 and August, 2008. Following cardiac magnetic resonance, 60 significant great vessel stenoses were identified and referred to cardiac catheterisation for intervention. All patients were catheterised within a median and interquartile range of 84 and 4-149 days, respectively, of cardiac magnetic resonance. At cardiac catheterisation, the children were aged 11.5 years - with an interquartile range of 3.8-16.9 years - and weighed 34 kilograms - with an interquartile range of 15-56 kilograms. Comparing cardiac magnetic resonance and cardiac catheterisation findings, 53 (88%) findings were concordant and seven were discordant. In six of seven (86%) discordant observations, cardiac magnetic resonance defined moderate-severe great vessel stenosis - involving three branch pulmonary arteries and three aortas. This was not confirmed by cardiac catheterisation, which revealed mild stenoses and haemodynamic gradients insufficient for intervention. In one patient, a mild, proximal right pulmonary artery narrowing was found at cardiac catheterisation, which was not mentioned in the cardiac magnetic resonance report. There was no difference between discordant and concordant groups on the basis of patient age, weight, interval between cardiac magnetic resonance and cardiac catheterisation, or type of lesion. Invasive assessment confirmed cardiac magnetic resonance-diagnosed great vessel stenosis in the majority of this cohort. The predominant discordant finding was lower catherisation gradient than predicted by morphologic and functional cardiac magnetic resonance assessment. Flow volume diversion - for example, unilateral pulmonary artery stenosis - and anaesthetic effects may account for some differences. Prospective refinement of cardiac magnetic resonance and interventional data may further improve the validity of non-invasive imaging thresholds for intervention.

Takayasus's Arteritis in Pregnancy. Case Report and Literature Review

Takayasus's Arteritis (TA) is a chronic, inflammatory, progressive, idiopathic disease that causes narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. During pregnancy, one should pay special attention to these patients. The objective of this report was to present the peripartum anesthetic care of a patient with TA and a review of the literature. This is a 31-year old gravida who underwent exchange of the aortic arch and placement of a metallic aortic valve for TA four years ago. She had no complications during pregnancy, and she was admitted at 34 weeks of pregnancy for anticoagulation management. Elective cesarean section was performed at 39 weeks with continuous epidural anesthesia. Fractionated doses of local anesthetic were administered to guarantee slow installation of the blockade. The patient remained hemodynamically stable and was transferred to the ICU in the postoperative period. Several complications can affect gravidas with TA. Careful patient evaluation, treatment of TA complications, and anestheticsurgical planning are fundamental. Maintenance of perfusion is the main concern in these patients, and neuraxial blocks may be used without harming the mother and fetus. In patients with compensated TA complications, monitoring does not differ from that routinely used in cesarean sections. Continuous epidural anesthesia with slow installation maintains hemodynamic stability and allows monitoring cerebral perfusion through the level of consciousness. To avoid postoperative hypoperfusion or hypertensive complications patients should be monitored in an intensive or semi-intensive care unit for 24 hours.

Lessons from inter-stage cardiac magnetic resonance imaging in predicting survival for patients with hypoplastic left heart syndrome

This study describes single-unit experience and explores risk stratification, with protocolised inter-stage cardiac magnetic resonance imaging for infants with hypoplastic left heart syndrome. Survival was retrospectively analysed among the cohort of locally followed survivors of Norwood Stage I procedure, who underwent magnetic resonance imaging under general anaesthesia from 2003 to 2008. This included 32 patients: 17 with Sano conduit and 15 with arterio-pulmonary shunt. The median (inter-quartile range) age and weight at scan were 3.1 (2.6-4.6) months and 5.0 (4.5-5.3) kilograms, respectively. Using morphologic definitions, the median coarctation index was 0.71 (0.57-0.83). The degree of proximal right and left pulmonary artery narrowing was 25% (14-44%) and 25% (11-50%), respectively. The median right ventricular ejection fraction was 54% (48-59%). The ejection fraction was not related to the coarctation index or to pulmonary artery narrowing. Patients were followed up for a median of 19.2 (10.8-46.0) months, during which 13 (41%) had an intervention in addition to routine Norwood Stage II surgery and seven died. Risk of death was related to reduced right ventricular ejection fraction, with a hazard ratio of 0.91 (95% confidence interval 0.85-0.98, p = 0.02), and the cumulative number of focal stenoses of neo-aortic arch and pulmonary arteries (hazard ratio 2.71, 95% confidence interval 1.14-6.44, p = 0.02). In addition to comprehensive three-dimensional morphologic imaging, inter-stage cardiac magnetic resonance imaging provides a ventricular functional index that may predict outcome in patients with hypoplastic left heart syndrome. Measures to preserve right ventricular systolic function and relieve stenoses are paramount within the complex management strategies for these patients.

Medium-Term Outcomes for Peripheral Pulmonary Artery Stenting in Adults with Congenital Heart Disease

We describe our medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease. Improved outcomes in congenital heart disease have lead to the evolution of transcatheter therapies in adults aimed at maintaining normal hemodynamics. Stenting for pulmonary artery narrowing is effective in children, however little is known about outcomes in adults. Retrospective data analysis and follow-up review of our complete experience with peripheral pulmonary artery stenting in adults. Over a 9-year period we carried out 15 procedures, implanting 23 stents (11-left pulmonary artery) in the pulmonary arteries of 12 adult patients (7 female). Eleven patients had previous cardiac surgery. Median age at implantation was 32.5 years (range, 18.7-56.7 years) with median weight of 71.3 kg (range, 44.5-95 kg). Six patients underwent bilateral pulmonary artery stenting. Median procedure time was 140 minutes (range, 76-263 minutes) and 4 patients had other interventions performed during the same procedure. Median systolic pressure gradient across the narrowing's of 24 mmHg (range, 11-61 mmHg) was reduced to 3 mmHg (range, 0-17 mmHg) postprocedure (P < 0.001). Three patients had acute stent embolization, one of whom required surgical removal. No aneurysm formation or significant stent fractures have been noted on median follow-up of 27.4 months (range, 1-97 months). Two patients required reintervention with further stent implantation. Pulmonary artery stenting provides effective relief of narrowing in adults with congenital heart disease. Bilateral and/or multiple stenting are often required. Stent embolization may occur particularly in patients with associated significant pulmonary regurgitation. (J Interven Cardiol 2011;24:373-377).

The Results of Transcatheter Occlusion of Patent Ductus Arteriosus: Success Rate and Complications Over 12 Years in a Single Center

Background and ObjectivesPercutaneous occlusion of patent ductus arteriosus (PDA) has become increasingly attractive with the evolution of devices and techniques. We reviewed results for percutaneous occlusion of PDA using various devices in a single center.Subjects and MethodsA retrospective review was done for 118 consecutive procedures performed in 111 patients with PDA between January 1996 and December 2007.ResultsThe median age of the patients was 4.5 years (0.9 to 60.3 years); body weight was 16.9 kg (6.8 to 74.7 kg). The median PDA diameter at the pulmonic end was 3.8 mm (0.7 to 10 mm); mean pulmonary artery pressure was 21.0 mmHg (7 to 60 mmHg). Complete occlusion occurred in 76/111 (68.4%) immediately after implantation and in 100/111 (90.0%) at one year of follow-up. Second procedures for residual shunts were done in 7 patients. After the year 2001, the complete closure rate was 95.2% compared to 71.4% before 2001. Complications associated with the procedure were left pulmonary artery narrowing (all <20 mmHg) in 14, arrhythmia in 2, and death in 1.ConclusionEvolution of devices, cumulative experience, and health insurance covering the cost of devices have contributed to good outcomes in our center for percutaneous occlusion of PDA. Our results have improved over the years, particularly with the use of the Amplatzer duct occluder.

Tetralogy of Fallot: A Possible Etiology for Narrowing of the Right Pulmonary Artery

Patients with tetralogy of Fallot have right ventricular outflow and pulmonary valve stenosis. They may also have more distal peripheral pulmonary artery stenoses. Peripheral stenosis is believed to be part of the spectrum of the genetic manifestation of tetralogy. Our hypothesis was that narrowing of the right pulmonary artery may be due to compression from the adjacent dilated ascending aorta. We identified 27 patients with tetralogy of Fallot who underwent magnetic resonance imaging scanning postoperatively, most often for evaluation of pulmonary valve stenosis and regurgitation. On the axial image at the level of the right pulmonary artery, we measured the transverse diameters of the ascending and descending aorta, and the minimum and maximum right pulmonary artery diameters. There was a significant correlation between the ratios of the ascending:descending aorta diameters and the maximum:minimum right pulmonary artery diameters. Thus, increasing ascending aorta size is associated with decreasing size of the adjacent right pulmonary artery. In our patient population with tetralogy of Fallot, right pulmonary artery narrowing is at least partly because of compression from the adjacent enlarged ascending aorta.

Quantitative Analysis of Extracardiac Versus Intraatrial Fontan Anatomic Geometries

There exists large geometric variability among total cavopulmonary connections (TCPC) because of the patient-specific anatomies and the chosen surgical procedure. In this study we present quantitative comparison of the geometric characteristics of the extracardiac and intraatrial Fontan anatomies, the two commonly used TCPC procedures. A method of centerline approximation of the three-dimensional geometries (skeletonization) was used to quantify the TCPC geometric parameters such as vessel areas, curvature, and collinearity. The TCPC anatomies of 26 patients, 13 extracardiac and 13 intraatrial, were analyzed in this study. There was no significant difference in the vessel dimensions between extracardiac and intraatrial TCPCs, with the overall magnitudes agreeing well with that seen in normal children except for the inferior vena cava. Intraatrial baffles had significant fluctuations in cross-sectional area along the length of the baffle as opposed to extracardiacs (p < 0.05). Patients with hypoplastic left heart syndrome had significant narrowing of the left pulmonary artery (p < 0.05), suggesting a possible physical constriction from the reconstructed aorta. This study benchmarks the anatomic variability of patient-specific TCPCs. Intraatrial Fontan geometries have significant difference in the area variations across the vessel length compared with the extracardiac geometry. Also, patients with hypoplastic left heart are at a higher risk of left pulmonary artery narrowing.

Leiomyosarcoma Involving Main and Left Pulmonary Artery Treated Surgically With Homograft Replacement and Concomitant Left Pneumonectomy

A 47-year-old woman presented with progressive dyspnea on exertion and generalized weakness for 6 months. On physical examination, a grade-III ejection systolic murmur was heard on her upper sternal border. Her chest x-ray showed mild cardiomegaly with multiple, variable-sized nodular opacities in the right lung (Figure 1). Echocardiography revealed severe supravalvular pulmonary stenosis (peak and mean pressure gradient 76 mm Hg and 45.6 mm Hg, respectively) due to diffuse tubular supravalvular stenosis associated with increased right ventricular pressure (93.9 mm Hg) and left pulmonary artery narrowing. Multislice computed tomogram showed an intravascular mass lesion at the suprapulmonic valvular area, narrowing the lumen and extending …

Abstract 376: A Potential Role for TRAIL in the Pathogenesis of Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a life threatening disease characterised by the narrowing and occlusion of small pulmonary arteries. Endothelial cell (EC) loss, and increased proliferation and migration of pulmonary artery smooth muscle cells (PA-SMC) are strongly implicated in disease pathogenesis. Tumor necrosis factor (TNF)-Related Apoptosis-Inducing Ligand (TRAIL) induces EC apoptosis and SMC migration, consistent with an important role in vascular biology. TRAIL is a type II TNF family transmembrane protein, whose extracellular domain can be proteolytically cleaved from the cell surface to act as a soluble cytokine (sTRAIL) capable of binding to five TRAIL receptors, (TRAIL-R1– 4) and osteoprotegerin (OPG). We hypothesised that TRAIL expression is increased in PAH and that this contributes to the excessive migration of PA-SMC that characterises this condition. TRAIL gene expression was studied in microarrays of PA-SMC RNA isolated from idiopathic PAH (IPAH) patients, and from the lungs of monocrotaline-treated (Mct) rats. Immunohistochemistry was performed to localise TRAIL in both human and rat lung sections. To investigate the functional effects of TRAIL in PA-SMC, human PA-SMC were incubated with recombinant human TRAIL (1–50 ng/ml) for 5h and migration assessed by transwell assay. TRAIL gene expression was 10-fold higher in PA-SMC from IPAH patients compared to controls. Moreover, strong TRAIL immunoreactivity was observed in pulmonary vascular lesions from IPAH patients but not in vessels from patients undergoing lobectomy for lung carcinoma. In the Mct-rat model of PAH we found a 20-fold increase in TRAIL gene expression and a 2-fold increase in protein from whole lung extracts. Immunohistochemistry revealed strong TRAIL immunoreactivity within the muscularised pulmonary arteries of Mct-treated but not saline-treated control rats. Recombinant TRAIL was found to induce a dose dependent (maximum 3 fold) increase in migration of human PA-SMC compared with cells incubated with 0.1% serum alone. These data suggest that TRAIL may be an important molecule in the pathogenesis of PAH. Further studies to elucidate the regulation and function of this molecule in PAH are warranted.

Computed tomography findings in fibrosing mediastinitis

To describe the CT features of fibrosing mediastinitis. The clinical notes, histology, and CT images from 12 patients with fibrosing mediastinitis were reviewed. Clinical data regarding the presentation and suspected aetiology were correlated with location of mediastinal disease, calcification, effect on mediastinal structures, and additional pulmonary findings on computed tomography (CT). The mean age was 40.5 years, with seven female and five male patients. The most common presenting symptom was shortness of breath. Fibrosing mediastinitis diffusely infiltrated the mediastinum in five patients and was localized in seven. Calcification was present in two cases. Eleven of 12 cases had narrowing of mediastinal structures, including five with pulmonary artery narrowing, five with superior vena cava obstruction, four with bronchial narrowing, three with tracheal narrowing, and one with narrowing of the pulmonary vein. The disease was considered idiopathic in seven cases with a demonstrable aetiology in five cases. Eight out of 12 patients had additional pulmonary findings, including all patients with a known aetiology. In the present series of patients, fibrosing mediastinitis more commonly presented as a localized mediastinal mass than as diffuse mediastinal disease, with the anterior mediastinal compartment most frequently involved. Most cases were idiopathic compared with the majority of previous cases at this institution being ascribed to tuberculosis. There is a high incidence of concomitant pulmonary findings, in particular when an identifiable aetiology is present. Obstruction of vital structures frequently gives rise to complications.

Rare fibrosing granulomatous mediastinitis of tuberculosis with involvement of the transverse sinus

Clinical Summary A 63-year-old man was admitted to the hospital with reports of intermittent dyspnea and palpitation for 3 years. No abnormalities were evident on blood tests. The electrocardiogram showed premature atrial beats. The chest radiograph revealed mild elevation of the left bronchus. Echocardiography showed a large capsular space around the roots of the aorta and main pulmonary artery. The magnetic resonance imaging scan showed a giant mass near the aorta, main pulmonary artery, and left atrium, which severely compressed the vessels. The computed tomographic angiogram confirmed the giant mediastinal mass with dimensions of 7.5 7.0 6.5 cm in the transverse sinus involving the aorta, pulmonary artery, pulmonary veins, and coronary artery (Figure 1 and 2, A). Seven days later, the patient underwent surgery. After the chest was opened through a median sternotomy, the pericardium appeared adhesive and very tense, particularly consistently tense and hard around the roots of aorta and main pulmonary artery. The pericardium was separated, starting from the right ventricle where the surface was less tense. After an incision between the aorta and main pulmonary artery was made, a great deal of flavescent viscous liquid with caseous necrosis flowed out of the mass from the incision (Figure 2, B). The encapsulated wall, which was toughly adherent to the aorta, pulmonary artery, and left atrium, was very thick and hard. The surgeon could not completely excise the wall of mass. A tube was placed into the cavity for drainage. The patient had an uneventful postoperative recovery and was discharged on the seventh postoperative day. The pathologic report showed the mass was fibrous granuloma of tuberculosis. On follow-up, the patient was well without any reports such dyspnea, cough, or palpitation. The body temperature was normal and he constantly took antituberculosis drugs. The postoperative computed tomographic angiogram on a follow-up visit showed that the dimensions of cavity had obviously decreased and the narrowing of pulmonary artery, pulmonary veins, and coronary artery had disappeared.

Ascending Aortic Extension for Enlargement of the Aortopulmonary Space in Children with Pulmonary Artery Stenosis

Complex reconstruction of the aorta can be complicated by compression within the aortopulmonary space resulting in airway or pulmonary artery narrowing. Pulmonary artery compression is especially problematic in children with single ventricle physiology in which an increase in pulmonary vascular resistance may impair systemic venous flow and reduce cardiac output. We operated on 7 patients (mean age, 2.9 years) with pulmonary artery stenosis presenting after a complex neonatal aortic reconstruction. All 7 patients underwent aortic extension with a polytetrafluoroethylene interposition graft and homograft patch angioplasty of the pulmonary artery to open the aortopulmonary space and relieve pulmonary artery narrowing. Five patients (hypoplastic left heart syndrome, n = 2; transposition of the great arteries with tricuspid atresia and aortic hypoplasia, n = 1; double outlet right ventricle with aortic hypoplasia, n = 2) had previously undergone first stage repairs for single ventricle morphology. Two of the patients had multiple interim procedures, including placement of bilateral pulmonary artery stents, prior to our repair. There was 1 early death secondary to fungal sepsis. Six patients were discharged from the hospital. There was 1 late, noncardiac death from aspiration pneumonia in a patient with a severe craniofacial defect. Follow-up echocardiograms in the intermediate term have demonstrated relief of pulmonary artery narrowing and unobstructed aortic flow. Aortic extension is an option in children with pulmonary artery compression of structures in the aortopulmonary space after complex aortic reconstruction.

MRT der Pulmonalarterien bei Kindern nach arterieller Switch-Operation (ASO) bei Transposition der großen Gefäße (d-TGA)

To determine the value of MRI in postoperative evaluation of patients with arterial-switch-operation (ASO) for d-TGA. 14 consecutive patients with d-TGA and ASO were examined with MRI in addition to ultrasound because the acoustic window in echocardiography was insufficient. Nine patients had a pulmonary-artery-bifurcation anterior to the aortic root (group 1), and five (group 2) laterally (two of them left, three of them right). MRI was performed in six patients as contrast-enhanced MR-angiography, in 8 patients as native examination. Diameters of pulmonary arteries were measured in two perpendicular views at the origin and in two further locations each with a distance of one cm. One patient showed a supravalvular pulmonary artery stenosis with subsequent pulmonary artery aneurysm, which had not been detected in echocardiography. This patient showed only indirect signs of pulmonary artery stenosis in echocardiography. Compared to group 1, pulmonary arteries in group 2 generally had greater diameters. Those pulmonary arteries in Group 2 which cross the mediastinum underneath the aortic arch had lower diameters compared to the pulmonary artery positioned on the other side. In group 1, the left-sided pulmonary artery had lower diameters than the right-sided pulmonary arteries. It seems remarkable that the narrowing of pulmonary arteries is associated with a flattening of the transversal vessel diameter. Narrowing of pulmonary arteries after ASO is associated with oval vessel diameters. Therefore, multiplanar diagnostic methods are necessary. MRI meets this prerequisite and is therefore advantageous to echocardiography in follow-up examinations at patients with ASO for d-TGA. Special attention should be focused on the main pulmonary artery, on the left pulmonary artery in patients with preaortic pulmonary artery bifurcation as well as on the pulmonary artery which crosses the mediastinum in patients with laterally placed pulmonary artery bifurcation. Angiography should only be performed when intervention is planned.