Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-28T10:22:18.188Z Has data issue: false hasContentIssue false
  • English
  • Français

Anomalous origin of one pulmonary artery from the ascending aorta: 36 years' experience from one centre

Published online by Cambridge University Press:  19 August 2008

Riyadh M. Abu-Sulaiman ,
Aijaz Hashmi ,
Brian W. McCrindle ,
William G. Williams  and
Robert M. Freedom
Riyadh M. Abu-Sulaiman
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Aijaz Hashmi
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Brian W. McCrindle*
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
William G. Williams
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Robert M. Freedom
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
*
Brian W McCrindle, MD, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel: (416) 813-7609; Fax:(416) 813-7547
Get access Rights & Permissions [Opens in a new window]

Abstract

Anomalous origin of one pulmonary artery from the ascending aorta is an uncommon lesion with an uncertain outcome. We reviewed 16 consecutive children (9 males) presenting with this lesion over a 36 year period at a single institution. Median age at presentation was 2 days (range, birth to 3.2 years). The anomalous pulmonary was the right in 12 and the left in 4, all originating from the proximal ascending aorta, with no patient having stenosis at the origin of the anomalous pulmonary artery. Associated cardiac anomalies were noted in 9 patients. No intervention was attempted in 2 patients: one was deemed inoperable due to complex associated lesions and pulmonary vascular obstructive disease, while the other one died before repair. Surgical intervention was attempted in 14 patients, with 3 intraoperative deaths (21%). Of 11 operative survivors, 8 developed pulmonary arterial stenosis graded severe in 2, moderate in 1 and mild in 5. Patients with severe stenosis required surgical angioplasty, 1 after unsuccessful dilation combined with placement of an endovascular stent. One patient with moderate, and one with mild, stenosis underwent successful transcatheter balloon dilation. The remaining 4 patients with mild stenosis remain unchanged during follow-up. One patient had biopsy evidence of pulmonary vascular obstructive disease at 3.3 years of age. There were no late deaths, giving a total mortality of 25% (4/16).

Conclusion

While early diagnosis and repair of anomalous origin of one pulmonary artery from the ascending aorta is necessary, restenosis of the site of repair is common.

Keywords

Anomalous pulmonary arterypulmonary artery stenosis
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 4 , October 1998 , pp. 449 - 454
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Penkoske, PA, Castaneda, AR, Fyler, DC, Van Praagh, R. Origin of pulmonary artery branch from ascending aorta. Primary surgical repair in infancy. J Thorac Cardiovasc Surg 1983; 85: 537–545.Google Scholar
2.Fucci, C, di Carlo, DC, Di Donato, R, Marino, B, Calcaterra, G, Marcelletti, C. Anomalous origin of the right pulmonary artery from the ascending aorta: repair without cardiopulmonary bypass. Int J Cardiol 1989; 23: 309–313.CrossRefGoogle ScholarPubMed
3.Freedom, RM, Mawson, JB, Yoo, S-J, Benson, LN. Congenital Heart Disease. Textbook of Angiocardiography. Futura Publishing Company, New York, 1997.Google Scholar
4.Kirklin, JW, Barratt-Boyes, BG. Origin of the right or left pulmonary artery from the ascending aorta. In Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications. John Wiley and Sons, New York, 1986: 939–944.Google Scholar
5.Cucci, CE, Doyle, EF, Lewis, EL. Absence of a primary division of the pulmonary trunk: an ontogenetic theory. Circulation 1964; 29: 124–131.CrossRefGoogle ScholarPubMed
6.Richardson, JY, Doty, DB, Rossi, NP, Ehrenhaft, JL. The spectrum of anomalies of aortopulmonary septation. J Thorac Cardiovasc Surg 1979; 78: 21–27.CrossRefGoogle ScholarPubMed
7.Fong, LY, Anderson, RH, Siewers, RD, Trento, A, Park, SC. Anomalous origin of one pulmonary artery from the ascending aorta: a review of echocardiographic, catheter, and morphological features. Br Heart J 1989; 62: 389–395.CrossRefGoogle ScholarPubMed
8.Keane, JF, Maltz, D, Bernhard, WF, Corwin, RD, Nadas, AS. Anomalous origin of pulmonary artery from the ascending aorta. Diagnostic, physiological and surgical considerations. Circulation 1974; 50: 588–594.Google Scholar
9.Kutsche, LM, Van Mierop, LH. Anomalous origin of a pulmonary artery from the ascending aorta: associated anomalies and pathogenesis. Am J Cardiol 1988; 61: 850–856.Google Scholar
10.Anjos, RT, Suzuki, A, Ho, SY. A rare case of tetralogy of Fallot with unusual blood supply to left lung. Int J Cardiol 1989; 24: 363–366.CrossRefGoogle ScholarPubMed
11.Morgan, J, Capt, MC. Left pulmonary artery from ascending aorta in tetralogy of Fallot. Circulation 1972; 45: 653–657.Google Scholar
12.Robin, E, Silberberg, D, Ganguly, SN, Magnisalis, K. Aortic origin of the left pulmonary artery. Variant of tetralogy of Fallot. Am J Cardiol 1975; 35: 324–329.Google Scholar
13.Presbitero, P, Pedretti, E, Orzan, F, Malara, D, Villani, M, Ferrazzi, P, Crupi, G, Parenzan, L. Absent pulmonary valve syndrome with associated anomalies of pulmonary blood supply. Int J Cardiol 1984; 6: 587–598.Google Scholar
14.Saxena, A, Shrivastava, S, Sharma, S. Anomalous origin of the left pulmonary artery from the ascending aorta in a patient with tetralogy of Fallot and ‘absent pulmonary valve’. Int J Cardiol 1991; 33: 315–317.Google Scholar
15.Calder, AL, Brandt, PW, Barratt-Boyes, BG, Neutze, JM. Variant of tetralogy of Fallot with absent pulmonary valve leaflets and origin of one pulmonary artery from the ascending aorta. Am J Cardiol 1980; 46: 106–116.Google Scholar
16.Berry, TE, Bharati, S, Muster, AJ, Idriss, FS, Santucci, B, Lev, M, Paul, MH. Distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum, patent ductus arteriosus and hypoplasia of the aortic isthmus: a newly recognized syndrome. Am J Cardiol 1982; 49: 108–116.CrossRefGoogle ScholarPubMed
17.Boonstra, PW, Talsma, M, Ebels, T. Interruption of the aortic arch, distal aortopulmonary window, arterial duct and aortic origin of right pulmonary artery in a neonate: report of a case successfully repaired in one-stage operation. Int J Cardiol 1992; 34: 108–110.Google Scholar
18.Dodo, H, Alejos, JC, Perloff, JK, Laks, H, Drinkwater, DC, Williams, RG. Anomalous origin of the left main pulmonary artery from the ascending aorta associated with DiGeorge syndrome. Am J Cardiol 1995; 75: 1294–1295.Google Scholar
19.Griffiths, SP, Levine, OR, Anderson, DH. Aortic origin of the right pulmonary artery. Circulation 1962; 25: 73–84.Google Scholar
20.Heath, D, Edwards, JE: The pathology of hypertensive pulmonary vascular disease. Circulation 1958; 18: 533.CrossRefGoogle ScholarPubMed
21.Heath, D, Helmholz, HF Jr, Burchell, HB, DuSahne, W, Edwards, JE: Graded pulmonary vascular changes and hemodynamic findings in cases of atrial and ventricular septal defect and patent ductus arteriosus. Circulation 1958; 18: 1155.Google Scholar
22.Rabinovitch, M, Haworth, SG, Castaneda, AR, Nadas, AS, Reid, LM. Lung biopsy in congenital heart disease: A morphometric approach to pulmonary vascular disease. Circulation 1978; 58: 1107–1122.CrossRefGoogle ScholarPubMed
23.Yamaki, S, Suzuki, Y, Ishizawa, S, Kagawa, Y, Horiuchi, T, Sato, T. Isolated aortic origin of right pulmonary artery. Report of a case with special reference to pulmonary vascular disease in the left and right lungs. Chest 1983; 83: 575–578.Google ScholarPubMed
24.Nakamura, Y, Yasui, H, Kado, H, Yonenaga, K, Shiokawa, YTokunaga, S. Anomalous origin of right pulmonary artery from the ascending aorta. Ann Thorac Surg 1991; 52: 1285–1291.Google Scholar
25.Sibley, YD, Roberts, KD, Silove, ED. Surgical correction of anomalous origin of right pulmonary artery from aorta in four day old neonate. Br Heart J 1986; 56: 98–100.CrossRefGoogle ScholarPubMed
26.Nashef, SA, Jamieson, MP, Pollock, JC, Houston, AB. Aortic origin of right pulmonary artery: successful surgical correction in three consecutive patients. Ann Thorac Surg 1987; 44: 536–538.Google Scholar
27.Benatar, A, Kinsley, RH, Milner, S, Dansky, R, Hummel, DA, Levin, SE. Surgical correction for one pulmonary artery arising from ascending aorta-report of five cases. Int J Cardiol 1987; 16: 249–255.CrossRefGoogle ScholarPubMed