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

Published online by Cambridge University Press:  06 July 2022

Javid Raja
Affiliation:
Pediatric Cardiac Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Sabarinath Menon*
Affiliation:
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
Sowmya Ramanan
Affiliation:
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
Sudip Dutta Baruah
Affiliation:
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
Arun Gopalakrishnan
Affiliation:
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
Baiju Dharan
Affiliation:
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
*
Author for correspondence: Dr Sabarinath Menon, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Tel: +914712524631. E-mail: sabarinath.menon@gmail.com.

Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Kutsche, LM, Van Mierop, LH. Anomalous origin of a pulmonary artery from the ascending aorta: associated anomalies and pathogenesis. Am J Cardiol 1988; 61: 850856. DOI 10.1016/0002-9149(88)91078-8.CrossRefGoogle ScholarPubMed
Patel, RJ, Zakir, RM, Sethi, V, et al. Unrepaired tetralogy of fallot with right hemitruncus in an adult: a rare case. Tex Heart Inst J 2007; 34: 250251.Google Scholar
Dong, S, Yan, J, Xu, H, Duan, Y, Liu, C. The surgical treatment of anomalous origin of one pulmonary artery from the ascending aorta. J Cardiothorac Surg 2019; 14: 432. DOI 10.1186/s13019-019-0904-0.CrossRefGoogle ScholarPubMed
Kajihara, N, Imoto, Y, Sakamoto, M, et al. Surgical results of anomalous origin of the right pulmonary artery from the ascending aorta including reoperation for infrequent complications. Ann Thorac Surg 2008; 85: 14071411. DOI 10.1016/j.athoracsur.2007.11.08.CrossRefGoogle ScholarPubMed
Johnson, MC, Watson, MS, Strauss, AW, Spray, TL. Anomalous origin of the right pulmonary artery from the aorta and CATCH 22 syndrome. Ann Thorac Surg 1995 Sep; 60: 681–2. DOI 10.1016/0003-4975(95)00509-J.CrossRefGoogle ScholarPubMed
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: 249255. DOI 10.1016/0167-5273(87)90148-3.CrossRefGoogle ScholarPubMed
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: 537545.CrossRefGoogle ScholarPubMed
Prifti, E, Bonacchi, M, Murzi, B, et al. Anomalous origin of the right pulmonary artery from the ascending aorta. J Card Surg 2004; 19: 103112. DOI 10.1111/j.0886-0440.2004.04023.x.CrossRefGoogle ScholarPubMed
Armer, RM, Shumacker, HB, Klatte, EC. Origin of the right pulmonary artery from the ascending aorta. Report of a surgically corrected case. Circulation 1961; 24: 662668. DOI 10.1161/01.CIR.24.3.662.CrossRefGoogle ScholarPubMed
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: 309313. DOI 10.1016/0167-5273(89)90189-7.CrossRefGoogle ScholarPubMed
Nakamura, Y, Yasui, H, Kado, H, Yonenaga, K, Shiokawa, Y, Tokunaga, S. Anomalous origin of the right pulmonary artery from the ascending aorta. Ann Thorac Surg 1991; 52: 12851291. DOI 10.1016/0003-4975(91)90014-H.CrossRefGoogle ScholarPubMed
Salaymeh, KJ, Kimball, TR, Manning, PB. Anomalous pulmonary artery from the aorta via a patent ductus arteriosus: repair in a premature infant. Ann Thorac Surg 2000; 69: 12591261. DOI 10.1016/S0003-4975(99)01428-9.CrossRefGoogle Scholar
Kirkpatrick, SE, Girod, DA, Caplan, HL, King, H. Aortic origin of the right pulmonary artery. Circulation 1967; 36: 777779.CrossRefGoogle ScholarPubMed
Peng, EW, Shanmugam, G, Macarthur, KJ, Pollock, JC. Ascending aortic origin of a branch pulmonary artery--surgical management and long-term outcome. Eur J Cardiothorac Surg. 2004; 26: 762766. DOI 10.1016/j.ejcts.2004.07.007.CrossRefGoogle ScholarPubMed
Fong, LV, 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: 389395. DOI 10.1136/hrt.62.5.389.CrossRefGoogle ScholarPubMed
Liu, Y, Cheng, L, Qian, X, et al. Surgical correction of anomalous origin of one pulmonary artery without grafts in infants. J Cardiac Surg. 2015; 30: 8591.CrossRefGoogle ScholarPubMed
Dimopoulos, K, Diller, GP, Opotowsky, AR, et al. Definition and management of segmental pulmonary hypertension. J Am Heart Assoc 2018 Jul 4; 7: e008587. DOI 10.1161/JAHA.118.008587 PMID: 29973393; PMCID: PMC6064837.CrossRefGoogle Scholar
Ross, RD, Bollinger, RO, Pinsky, WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol. 1992; 13: 7275. DOI 10.1007/BF00798207.CrossRefGoogle ScholarPubMed