Anomalous right pulmonary artery from aorta, surgical approach case report and literature review

Abstract

Background: Anomalous origin of one pulmonary artery from the aorta is a rare congenital anomaly affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. Early surgical treatment has been proven safe with excellent results. The surgical approach and technique is challenging and should be decided ahead before the patient to surgery. Different techniques were described including direct reimplantation, conduit interposition, aortic ring flap. Aim: We present a neonate with anomalous origin of the right pulmonary artery from the aorta and discuss the surgical technique and complications in the literature.

Anomalous origin of branch pulmonary artery from the aorta: Current challenges in the management

“…Appropriate surgical techniques should be chosen based on the site of origin of AOPA. [ 3 ] When it arises close to the MPA, like in postero-lateral or posterior aortic origin, direct reimplantation is the procedure of choice. [ 3 ] Although the most commonly employed technique worldwide, direct reimplantation is still associated with a high incidence of reinterventions (12.5%–36%), and the majority of these are for anastomotic stenosis.…”

“…[ 3 ] When it arises close to the MPA, like in postero-lateral or posterior aortic origin, direct reimplantation is the procedure of choice. [ 3 ] Although the most commonly employed technique worldwide, direct reimplantation is still associated with a high incidence of reinterventions (12.5%–36%), and the majority of these are for anastomotic stenosis. [ 3 9 ] We practice the following steps to ensure an adequate, wide, tension-free anastomosis.…”

“…[ 3 ] Although the most commonly employed technique worldwide, direct reimplantation is still associated with a high incidence of reinterventions (12.5%–36%), and the majority of these are for anastomotic stenosis. [ 3 9 ] We practice the following steps to ensure an adequate, wide, tension-free anastomosis. The anomalous PA is mobilized extensively up to the hilar branches, and it is harvested from aorta with a generous cuff.…”

“…[ 1 2 ] Nearly 300 cases of AOPA have been reported worldwide in the English literature. [ 3 ] The rate of re-intervention after surgery still remains high, and many aspects of management could be refined.…”

Bir pulmoner arterin asendan aortadan anormal çıkışı: Nadir bir konjenital kalp hastalığı

“…Current ontogenetic theories suggest a partial or complete developmental failure of the fifth and sixth arches or the neural crest cells (4). This anomaly results in a large left-to-right shunt, with one lung receiving blood at systemic pressure from the aorta, and the other receiving all cardiac output from the right ventricle (5). Therefore, early recognition and intervention can prevent pulmonary vascular obstructive disease.…”