Right Pulmonary Artery to Left Atrial Fistula in a Neonate

Abstract

A communication between the right pulmonary artery (RPA) and the left atrium is a rare congenital anomaly that presents with cyanosis and heart failure. We describe the surgical repair of an RPA to left atrial fistula using cardiopulmonary bypass in a neonate. Advanced imaging (computed tomography scan) guided the surgical approach. Although previous reports have associated a patent ductus arteriosus with high neonatal mortality, in our case, the ductus arteriosus was actually important for maintaining enough total pulmonary blood flow.

Right pulmonary artery to left atrium fistula

“…Other presenting symptoms include abdominal pain due to splenic infarction, cerebral abscesses, and infarcts 2,4,5 . In rare instances, cyanosis and hypoxemia due to RPA to LA fistula were unmasked after surgical correction of an associated atrial septal defect or a patent ductus arteriosus 6,7 . In addition, common associations are major aortopulmonary collaterals, 2,4 absence of the lower or middle lobe of the lungs, right lung sequestration, and diverticulum of the right main bronchus.…”

Iatrogenic left pulmonary artery to left atrium fistula

“…The adherent LA wall tore along with the surrounding scar tissue resulting in a communication between these two structures. While congenital communications between the pulmonary arteries and the LA do rarely occur—more commonly between the right PA and the LA—this was certainly an unanticipated complication of balloon angioplasty . This complication may have been avoided by primary stent angioplasty, which does not require over distention of the PA to achieve a durable result.…”