The anomalous origin of the branch pulmonary artery from the ascending aorta

• Published in: Interactive cardiovascular and thoracic surgery 2012-07, Vol.15 (1), p.86-92
• Main Authors: Garg, Pankaj, Talwar, Sachin, Kothari, Shyam Sunder, Saxena, Anita, Juneja, Rajnish, Choudhary, Shiv Kumar, Airan, Balram
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aorta - abnormalities; Aorta - diagnostic imaging; Aorta - physiopathology; Aorta - surgery; Aortography; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Child; Child, Preschool; Cineangiography; Female; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Hemodynamics; Humans; India; Infant; Intensive Care Units; Length of Stay; Male; Original; Postoperative Complications - etiology; Pulmonary Artery - abnormalities; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivs110

The anomalous origin of one pulmonary artery branch from the aorta (AOPA) is rare. We report our single-institution surgical experience with this condition. Between January 1994 and February 2011, 17 patients (age: 1 month-25 years) with AOPA underwent surgery at our institute. Thirteen patients had an anomalous origin of the right pulmonary artery (RPA) while four had an anomalous origin of the left pulmonary artery (LPA) from the aorta. In patients with anomalous RPA, 11 patients had the proximal type and two patients had the distal type of AOPA. Four patients had associated Tetralogy of Fallot (TOF). In 14 patients, direct implantation into the main pulmonary artery was performed, while three patients required interpositon of a graft. There was one operative death due to persistent hypoxia in a 7-month old child with TOF and an anomalous LPA from the aorta. At a median follow-up of 36.5 months (range: 2-192 months), all 16 survivors were asymptomatic. On echocardiography, two patients showed a gradient of 25 and 30 mmHg across the anastomosis and are being followed up. In our experience, early repair of AOPA results in acceptable haemodynamic and anatomic results. Long-term survival can be expected with a low incidence of re-operation or re-intervention.