Ductal Origin of the Pulmonary Artery in Isolation: A Case Series

Abstract

We present three cases of ductal origin of a pulmonary artery in the absence of associated structural heart disease. No geographic or genetic explanation for the temporal occurrence of these cases could be identified. This series illustrates the importance of angiography in achieving an accurate diagnosis as well as appropriate surgical planning. An understanding of the embryologic origin of this lesion supports the strategic approach at catheterization as well as the surgical choice of interposition graft versus direct anastomosis. We report our experience and highlight diagnostic and surgical approaches to such patients based on the underlying embryology of this congenital cardiac anomaly.

Pulmonary artery resuscitation for isolated ductal origin of a pulmonary artery

“…The correct understanding of this lesion, and that it is imminently correctable, has been known for many decades. Here we report, as have others, 2,[21][22][23][24][25][26][27][28][29][30][31][32] evidence that this lesion is clearly amenable to surgical correction by restoring flow to the affected PA.…”

Stenting and Reimplanting Disconnected Pulmonary Artery in Tetralogy of Fallot

“…Probing the disconnected LPA segment is risky, but it should be attempted because of the potential long-term benefits of improved pulmonary blood flow and lung growth. The demonstration of a diverticulum suggestive of a ductal stump is a consistent and definitive clue to the presence of a disconnected PA [8]. The case demonstrates that rehabilitation of disconnected PA is feasible, even beyond infancy, and a diligent and committed search for the arterial supply is warranted in patients with normal lung parenchyma and pulmonary venous return.…”

Reanastomosis and rehabilitation of interrupted left pulmonary artery derived from atretic ductus

“…Less invasive alternatives include cardiac CT and cardiac MRI, but are less sensitive if the ductus has closed. 13 There are two broad strategies for resuscitation of ductal origin pulmonary artery: primary reanastomosis of ductal origin pulmonary artery to the main pulmonary artery and augmentation of distal pulmonary blood flow (via Blalock-Taussig shunt or ductal stenting) followed by reanastomosis. Primary reanastomosis has been recommended at earlier age of diagnosis.…”