Surgical Results of Anomalous Origin of One Pulmonary Artery Branch from the Ascending Aorta

Abstract

We reviewed our surgical experience with anomalous origin of one pulmonary artery from the ascending aorta (AOPA). From 1989 to 2012, 12 children (five neonates) aged 3-734 days (mean 152 ± 222) with AOPA underwent operations. Eight patients had right AOPA, and four patients had left AOPA. The majority of the patients had elevated right ventricular pressure, with 58 % (7 of 12) demonstrating suprasystemic right ventricular pressure. Surgery was performed by direct anastomosis (group 1) in seven patients and by employing an autologous patch (group 2) in five patients. There were two postoperative mortalities caused by heart failure and pulmonary hypertensive crisis. The mean follow-up duration was 12.6 ± 8 years. Catheterization showed that the right ventricle-to-systemic pressure ratio decreased following operation (preoperative vs. postoperative; 1.13 ± 0.19 vs. 0.48 ± 0.03, p = 0.043). There was no difference in the perfusion of the affected lung as measured by the final lung perfusion scan, between the two groups (group 1 vs. group 2; 50.0 ± 10.3 vs. 42.7 ± 28.7 %, p = 0.158). Two patients required reoperations for pulmonary regurgitation and pulmonary artery stenosis. There were two catheter-based interventions. At 20 years, survival by the Kaplan-Meier was 91.7 ± 8.0 %, freedom from reoperation was 80.0 ± 17.9 %, and freedom from catheter intervention was 80.8 ± 12.2 %. Early repair of AOPA improves right ventricular pressure and overall hemodynamics with excellent survival and low risk of reintervention. The type of surgical repair did not significantly affect the long-term outcomes (measured via lung perfusion scan).

Current outcomes of one-stage surgical correction for Berry syndrome

“…This procedure is now the most frequently performed in patients with isolated AROPA. 21 As long as the mobilization of the RPA is feasible, the RPA can be directly anastomosed to MPA with only an anterior patch augmentation to reduce the tension. If the distance is too far for direct suture, a trapdoor flap from the anterolateral wall of the MPA has been described by Chang and colleagues 22 to ensure a native tissue-to-tissue anastomosis with growth potential.…”

Older patients with anomalous origin of the pulmonary artery from the ascending aorta: Guidance via lung biopsy

“…Since the first description of AOPA by Fraentzel in 1868, less than 250 cases have been reported in the literature. The majority of the reported cases are in children <1 year of age . We reported 2 cases of AOPA in individuals over 14‐years age, and our patients had the longest documented follow‐up of this condition.…”

“…The RPA arising anomalously from the ascending aorta is the most common type of AOPA. Both the right and left type have the same hemodynamics and pathophysiology . AOPA results in a large left‐to‐right shunt with the entire cardiac output from the right ventricle directed to one lung and the other lung fed by the aorta at systemic pressure.…”

Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases

“…usually distant from its origin before surgery. 1,[22][23][24][25] The behavior of the narrowed proximal pulmonary artery is similar to that of the ductus arteriosus. This may explain the narrowing that is present in some cases with the distal form after birth, or re-narrowing shortly after direct anastomosis surgery.…”