The Patterns of Pulmonary Circulation in Pulmonary Atresia

Absent sixth aortic arch: a form of pulmonary atresia.

“…It is a curious paradox that this may occur despite absence or complete obstruction of the pulmonary artery. Similar cases in other forms of pulmonary atresia have been reported by Campbell and Deuchar (1961) and by Venables (1964). Cyanosis is slight, the arterial pulses are collapsing in character, and congestive cardiac failure is common.…”

Coronary-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia

“…Much less frequently, the supply is derived via an aortopulmonary window or fistulous communication from the coronary arteries. [1][2][3][4][5] The latter arrangement was first reported in 1950 by Allanby and colleagues 6 from Guy's Hospital in London. Subsequently, there have been several accounts of fistulous communications as the predominant source of pulmonary arterial supply.…”

“…1,6 It is very rare for major collateral arteries to supply a lung that was initially fed through a persistently patent arterial duct. [1][2][3][15][16][17] We are aware of less than 40 patients reported in the English medical literature in whom fistulous communication from the coronary arteries have provided the predominant or a significant source of pulmonary arterial supply. [7][8][9]12,18 In physiological and hemodynamic terms, fistulous communications from the coronary arteries are more likely to supply through the arterial duct than the more usual systemic-to-pulmonary collateral arteries.…”