EJCTS Click here for details of sales representative
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Edvin Prifti
Massimo Bonacchi
Massimo Bernabei
Marzia Leacche
Fabio Bartolozzi
Vittorio Vanini
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Prifti, E.
Right arrow Articles by Vanini, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Prifti, E.
Right arrow Articles by Vanini, V.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Great vessels

Eur J Cardiothorac Surg 2003;24:21-27
© 2003 Elsevier Science NL

Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta

Edvin Priftia,b, Adrian Cruceana, Massimo Bonacchib*, Massimo Bernabeia, Marzia Leaccheb, Bruno Murzia, Fabio Bartolozzic, Vittorio Vaninia

a Department of Pediatric Cardiac Surgery, ‘G. Pasquinucci’ Hospital, Massa, Italy
b Division of Cardiac Surgery, Policlinico di Careggi, University of Florence, Florence, Italy
c Cardiothoracic Department, St. James Hospital, Dublin, Ireland

Received 8 November 2002; received in revised form 28 February 2003; accepted 4 March 2003.

* Corresponding author. Tel.: +39-0338-985-5782; fax: +39-0573-985-427
e-mail: mbonacchi{at}hotmail.com


   Abstract
Top
 Abstract
1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 References
 
Objectives: The aim was to review our experience with the surgical repair of the anomalous origin of one pulmonary branch from the aorta (AOPA). Materials and method: Between January 1991 and March 2002, eight patients with AOPA underwent surgical correction. Three patients presented isolated AOPA. Five patients presented right AOPA and three, left AOPA. Implantation of the AOPA to the main pulmonary artery was performed by: (I) direct anastomosis in two patients with left AOPA; (II) interposition of a synthetic graft in one patient with left AOPA; (III) employing an autologous pericardial patch in two patients with right AOPA; (IV) using an aortic flap in three other patients with right AOPA. The mean follow-up time was 37.7 months. Results: One patient died postoperatively due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in another patient. Within 1 year after surgery, the mean residual gradient across the anastomotic site at follow-up was 14±8 mmHg. The patient undergoing interposition of a synthetic graft presented a residual gradient of 29 mmHg and underwent reoperation at almost 2.5 years after the first correction. The residual gradient in patients undergoing correction according to technique I was 17±3 mmHg, and in patients undergoing implantation of the AOPA according to techniques III or IV was 9.5±4.6 mmHg (P=0.11). Similarly, the Tc-99m scintigraphy demonstrated that a lower lung perfusion (the lung perfused from the respective AOPA compared with the contralateral lung) in patients undergoing AOPA implantation according to technique I was 59±6(%) and in patients undergoing techniques III or IV was 72±4.5(%) (P=0.038). At follow-up, all patients were alive. Conclusion: The AOPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients presenting this anomaly may undergo correction using various surgical techniques with acceptable results. The techniques employing autologous tissues for enlarging and lengthening the AOPA seems to be associated with less restenosis at the anastomotic site, however, larger series of patients are required to confirm such outcome.

Key Words: Anomalous origin of the pulmonary artery • Pulmonary scintigraphy • Restenosis


   1. Introduction
Top
 Abstract
 1. Introduction
2. Patients and methods
 3. Results
 4. Discussion
 References
 
Anomalous origin of one pulmonary artery (AOPA) from the aorta is a rare congenital cardiac malformation, that should be distinguished from other heart defects associated with an anomalous blood supply to the lungs such as patent ductus arteriosus, major collaterals between the systemic and pulmonary circulation and truncus arteriosus [1]. This type of cardiac malformation was described first by Fraentzel in 1868 [2]. Since then, almost 200 cases have been reported in the literature with a high mortality among patients not surgically treated [1,3–5]. The AOPA from the aorta is frequently associated with other cardiac malformations [6–9] and rarely is presented as an isolated anomaly [10–12]. In 1961, Armer et al. [13] reported the first successful anatomic repair of the right AOPA using a polyester fiber graft. Different techniques have been successfully employed to reimplant the AOPA to the main pulmonary artery trunk (MPAT) such as direct implantation [11,14,15], end-to-end anastomosis with a synthetic graft [3,13], homograft patch [3,4,14], and ‘aortic-ring’ flap [9,12]. However, postoperative restenosis across the anastomotic site is frequently observed. We are reporting our experience with the surgical repair of the AOPA including an overall literature review.


   2. Patients and methods
Top
 Abstract
 1. Introduction
 2. Patients and methods
3. Results
 4. Discussion
 References
 
Between January 1991 and March 2002, eight consecutive patients presenting AOPA in normally connected heart underwent surgical correction. Patients with common arterial trunk with non-confluent pulmonary arteries were excluded from the study.

2.1. Patients' characteristics
The preoperative patients' characteristics are given in Table 1. There were three females and five males. The mean age was 64±81 days (median 35.5) and mean weight was 4.3±1.6 kg (median 3.75). The Waardenburg syndrome was diagnosed in patient 2 and Di George syndrome in patient 8 (Table 1). Patients 1, 3, and 7 presented moderate to severe pulmonary hypertension. Congestive heart failure was present in patients 1, 3, 5, and 7 (Table 1). Three patients presented isolated AOPA. Five patients presented right AOPA and three, left AOPA. In one case, the origin of the left AOPA was from the ipsilateral wall of the descending aorta (Fig. 1A ). In another patient, the origin of the right AOPA was from the contro-posterolateral wall of the ascending aorta (Fig. 1B). The diagnosis was established according to the echocardiographic, angiographic, and operative findings.


View this table:
[in this window]
[in a new window]
  		Table 1. Preoperative demographic and clinical characteristics, early and late postoperative outcome

 


View larger version (88K):
[in this window]
[in a new window]
  		Fig. 1. Preoperative angiography: ((A), patient 2) the anomalous left pulmonary artery originating from the descending aorta, ((B), patient 5) the anomalous right pulmonary artery originating from the controlateral wall of the ascending aorta. AOLPA, anomalous origin left pulmonary artery; AO, aorta; TH-AO, thoracic aorta; AORPA, anomalous origin right pulmonary artery.

 
2.2. Surgical procedure
Four surgical techniques were employed depending on the intraoperative findings and surgeon's preference.

2.2.1. Technique I
Technique I consisted in direct implantation of the AOPA to the MPAT. This technique was employed in patients 3 and 6 presenting left AOPA (Fig. 2A, B ) (Table 1). The left AOPA was identified and encircled with a silastic vascular loop. Then, it was carefully mobilized for a long tract, including the first part of the lobar branches, and temporarily occluded with a tourniquet. The AOPA was detached from the aorta and directly anastomosed to the MPAT with a continuous 6-0 Prolene suture. The anterior half of the suture line was completed with interrupted sutures to allow tissue growth. The aortotomy was sutured primarily or with an autologous pericardial patch.



View larger version (73K):
[in this window]
[in a new window]
  		Fig. 2. (A) Anomalous origin of the left pulmonary artery from the ascending aorta in patient 6. (B) Echocardiographic view demonstrating the anomalous origin of the left pulmonary artery in patient 3. AOLPA, anomalous origin left pulmonary artery; AO, aorta; TH-AO, thoracic aorta.

 
2.2.2. Technique II
A synthetic graft was employed in patient 2. A standard postero-lateral thoracotomy was performed. The left AOPA was identified just beneath the ductus arteriosus. The MPAT was identified easily after opening the pericardium. The left AOPA was clamped at its origin. Then the descending aorta was clamped just above and beneath the left AOPA, which was detached at its origin. A 6 mm Goretex prosthesis was anastomosed end-to-end to the left AOPA and then, end-to-side to the MPAT.

2.2.3. Technique III
In patient 5, presenting right AOPA from the contro-posterolateral wall of the ascending aorta and in patient 1, the distance between the right AOPA and MPAT was small enough to permit a direct posterior anastomosis between them, and later, an autologous pericardial patch was employed to enlarge the anterior aspect of the anastomosis.

2.2.4. Technique IV
In all other patients with the right AOPA originating from the right postero-lateral aspect of the ascending aorta, we prolonged the length of the right AOPA using the aortic ring.

2.2.4.1. IVA (single aortic flap technique)
In patients 4 and 7 (Table 1, Fig. 3A–C ), the ascending aorta, MPAT, and its branches were mobilized. Then ascending aorta was transected, just above and beneath the origin of the right AOPA. The resulting aortic ring was fashioned into an elongated tube for the pulmonary artery and the far end was connected to the MPAT side-to-end [10]. End-to-end anastomosis of the aorta in front of the right AOPA was performed (Fig. 4 ).



View larger version (95K):
[in this window]
[in a new window]
  		Fig. 3. Preoperative examinations data for patient 7: (A) anomalous origin of the right pulmonary artery from the ascending aorta, (B) the origin of the left pulmonary artery from the MPAT and the visualization of the ascending aorta through the patent ductus arteriosus, (C) echocardiographic examination showing the anomalous origin of the right pulmonary and the presence of ductus arteriosus and in patient 8, (D) anomalous origin of the right pulmonary artery from the right lateral aspect of the ascending aorta; (E) the origin of the left pulmonary artery from the MPAT. AOLPA, anomalous origin left pulmonary artery; LPA, Left Pulmonary Artery; RPA, right pulmonary artery; MPA, main pulmonary artery; AO, AORTA; AS-AO, ascending aorta; TH-AO, thoracic aorta; AORPA, anomalous origin right pulmonary artery; PDA, patent ductus arteriosus; LV, left ventricle; RV, right ventricle.

 


View larger version (34K):
[in this window]
[in a new window]
  		Fig. 4. Single aortic flap technique: the reimplantation of the right pulmonary artery to the main pulmonary trunk by using an aortic ring. LPA, left pulmonary artery; MPA, main pulmonary artery; AO, aorta, RPA, right pulmonary artery; AV, aortic valve; PV, pulmonary valve.

 
2.2.4.2. IVB (double flap technique)
In patient 8, the right AOPA originated from the right antero-lateral aspect of the ascending aorta (Fig. 3D, E). We employed a modified technique as previously described [16]. The right AOPA is carefully mobilized for a long tract, including the first part of the lobar branches, and temporarily closed with a tourniquet. The ascending aorta is transected obliquely, just above and beneath the right AOPA, providing a symmetric large aortic ring almost 1.5 times more than the right AOPA diameter (Fig. 5A ). Then, an anterior vertical incision of MPAT, at the origin of the left pulmonary artery, is performed extending superiorly to the half of left pulmonary artery circumference and inferiorly to the MPAT. Two transversal incisions, creating a right angle with the first longitudinal incision nearly half MPAT circumference, are performed creating a posterior pulmonary flap (Fig. 5A). Under direct vision, after measuring the length of the created pulmonary flap, the aortic ring is cut transversely, leaving a small aortic flap posteriorly, and an anterior aortic flap is created. The ascending aorta is retracted posteriorly and an end-to-end anastomosis is performed (Fig. 5B). The pulmonary flap is sutured to the small posterior aortic flap, anterior to the ascending aorta. The anterior aortic flap is laid above the pulmonary flap and further to MPAT and sutured (Fig. 5C).



View larger version (23K):
[in this window]
[in a new window]
  		Fig. 5. Double flap technique: (A) aortic and pulmonary flap preparation, (B) anterior positioning of the aortic and pulmonary flaps and posterior anastomosis, (C) newly created communication between anomalous right pulmonary artery and main pulmonary artery. LPA, left pulmonary artery; MPA, main pulmonary artery; AO, aorta; RPA, right pulmonary artery.

 
All the associated malformations were corrected during the same surgical procedure. Patients 1, 3, 4, and 5 (Table 1) underwent interventricular septal defect (VSD) closure using an autologous pericardial patch. Patient 8 underwent direct interatrial septal defect closure. Patient 1 underwent concomitant pulmonary valve commissurotomy and patient 4 underwent transannular patch enlargement of the right ventricular outflow tract. Extracorporeal circulation was employed in all patients except patient 2 (see Table 1).

2.3. Statistical analysis
Group statistics were expressed as mean±SD. The generalized Wilcoxon test was performed for the statistical analysis between groups. Fisher's exact test was used for the non-continuous variables. Significance between data was considered achieved when P<0.05.


   3. Results
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
4. Discussion
 References
 
The in-hospital mortality was 12.5% (one patient). Postoperatively, patient 1 (Table 1) developed low cardiac output, acute renal failure, and pulmonary hypertension crisis and died in the fifth postoperative day due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in patient 7 that was managed by intravenous prostacyclin. The same patient necessitated mechanical ventilation for 11 days. Chylopericardium was identified in patient 6 (Table 1), which was treated with pleural draining and parenteral nutrition during the first 2 postoperative weeks.

Within 1 year after surgery, all patients were alive and underwent cardiac catheterisation. The mean residual gradient for all patients was 14±8 mmHg. The residual gradient in patients undergoing correction according to the technique I was 17±3 mmHg and in patients undergoing implantation of the AOPA according to the techniques III or IV was 9.5±4.6 mmHg (P=0.11). Similarly, the Tc-99m scintigraphy demonstrated that a lower lung perfusion (the lung perfused from the respective AOPA compared with the contralateral lung) in patients undergoing AOPA implantation according to technique I was 59±6(%) and in patients undergoing techniques III or IV 72±4.5(%) (P=0.038).

At follow-up, all patients were alive – the mean follow-up was 37.7 months/patient. Patient 2 (Table 1) underwent reoperation at 28 months after the first surgical procedure: the employed graft presented significant stenosis in both anastomotic sites. He underwent graft's replacement employing an 8-mm Goretex graft combined with left pulmonary arterioplasty. All survivors underwent serial echocardiographic examinations during follow-up, demonstrating a progressive regression of the ventricular hypertrophy and dimensions.

We reviewed the age, associated malformations, and surgical procedure undertaken through the literature during the last 30 years, in patients with AOPA from the aorta undergoing repair (Table 2). There were 77 reports of patients with AOPA from the aorta undergoing surgery. Almost 55% of patients were under 6 months of age at operation. Major associated heart defects were identified in 28.7% patients. The most frequently found cardiac malformations was the tetralogy of Fallot or double outlet right ventricle in 12.6% of cases, the aorto-pulmonary window, interrupted aortic arch, and VSD (Table 2). The overall mortality was 12.5% (17 patients). According to the univariate analysis, the associated cardiac malformations resulted to be strong predictors for early postoperative mortality. There were non-significant differences regarding the operation period before 1990, age less than 6 months, employment of synthetic prosthesis for anomalous AOPA reimplantation to the main pulmonary trunk, or the presence of the anomalous origin of the left or right pulmonary artery.


View this table:
[in this window]
[in a new window]
  		Table 2. Summary of the reported patients with AOPA undergoing surgical correction

 

   4. Discussion
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
References
 
AOPA from the aorta remains a field of investigation in cardiac surgery due to the low incidence of this congenital malformation [4,15,17]. The largest reported series includes only 16 patients with this anomaly undergoing surgery over a 36-year period [4].

Little is known about the embryogenesis and pathogenesis of this malformation, although an association has been suggested with the CATCH 22 syndrome complex [6,7,18,19], including Di George syndrome [19]. Different authors have reported the important role of the neural crest cells in the development of the third and fourth pharyngeal pouch derivatives as well as the aortic arches and trunco-conal part of the heart [20]. It is plausible that deletions interesting the chromosomic band 22q11 may cause some degree of derangement in the neural crest. Similar defects have recently been described in association with the fetal valproate syndrome [21], another condition linked to disorders of the neural crest cells migration. In our series, one patient presented the Waardenburg syndrome, which is associated with the neural crest-derived melanocyte deficiency. Aru et al. [22] included this anomaly as an aortic arch anomaly complex hypothesizing that a failure of media fusion of the AOPA with the MPAT results in persistence of the aortic sac from which the AOPA originates. In the absence of the left sixth arch, the AOPA may not find connection to the MPAT and consequently, the aortic sac connection persists.

The AOPA may be isolated or associated with other congenital heart defects. Most of the reported cases presented some major associated cardiovascular defect such as tetralogy of Fallot, VSD, and patent ductus arteriosus [4,7]. Surprisingly, we did not observe in any case the association with aorto-pulmonary window, interrupted aortic arch or aortic isthmal hypoplasia [18]. The right aortic arch has been reported in almost 50–75% of patients with left AOPA [4,6,8]. Different cases have been reported with isolated malformation [10–12], although its incidence is very limited. In our series, there were three cases with isolated malformation. Two of them presented left AOPA and one patient presented right AOPA.

According to some previous studies, the echocardiography is sufficient in recognising the AOPA [6,11]. Complete diagnosis employing echocardioraphy is demonstrated by the presence of two concordant ventricular outflow tracts, absence of the usual MPAT bifurcation pattern and the right or left pulmonary artery arising directly from the aorta with the MPAT continuing with the controlateral pulmonary branch. We believe that this is not always easily demonstrated by echocardiography alone [11]. The third patient in our series, after undergoing echocardiographic examination in another institution was referred with the diagnosis of transposition of the great arteries and patent ductus arteriosus. Cardiac catheterisation showed right AOPA and patent ductus arteriosus arising from the left pulmonary artery. Cardiac catheterisation remains the gold standard diagnostic procedure in such cases and should be indicated preoperatively in all patients.

Most commonly, the surgical correction has been achieved within the first month of age [4,15], although, successful repair has been reported in adults [10,11,17,23]. Fontana et al. [5] found a 30% 1-year survival in a series of 23 cases with AOPA not surgically treated. Successful correction of this anomaly in the first days of life, even in prematures, have been reported [14]. Early repair is preferred to avoid pulmonary hypertension and irreversible pulmonary vascular disease. Serious pulmonary vascular disease has been observed in patients with AOPA as early as the third month of life [24]. Several mechanisms have been postulated for the development of pulmonary vascular disease: high pulmonary blood flow, circulating vasoconstrictor substances, neurogenic crossover from the unprotected lung, and left ventricular failure. In our series, the patient presenting left AOPA from the descending aorta, necessitated catheterisation control due to presence of respiratory symptoms. Moderate restenosis across the anastomotic site was associated with ipsilateral lung hypoperfusion at 99mTc pulmonary scintigraphy. The pulmonary biopsy (at reoperation) demonstrated a Heath–Edwards grade-II pulmonary vascular disease of the respective lung.

The origin site of the AOPA is different. Some authors [15] advocate the existence of two forms: a proximal one, the AOPA originates from the ascending aorta close to the valvar plane; and a distal one, the AOPA arises via a patent ductus arteriosus [1]. The third form of presentation is the origin site close to the innominate artery or in extreme cases, the right AOPA may originate from the innominate artery itself [25]. In six of the eight cases in this series, the AOPA originated from the respective proximal postero-lateral part of the ascending aorta. Usually, the origin is from the respective postero-lateral aspect of the ascending aorta [4]. Nevertheless, a more antero-lateral origin of the right AOPA from the ascending aorta was detected in one patient, while an anomalous origin of the right AOPA from the contro-posterolateral wall of the ascending aorta was diagnosed in another case. In another patient, the left AOPA originated from the descending aorta. It is postulated that the ductus arteriosus and the left AOPA develop from the left sixth aortic arch [23]. In our case, we did not find the ductus arteriosus remnant indicating a complete absence of the left sixth aortic arch in this patient.

Different surgical techniques have been employed. The direct anastomosis of the AOPA to the MPAT is most frequently used in the previously described series [4,11,14,15]. End-to-end anastomosis with a synthetic graft [3,15], interposition of a homograft patch [3,4,15], aortic flap [9,12], or interposition of autologous pericardial patch, for increasing the AOPA length, have been successfully employed in specific cases, when direct implantation of the AOPA was not possible. In our experience, we employed four techniques depending on the anatomic characteristics of the malformation. In our hands, the direct implantation was associated with more anastomotic suture tension predisposing to higher risk of dehiscence. Therefore, we preferred this approach, which could easily be performed without extracorporeal circulation, when the distance between the AOPA and MPAT was minimal.

Mortality in our series was 12.5% similar to other reports [4] and the overall mortality in the collected reports (Table 2): the only death occurred at the beginning of our experience with this malformation. This patient presented associated VSD, pulmonary valve stenosis, and congestive heart failure. We believe that a learning curve can explain the improvement in clinical outcome, however, the presence of associated heart defects and preoperative heart failure should be considered as predictors for poor postoperative results. Analysing the 136 reported cases, the associated cardiac malformations resulted to be the main predictor for early postoperative mortality in patients with AOPA.

Occurrence of stenosis at the anastomotic site has been a major problem in some reported series remaining the main late complication [4]. The gradient across the anastomotic site accurately demonstrates the stenosis. The residual gradient seems to be higher and the respective lung less perfused when repair is accomplished according to the direct reimplantation technique than reimplantation using adjunctive autologous material. However, in our analysis, we were not able to demonstrate statistically the benefits that the reimplantation techniques using adjunctive autologous material offer versus the direct reimplantation technique regarding to the residual gradient through the anastomotic site; this due to the very small number of patients. However, the residual gradient through the anastomotic site was twice as high in patients undergoing direct reimplantation technique as in patients undergoing other reimplantation techniques using adjunctive tissue. Probably, the direct reimplantation and synthetic graft interposition fail to gradually accommodate larger volumes with patient's somatic growth, due to growth failure of the anastomotic site. The other techniques (consisting in interposition of autologous tissue for increasing the length and coaptation between the AOPA and MPAT) seems to offer better results in term of late restenosis.

We may conclude that the AOPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients presenting this anomaly may undergo correction using various surgical techniques with acceptable results. The techniques employing autologous tissues for enlarging and lengthening the AOPA seems to be associated with less restenosis at the anastomotic site, however, larger series of patients are required to confirm such outcome.


   References
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 References
 

  1. Penkoske P.A., Castaneda A.R., Fyler D.C., Van Praagh R. Origin of pulmonary artery branch from ascending aorta. J Thorac Cardiovasc Surg 1983;85:537-545.[Abstract]
  2. Fraentzel O. Ein fall von abnormer communication der aorta mit der arteria pulmonalis. Arch Pathol Anat 1868;43:420-426.[CrossRef]
  3. Fucci C., di Carlo D.C., Di Donato R., Marino B., Calcaterra G., Martelletti C. Anomalous origin of the right pulmonary artery from the ascending aorta: repair without cardiopulmonary bypass. Int J Cardiol 1989;23:309-313.[CrossRef][Medline]
  4. Abu-Sulaiman R.M., Hashmi A., McCrindle B.W., Williams W.G., Freedom R.M. Anomalous origin of one pulmonary artery from the ascending aorta: 36 years' experience from one centre. Cardiol Young 1998;8(4):449-454.[Medline]
  5. Fontana G.P., Spach M.S., Effmann E.L., Sabiston D.C., Jr Origin of the right pulmonary artery from the ascending aorta. Ann Surg 1987;206(1):102-113.[CrossRef][Medline]
  6. Fong L.V., Anderson R.H., Siewers R.D., Trento A., Park S.C. Anomalous origin of one pulmonary artery from the ascending aorta: a review of echocardiographic, catheter, and morphological features. Br Heart J 1989;62:389-395.[Abstract/Free Full Text]
  7. Boonsera P.W., Talsma M., Ebels T. Interruption of the aortic arch, distal aortopulmonary window, arterial duct and aortic origin of right pulmonary artery in a neonate: report of a case successfully repaired in one-stage operation. Int J Cardiol 1992;34:108-110.[CrossRef][Medline]
  8. Saxena A., Shrivastava S., Sharma S. Anomalous origin of the left pulmonary artery from the ascending aorta in a patient with tetralogy of Fallot and ‘absent pulmonary valve’. Int J Cardiol 1991;33:315-317.[CrossRef][Medline]
  9. Gybels Y., Grapow M.T.R., Todorov A., Wagner G., Zerkowski H.-R. Aberrant right pulmonary artery and double outlet ventricle: one stage repair. Ann Thorac Surg 2000;69:630-632.[Abstract/Free Full Text]
  10. Igarashi K., Horimoto M. Origin of the right pulmonary artery from the ascending aorta. Longest survivor without receiving surgical repair. Chest 1994;105(4):1280-1282.[Abstract]
  11. Mittal P.K., Agarwal S.K., Ghosh P.K. Isolated anomalous origin of left pulmonary artery from the ascending aorta in an adult. J Thorac Cardiovasc Surg 1993;106:1220-1222.[Medline]
  12. Van Son J., Hanley F.L. Use of autogenous aortic and main pulmonary artery flaps for repair of anomalous origin of the right pulmonary artery from the ascending aorta. J Thorac Cardiovasc Surg 1996;111:675-676.[Free Full Text]
  13. Armer R.M., Shumacker H.B., Klatte E.C. Origin of the right pulmonary artery from the ascending aorta: report of a surgically corrected case. Circulation 1961;24:662-668.[Abstract/Free Full Text]
  14. Salaymeh K.J., Kimball T.R., Manning P.B. Anomalous pulmonary artery from the aorta via a patent ductus arteriosus: repair in a premature infant. Ann Thorac Surg 2000;69:1259-1261.[Abstract/Free Full Text]
  15. Nakamura Y., Yasui H., Kado H., Yonenaga K., Shiokawa Y., Tokunaga S. Anomalous origin of the right pulmonary artery from the ascending aorta. Ann Thorac Surg 1991;52:1285-1291.[Abstract]
  16. Prifti E., Frati G., Crucean A., Vanini V. A modified technique for repair of the anomalous origin of the right pulmonary artery from the ascending aorta. Eur J Cardiothorac Surg 2002;22(1):148-150.[Abstract/Free Full Text]
  17. Rangel A., Arguero R., Albarran H., Ocampo S., Baleon R., Nandayapa O., Careaga G., Quintero L.R., Chavez E. Aortic origin of the right pulmonary artery associated with ductus arteriosus in an adult. A case report. Arch Inst Cardiol Mex 2000;70(6):596-602.[Medline]
  18. Johnson M.C., Watson M.S., Strauss A.W., Spray T.L. Anomalous origin of the right pulmonary artery from the aorta and CATCH 22 syndrome. Ann Thorac Surg 1995;60:681-683.[Abstract/Free Full Text]
  19. Dodo H., Alejos J.C., Perloff J.K., Laks H., Drinkwater D.C., Williams R.G. Anomalous origin of the left main pulmonary artery from the ascending aorta associated with Di George syndrome. Am J Cardiol 1995;75(17):1294-1295.[CrossRef][Medline]
  20. Bergwerrf M., Verberne M.E., DeRuiter M.C., Poelmann R.E., Gittenberger-de-Groot A.C. Neural crest cell contribution to the developing circulatory system: implications for vascular morphology?. Circ Res 1998;82:221-231.[Abstract/Free Full Text]
  21. Mo C.N., Ladusans E.J. Anomalous right pulmonary artery origins in association with the fetal valproate syndrome. J Med Genet 1999;36(1):83-84.[Abstract/Free Full Text]
  22. Aru G.M., English W.P., Gaymes C.H., Heath B.J. Origin of the left pulmonary artery from the aorta: embryologic considerations. Ann Thorac Surg 2001;71:1008-1010.[Abstract/Free Full Text]
  23. Kuinose M., Tanemoto K., Murakami T., Kanaoka Y., Kobayashi G., Makabe M. Surgical treatment for a 16-year-old girl with anomalous origin of the right pulmonary artery from ascending aorta. Jpn J Thorac Cardiovasc Surg 1998;46(4):380-384.[Medline]
  24. Yamaki S., Suzuki Y., Ishizawa S., Kagawa Y., Horiuchi T., Sato T. Isolated aortic origin of right pulmonary artery. Report of a case with special reference to pulmonary vascular disease in the left and right lung. Chest 1983;83:575-578.[Abstract/Free Full Text]
  25. Tsutsumi Y., Ohnaka M., Ohashi H., Murakami A., Takahashi M., Tanaka T. A case report of anomalous origin of right pulmonary artery from innominate artery associated with left sided unilateral pulmonary hypertension. Nippon Kyobu Geka Gakkai Zasshi 1991;39(4):447-451.[Medline]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
E. Prifti, A. Fagu, A. Baboci, and M. Bonacchi
Aortic origin of the right pulmonary artery: surgical techniques and outcome.
Ann. Thorac. Surg., February 1, 2009; 87(2): 677 - 678.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
N. Kajihara, Y. Imoto, M. Sakamoto, Y. Ochiai, M. Kan-o, K. Joo, M. Watanabe, T. Yuge, T. Asou, Y. Takeda, et al.
Surgical Results of Anomalous Origin of the Right Pulmonary Artery From the Ascending Aorta Including Reoperation for Infrequent Complications
Ann. Thorac. Surg., April 1, 2008; 85(4): 1407 - 1411.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Nathan, D. Rimmer, G. Piercey, P. J. del Nido, J. E. Mayer, E. A. Bacha, and F. A. Pigula
Early repair of hemitruncus: Excellent early and late outcomes
J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1329 - 1335.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Kostolny, E. Kocyildirim, M. R. de Leval, and R. H. Anderson
Anomalous Origin of the Right Pulmonary Artery From the Ascending Aorta With Fibrous Continuity to the Pulmonary Trunk
Ann. Thorac. Surg., November 1, 2005; 80(5): 1917 - 1918.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
E. Levy, E. Milgalter, A. Nir, and A. J. Rein
Repair of Anomalous Pulmonary Artery with Interposition Graft: Midterm Results
Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 217 - 221.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. Prifti, M. Bonacchi, V. Vanini, and F. Bartolozzi
Double-Flap Technique for Repair of Anomalous Origin of Right Pulmonary Artery From Ascending Aorta
Ann. Thorac. Surg., November 1, 2004; 78(5): 1883 - 1884.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
E. W.K. Peng, G. Shanmugam, K. J.D. Macarthur, and J. C.S. Pollock
Ascending aortic origin of a branch pulmonary artery--surgical management and long-term outcome
Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 762 - 766.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Edvin Prifti
Massimo Bonacchi
Massimo Bernabei
Marzia Leacche
Fabio Bartolozzi
Vittorio Vanini
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Prifti, E.
Right arrow Articles by Vanini, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Prifti, E.
Right arrow Articles by Vanini, V.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Great vessels

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS