Abnormal Origin of the Pulmonary Artery from the Ascending Aorta in the Neonate

The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.

Keywords:
Aorta; Computed Tomography Angiography; General Surgery; Heart Deffects, Congenital; Infant, Newborn; Information; Pulmonary Artery; Research Report

Authorship

Marina Costa Jonas Correspondence Address: Marina Costa Jonas https://orcid.org/0000-0003-2419-3508 Biocor Institute, Alameda Oscar Niemeyer, 217, Vila da Serra, Nova Lima, MG, Brazil. Zip Code: 34006-056 E-mail: marina_jonas@hotmail.com

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

https://orcid.org/0000-0003-2419-3508

Cristiane Nunes Martins

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

Bayard Gontijo Filho

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

Clarissa de Paula Freitas Rocha Ramalho

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

Erika Correa Vrandecic

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

Fernando Amaral

Department of Cardiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, BrazilUniversidade de São PauloBrazilRibeirão Preto, São Paulo, BrazilDepartment of Cardiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil

This study was carried out at the Biocor Institute, Nova Lima, Minas Gerais, Brazil.

Correspondence Address: Marina Costa Jonas https://orcid.org/0000-0003-2419-3508 Biocor Institute, Alameda Oscar Niemeyer, 217, Vila da Serra, Nova Lima, MG, Brazil. Zip Code: 34006-056 E-mail: marina_jonas@hotmail.com

No conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Biocor Institute, Nova Lima, Minas Gerais, BrazilBiocor InstituteBrazilNova Lima, Minas Gerais, BrazilBiocor Institute, Nova Lima, Minas Gerais, Brazil

Figures | Tables

Figures (3)
Tables (2)

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Fig. 1
Preoperative (A, B, C) and postoperative (D, E, F) anteroposterior (AP) chest radiography, echocardiogram, and computed tomography angiography in case number 1. Ao=aorta; LPA=left pulmonary artery; LV=left ventricle; PA=main pulmonary artery; RPA=right pulmonary artery.

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Fig. 2
Chest radiography (A), echocardiogram (B), computed tomography angiography (C), and postoperative chest radiography (D) and echocardiogram (E) in case number 2. Ao=aorta; LPA=left pulmonary artery; LV=left ventricle; PA=main pulmonary artery; RPA=right pulmonary artery.

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Fig. 3
Case number (CN) 1 – A) Right pulmonary artery (RPA) originated from ascending aorta (Ao). B) Aortic and caval cannulation; incision in proximal RPA. C) Disconnection of RPA from aortic wall; closure of aortic orifice with autologous pericardial patch. D) RPA reimplanted in the pulmonary trunk (PT); retraction suture in aortic wall. CN2 – A) Left pulmonary artery (LPA) originated from ascending Ao and hypoplastic PT in pulmonary atresia. B) Aortic and caval cannulation; disconnection of LPA from aortic wall; closure of aortic orifice with autologous pericardial patch. C) Blalock-Taussig-Thomas (BTT) modified shunt; LPA reimplanted in the PT. BCT=brachiocephalic trunk; IVC=inferior vena cava; RA=right atrium; RV=right ventricle; SVC=superior vena cava.

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Abbreviations, Acronyms & Symbols Ao = Aorta AO PA = Anomalous origin of pulmonary arteries from the ascending aorta AP = Anteroposterior BCT = Brachiocephalic trunk BTT = Blalock-Taussig-Thomas CN = Case number CPAP = Continuous positive airway pressure CT = Computed tomography IVC = Inferior vena cava LPA = Left pulmonary artery LV = Left ventricle PA = Main pulmonary artery PDA = Patent ductus arteriosus PT = Pulmonary trunk RA = Right atrium RPA = Right pulmonary artery RV = Right ventricle SVC = Superior vena cava

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Authors’ Roles & Responsibilities MCJ Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published CNM Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published BGF Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published CPFRR Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published ECV Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published FA Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published

Fig. 1 Preoperative (A, B, C) and postoperative (D, E, F) anteroposterior (AP) chest radiography, echocardiogram, and computed tomography angiography in case number 1. Ao=aorta; LPA=left pulmonary artery; LV=left ventricle; PA=main pulmonary artery; RPA=right pulmonary artery.

Fig. 2 Chest radiography (A), echocardiogram (B), computed tomography angiography (C), and postoperative chest radiography (D) and echocardiogram (E) in case number 2. Ao=aorta; LPA=left pulmonary artery; LV=left ventricle; PA=main pulmonary artery; RPA=right pulmonary artery.

Fig. 3 Case number (CN) 1 – A) Right pulmonary artery (RPA) originated from ascending aorta (Ao). B) Aortic and caval cannulation; incision in proximal RPA. C) Disconnection of RPA from aortic wall; closure of aortic orifice with autologous pericardial patch. D) RPA reimplanted in the pulmonary trunk (PT); retraction suture in aortic wall. CN2 – A) Left pulmonary artery (LPA) originated from ascending Ao and hypoplastic PT in pulmonary atresia. B) Aortic and caval cannulation; disconnection of LPA from aortic wall; closure of aortic orifice with autologous pericardial patch. C) Blalock-Taussig-Thomas (BTT) modified shunt; LPA reimplanted in the PT. BCT=brachiocephalic trunk; IVC=inferior vena cava; RA=right atrium; RV=right ventricle; SVC=superior vena cava.

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Abnormal Origin of the Pulmonary Artery from the Ascending Aorta in the Neonate

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[1] This study was carried out at the Biocor Institute, Nova Lima, Minas Gerais, Brazil.