Adult Diameter Artificial Vascular for Right Pulmonary Artery Originated from Ascending Aorta_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUKai-yu ¹ , JIAZhi-bo ¹ , CHENWei ¹ , SUNLu ¹ , BANDe-jun ² , JIANGShu-lin ¹ ,  TIANHai ¹

1. Department of Cardiovascular Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin 150086, P. R. China;
2. Department of Thoracic Surgery, Daqingshi No. 4 Hospital, Daqing 163712 Heilongjiang, P. R. China;

Corresponding author：

TIANHai, Email: clownemail@163.com

Keywords：

Anomalous right pulmonary artery; Ascending aorta; Adult diameter; Artificial vascular; Surgical treatment

DOI：

10.7507/1007-4848.20160062

Video：

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Objective To summarize our experience of surgical treatment for right pulmonary artery originated from the ascending aorta by using adult diameter artificial vascular and study the operative indication, design, method, and therapeutic efficacy. Methods We retrospectively analyzed clinical data of 11 patients with right pulmonary artery originated from ascending aorta in The Second Affiliated Hospital of Harbin Medical University from May 2008 through December 2013, who were treated by using adult diameter artificial vascular. The patients ranged from 4 months to 25 months old, weighted 4-15 kg. Among of them, 4 patients had persistent truncus arteriosus and 7 had aortopulmonary septal defect. All patients were complicated with moderate pulmonary hypertension. All the patients underwent one stage surgical repair under extracorporeal circulation and cardiac arrest. During the surgery, end to side anastomosis was done between the right pulmonary artery and 16-18 mm diameter artificial blood vessels. And artificial blood vessel was connected to the main pulmonary artery or right ventricle outflow tract incision from the aorta above. Results The average operation time was 179-325 (224±68) min. The average cardiopulmonary bypass (CPB) time was 81-208 (117±54) min. The average aortic clamping time was 29-63(42±21) min. The mean residence time in ICU was 71-197 (109±42) hours. The average assisted mechanical ventilator time was 59-191 (91±26) hours. The average length of stay in hospital was 21-39 (28±11) days. Low cardiac output syndromes caused by pulmonary arterial hypertension occurred in 5 patients including 2 deaths and 3 patients with good recovery by reducing the pulmonary arterial pressure and peritoneal dialysis. The result of postoperative cardiac color ultrasound examination of 9 survival patients showed vascular prosthesis, no distortion, no stenosis of the anastomosis, deformity correction satisfaction. Nine patients were followed up for 3-60 months. The results of echocardiography showed no anastomosis and artificial vascular stenosis, and the pulmonary arterial pressure decreased significantly. Conclusion The right pulmonary artery originated from the ascending aorta in children should be operated as soon as possible. Compared the adult diameter artificial vascular treatment for one stage repair of right pulmonary artery from the ascending aorta with other operation methods, both short-term and long-term effects are good. Postoperative low cardiac output syndrome is a common complication.

Citation： LIUKai-yu, JIAZhi-bo, CHENWei, SUNLu, BANDe-jun, JIANGShu-lin, TIANHai. Adult Diameter Artificial Vascular for Right Pulmonary Artery Originated from Ascending Aorta. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 264-267. doi: 10.7507/1007-4848.20160062 Copy

1.	Prifti E, Fagu A, Baboci A, et al. Aortic origin of the right pulmonary artery: surgical techniques and outcome. Ann Thorac Surg, 2009, 87(2): 677-678.
2.	Erdem A, Aydemir NA, Demir H, et al. Anomalous origin of one pulmonary artery branch from the ascending aorta: experience of our center. Turk Kardiyol Dern Ars, 2010, 38(6): 411-415.
3.	Amir G, Frenkel G, Bruckheimer E, et al. Anomalous origin of the pulmonary artery from the aorta: early diagnosis and repair leading to immediate physiological correction. Cardiol Young, 2010, 20(6): 654-659.
4.	Hu YN, Yang YJ, Kan CD. One-stage total repair of anomalous origin of right pulmonary artery from aorta by the double-flap technique, followed by coarctation repair using extended end-to-end arch reconstruction. Ann Pediatr Cardiol, 2013, 6(1): 71-73.
5.	Prifti E, Bonacchi M, Vanini V, at al. Double-flap technique for repair of anomalous origin of right pulmonary artery from ascending aorta. Ann Thorac Surg, 2004, 78(5): 1883-1884.
6.	Hadeed K, Ohanessian G, Acar P. Anomalous origin of the pulmo-nary artery from the ascending aorta in a neonate, assessed by two-dimensional echocardiography. Arch Cardiovasc Dis, 2010, 103(89): 493-495.
7.	Fraentzel O. Ein Fall von abnormer communication der aorticmit der arteria pulmonalis. Arch Pathol Anat, 1868, 43: 420-426.
8.	Arboleda M, de Guzman IN, Ticona E, et al. Surgical repair of the anomalous origin of the right pulmonary artery from the ascending aorta. Arq Bras Cardiol, 2004, 83(6):519-521.
9.	Kutsche LM, Van Mierop LH. Anomalous origin of a pulmonary artery from the ascending aorta: associated anomalies and pathoge-nesis. Am J Cardiol, 1988, 61(10): 850-856.
10.	Bi W, Ren W, Song G, et al. Anomalous origin of one pulmonary artery from the ascending aorta (hemitruncus) in a premature infant: a case report and literature review. J Clin Ultrasound, 2014, 42(6): 367-370.
11.	Prifti E, Crucean A, Bonacchi M, et al. Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta. Eur J Cardiothorac Surg, 2003, 24(1): 21-27.
12.	Abu-Sulaiman RM, Hashmi A, McCrindle BW, et al. Anomalous origin of one pulmonary artery from the ascending aorta: 36 years experience from one centre. Cardiol Young, 1998, 8(4): 449-454.
13.	Bando K, Turrentine MW, Sharp TG, et al. Pulmonary hyperten-sion after operation for congenital heart disease: Analysis of risk factors and management. J Thorac Cardiovasc Surg, 1996, 112(6): 1600-1609.
14.	刘承虎, 李玲, 苏俊武, 等.手术矫治右肺动脉起源于升主动脉的临床分析. 心肺血管病杂志, 2012, 31(2): 168-171.
15.	Armer BM, Shumacker HB, Klatte EC. Origin of right pulmonary artery from the ascending aorta: report of a surgically corrected case. Circulation, 1961, 24: 662.
16.	Kirkpatrick SE, Girod DA, King H. Aortic origin of the right pulmonary artery: surgical repair without a graft. Circulation, 1967, 36(5): 777-782.
17.	刘洋, 朱海龙, 刘金成, 等. 婴幼儿一侧肺动脉起源异常的外科治疗. 中国胸心血管外科临床杂志, 2012, 19(6): 585-588.
18.	Croti UA, Braile DM, Oliveira MA, et al. Surgical correction of the anomalous origin of the right pulmonary artery from the aorta. Rev Bras Cir Cardiovasc, 2010, 25(3): 422-423.
19.	Garg P, Talwar S, Kothari SS, et al. The anomalous origin of the branch pulmonary artery from the ascending aorta. Interact Cardio-vasc Thorac Surg, 2012, 15(1): 86-92.
20.	Kajihara N, Imoto Y, Sakamoto M, et al. Surgical results of anomalous origin of the right pulmonary artery from the ascending aorta including reoperation for infrequent complications. Ann Thorac Surg, 2008, 85(4): 1407-1411.
21.	李坤, 李守军, 公兵, 等. 姑息性右心室-肺动脉连接术中管道材料及型号的选择与应用.中国胸心血管外科临床杂志, 2013, 20(6): 632-636.
22.	Watanabe N, Anagnostopoulos PV, Shinkawa T, et al. Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg, 2012, 144(5): 1091-1094.
23.	张浩, 王德, 花中东, 等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志, 2013, 20(2): 135-138.
24.	Peng EW, Shanmugam G, Macarthur KJ, et al. Ascending aortic origin of a branch pulmonary artery--surgical management and long-term outcome. Eur J Cardiothorac Surg, 2004, 26(4): 762-766.
25.	Goldstein BH, Bergersen L, Powell AJ, et al. Long-term outcome of surgically repaired unilateral anomalous pulmonary artery origin. Pediatr Cardiol, 2010, 31(7): 944-951.

1. Prifti E, Fagu A, Baboci A, et al. Aortic origin of the right pulmonary artery: surgical techniques and outcome. Ann Thorac Surg, 2009, 87(2): 677-678.
2. Erdem A, Aydemir NA, Demir H, et al. Anomalous origin of one pulmonary artery branch from the ascending aorta: experience of our center. Turk Kardiyol Dern Ars, 2010, 38(6): 411-415.
3. Amir G, Frenkel G, Bruckheimer E, et al. Anomalous origin of the pulmonary artery from the aorta: early diagnosis and repair leading to immediate physiological correction. Cardiol Young, 2010, 20(6): 654-659.
4. Hu YN, Yang YJ, Kan CD. One-stage total repair of anomalous origin of right pulmonary artery from aorta by the double-flap technique, followed by coarctation repair using extended end-to-end arch reconstruction. Ann Pediatr Cardiol, 2013, 6(1): 71-73.
5. Prifti E, Bonacchi M, Vanini V, at al. Double-flap technique for repair of anomalous origin of right pulmonary artery from ascending aorta. Ann Thorac Surg, 2004, 78(5): 1883-1884.
6. Hadeed K, Ohanessian G, Acar P. Anomalous origin of the pulmo-nary artery from the ascending aorta in a neonate, assessed by two-dimensional echocardiography. Arch Cardiovasc Dis, 2010, 103(89): 493-495.
7. Fraentzel O. Ein Fall von abnormer communication der aorticmit der arteria pulmonalis. Arch Pathol Anat, 1868, 43: 420-426.
8. Arboleda M, de Guzman IN, Ticona E, et al. Surgical repair of the anomalous origin of the right pulmonary artery from the ascending aorta. Arq Bras Cardiol, 2004, 83(6):519-521.
9. Kutsche LM, Van Mierop LH. Anomalous origin of a pulmonary artery from the ascending aorta: associated anomalies and pathoge-nesis. Am J Cardiol, 1988, 61(10): 850-856.
10. Bi W, Ren W, Song G, et al. Anomalous origin of one pulmonary artery from the ascending aorta (hemitruncus) in a premature infant: a case report and literature review. J Clin Ultrasound, 2014, 42(6): 367-370.
11. Prifti E, Crucean A, Bonacchi M, et al. Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta. Eur J Cardiothorac Surg, 2003, 24(1): 21-27.
12. Abu-Sulaiman RM, Hashmi A, McCrindle BW, et al. Anomalous origin of one pulmonary artery from the ascending aorta: 36 years experience from one centre. Cardiol Young, 1998, 8(4): 449-454.
13. Bando K, Turrentine MW, Sharp TG, et al. Pulmonary hyperten-sion after operation for congenital heart disease: Analysis of risk factors and management. J Thorac Cardiovasc Surg, 1996, 112(6): 1600-1609.
14. 刘承虎, 李玲, 苏俊武, 等.手术矫治右肺动脉起源于升主动脉的临床分析. 心肺血管病杂志, 2012, 31(2): 168-171.
15. Armer BM, Shumacker HB, Klatte EC. Origin of right pulmonary artery from the ascending aorta: report of a surgically corrected case. Circulation, 1961, 24: 662.
16. Kirkpatrick SE, Girod DA, King H. Aortic origin of the right pulmonary artery: surgical repair without a graft. Circulation, 1967, 36(5): 777-782.
17. 刘洋, 朱海龙, 刘金成, 等. 婴幼儿一侧肺动脉起源异常的外科治疗. 中国胸心血管外科临床杂志, 2012, 19(6): 585-588.
18. Croti UA, Braile DM, Oliveira MA, et al. Surgical correction of the anomalous origin of the right pulmonary artery from the aorta. Rev Bras Cir Cardiovasc, 2010, 25(3): 422-423.
19. Garg P, Talwar S, Kothari SS, et al. The anomalous origin of the branch pulmonary artery from the ascending aorta. Interact Cardio-vasc Thorac Surg, 2012, 15(1): 86-92.
20. Kajihara N, Imoto Y, Sakamoto M, et al. Surgical results of anomalous origin of the right pulmonary artery from the ascending aorta including reoperation for infrequent complications. Ann Thorac Surg, 2008, 85(4): 1407-1411.
21. 李坤, 李守军, 公兵, 等. 姑息性右心室-肺动脉连接术中管道材料及型号的选择与应用.中国胸心血管外科临床杂志, 2013, 20(6): 632-636.
22. Watanabe N, Anagnostopoulos PV, Shinkawa T, et al. Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg, 2012, 144(5): 1091-1094.
23. 张浩, 王德, 花中东, 等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志, 2013, 20(2): 135-138.
24. Peng EW, Shanmugam G, Macarthur KJ, et al. Ascending aortic origin of a branch pulmonary artery--surgical management and long-term outcome. Eur J Cardiothorac Surg, 2004, 26(4): 762-766.
25. Goldstein BH, Bergersen L, Powell AJ, et al. Long-term outcome of surgically repaired unilateral anomalous pulmonary artery origin. Pediatr Cardiol, 2010, 31(7): 944-951.

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Adult Diameter Artificial Vascular for Right Pulmonary Artery Originated from Ascending Aorta

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