Surgical Treatment for Anomalous Origin of One Pulmonary Artery in Infants and Children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yang , ZHU Hailong , LIU Jincheng , SUN Guocheng , JIN Zhenxiao , LIU Weiyong , YI Dinghua.

Department of Cardiac Surgery,Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, P. R. China;

Corresponding author：

Keywords：

Anomalous origin of pulmonary artery; 　Congenital heart disease; 　Surgery

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Abstract：　Objective　To summarize our experience of surgical treatment for anomalous origin of one pulmonary artery in infants and children.　Methods　From March 2005 to May 2010，11 patients with anomalous origin of one pulmonary artery and other concomitant congenital cardiovascular malformations underwent surgical repair in Xijing Hospital of Fourth Military Medical University．The mean age of the patients was 11.5 months with a range from 2 months to 36 months．Their mean body weight was 7.1 kg with a range from 4 to 13 kg. Seven patients had anomalous origin of the right pulmonary artery from the ascending aorta, and four patients had anomalous origin of the left pulmonary artery from the ascending aorta. All the eleven patients had other concomitant intracardiac anomalies or vascular malformations as well as pulmonary hypertension, and underwent one stage surgical repair via median sternotomy under hypothermia and cardiopulmonary bypass.　Results　Their operation time was 169 - 293 （231±55） min, cardiopulmonary bypass time was 87-210 （138±47） min, and aortic-clamping time was 45-133 （86±28） min. There was one postoperative death who had low cardiac output syndrome after repair for tetralogy of Fallot and anomalous origin of the right pulmonary artery. The overall postoperative mortality was 9.1％. Postoperative echocardiography of all the surviving patients showed their left and right pulmonary artery origined from the right ventricle and pulmonary artery with satisfactory malformation correction but no residual shunt and pulmonary stenosis . All the surviving ten patients were followed up with a follow-up rate of 100% and mean follow-up time of 13.5 months with a range from 3 to 32 months. Their echocardiography during follow-up showed that there was no pulmonary stenosis in all the patients, and pulmonary blood pressure significantly decreased in 9 patients.　Conclusion　Patients with anomalous origin of one pulmonary artery should undergo surgical repair as early as possible with satisfactory short-term outcomes in infants and children. For elder patients with irreversible pulmonary hypertension, the choice of surgical treatment should be more cautious. During the surgery, the anomalous pulmonary artery and ascending aorta should be dissociated fully, and transection of the ascending aorta is helpful to get a satisfactory operating field view for the surgeon. Repairing aortic defect with autologous pulmonary arterial patch can effectively avoid the occurrence of postoperative aortic aneurysm.

Citation： LIU Yang,ZHU Hailong,LIU Jincheng,SUN Guocheng,JIN Zhenxiao,LIU Weiyong,YI Dinghua.. Surgical Treatment for Anomalous Origin of One Pulmonary Artery in Infants and Children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 585-588. doi: Copy

1.	Vida VL， Sanders SP， Bottio T， et al. Anomalous origin of one pulmonary artery from the ascending aorta. Cardiol Young， 2005， 15 （2）：176-181.
2.	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.
3.	Arboleda M， Niño de Guzman I， 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.
4.	Prifti E， Bonacchi M， Murzi B， et al. Anomalous origin of the right pulmonary artery from the ascending aorta. J Card Surg， 2004， 19 （2）：103-112.
5.	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.
6.	Maizza A， Cantinotti M， Susini C， et al. An unusual association：anomalous origin of the left pulmonary artery from the thoracic aorta with total anomalous venous return of the left lung. Pediatr Cardiol， 2010， 31 （5）：697-699.
7.	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.
8.	Pepeta L， Takawira FF， Cilliers AM， et al. Anomalous origin of the left pulmonary artery from the ascending aorta in two children with pulmonary atresia， sub-aortic ventricular septal defect and right-sided major aorto-pulmonary collateral arteries. Cardiovasc J Afr， 2011， 22 （5）：268-271.
9.	Hadeed K， Ohanessian G， Acar P. Anomalous origin of the pulmonary artery from the ascending aorta in a neonate， assessed by two-dimensional echocardiography. Arch Cardiovasc Dis， 2010， 103 （8-9）：493-495.
10.	Fu S， Xie C， Gong F， et al. Anomalous origin of the right pulmonary artery from the abdominal aorta with aberrant right subclavian artery and left patent ductus arteriosus. Pediatr Cardiol， 2011， 32 （5）：674-677.
11.	Prifti E， Bonacchi M， Vanini V， et al. Double-flap technique for repair of anomalous origin of right pulmonary artery from ascending aorta. Ann Thorac Surg， 2004， 78 （5）：1883-1884.
12.	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.
13.	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.
14.	Miyazaki K， Murashita T， Kubota T， et al. Neonatal repair of anomalous origin of the right pulmonary artery from the ascending aorta. A case report and review in the literature. J Cardiovasc Surg （Torino）， 2000， 41 （6）：863-868.
15.	Sun HF， Qin C， Liang JL. One-stage correction of tetralogy of Fallot associated with anomalous origin of the left pulmonary artery from the aorta and aortopulmonary window. J Card Surg， 2012， 27 （1）：112-114.
16.	Garg P， Talwar S， Kothari SS， et al. The anomalous origin of the branch pulmonary artery from the ascending aorta. Interact Cardiovasc Thorac Surg， 2012， 15 （1）：86-92.
17.	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.
18.	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.
19.	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.

1. 　Vida VL， Sanders SP， Bottio T， et al. Anomalous origin of one pulmonary artery from the ascending aorta. Cardiol Young， 2005， 15 （2）：176-181.
2. 　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.
3. 　Arboleda M， Niño de Guzman I， 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.
4. 　Prifti E， Bonacchi M， Murzi B， et al. Anomalous origin of the right pulmonary artery from the ascending aorta. J Card Surg， 2004， 19 （2）：103-112.
5. 　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.
6. 　Maizza A， Cantinotti M， Susini C， et al. An unusual association：anomalous origin of the left pulmonary artery from the thoracic aorta with total anomalous venous return of the left lung. Pediatr Cardiol， 2010， 31 （5）：697-699.
7. 　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.
8. 　Pepeta L， Takawira FF， Cilliers AM， et al. Anomalous origin of the left pulmonary artery from the ascending aorta in two children with pulmonary atresia， sub-aortic ventricular septal defect and right-sided major aorto-pulmonary collateral arteries. Cardiovasc J Afr， 2011， 22 （5）：268-271.
9. 　Hadeed K， Ohanessian G， Acar P. Anomalous origin of the pulmonary artery from the ascending aorta in a neonate， assessed by two-dimensional echocardiography. Arch Cardiovasc Dis， 2010， 103 （8-9）：493-495.
10. 　Fu S， Xie C， Gong F， et al. Anomalous origin of the right pulmonary artery from the abdominal aorta with aberrant right subclavian artery and left patent ductus arteriosus. Pediatr Cardiol， 2011， 32 （5）：674-677.
11. 　Prifti E， Bonacchi M， Vanini V， et al. Double-flap technique for repair of anomalous origin of right pulmonary artery from ascending aorta. Ann Thorac Surg， 2004， 78 （5）：1883-1884.
12. 　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.
13. 　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.
14. 　Miyazaki K， Murashita T， Kubota T， et al. Neonatal repair of anomalous origin of the right pulmonary artery from the ascending aorta. A case report and review in the literature. J Cardiovasc Surg （Torino）， 2000， 41 （6）：863-868.
15. 　Sun HF， Qin C， Liang JL. One-stage correction of tetralogy of Fallot associated with anomalous origin of the left pulmonary artery from the aorta and aortopulmonary window. J Card Surg， 2012， 27 （1）：112-114.
16. 　Garg P， Talwar S， Kothari SS， et al. The anomalous origin of the branch pulmonary artery from the ascending aorta. Interact Cardiovasc Thorac Surg， 2012， 15 （1）：86-92.
17. 　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.
18. 　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.
19. 　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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Anomalous Origin of One Pulmonary Artery in Infants and Children

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