Carlos M. Mery, MD, MPH, Kimberly M

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Presentation transcript:

Pulmonary artery resuscitation for isolated ductal origin of a pulmonary artery Carlos M. Mery, MD, MPH, Kimberly M. Molina, MD, Rajesh Krishnamurthy, MD, Charles D. Fraser, MD, Henri Justino, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 5, Pages 2235-2244.e1 (November 2014) DOI: 10.1016/j.jtcvs.2013.11.041 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A 4-year-old boy with ductal origin of the right pulmonary artery (PA) and aortopulmonary collaterals feeding into the distal PA. A and B, Magnetic resonance imaging; C and D, cardiac catheterization. A, Absence of the mediastinal portion of the right PA from the main PA (arrow) is evident. B, A small right PA (arrow) ending approximately 1 cm from the mediastinal pleura and fed by aortopulmonary collaterals is visible. Cardiac catheterization shows: C, a ductal stump at the base of the right brachiocephalic artery; and D, a small distal right PA with a blind end as visualized from retrograde pulmonary venous wedge injection of contrast. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2235-2244.e1DOI: (10.1016/j.jtcvs.2013.11.041) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Serial chest radiographs in a patient with late diagnosis of ductal origin of the right pulmonary artery. A, The patient had normal appearance of the lung as a newborn infant. B, A chest radiograph at 7 years of age showed severe hypoplasia of the right lung with significant mediastinal shift; he was subsequently diagnosed with ductal origin of the right pulmonary artery. C, A radiograph of the same patient after staged resuscitation of the right pulmonary artery demonstrating significant improvement in the size of the right lung. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2235-2244.e1DOI: (10.1016/j.jtcvs.2013.11.041) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Graph showing the increase in differential perfusion of the affected lung as measured by serial radionuclide lung perfusion scans starting at the time of surgery. Each line represents a different patient. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2235-2244.e1DOI: (10.1016/j.jtcvs.2013.11.041) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Cardiac catheterization images of a patient with ductal origin of the right pulmonary artery (patient 6). A, A cardiac catheterization performed shortly after creation of a modified Blalock-Taussig shunt with cryopreserved vein and revision of the shunt due to thrombosis. The image demonstrates a small right pulmonary artery with stenosis at the distal anastomosis. Balloon angioplasty was delayed for a few weeks because of the fresh anastomosis. B, A follow-up cardiac catheterization performed after centralization of the right pulmonary artery with anterior patch augmentation 9 months later. The image demonstrates a significant increase in the diameter of the native right pulmonary artery after resuscitation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2235-2244.e1DOI: (10.1016/j.jtcvs.2013.11.041) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 The management strategy of the 10 patients with isolated ductal origin of a pulmonary artery (DOPA) in the current series. Centralization of the pulmonary artery (PA) has been achieved in 9 patients either by a single procedure or in a staged fashion by undergoing ductal stenting or creation of a systemic to pulmonary arterial shunt before centralization. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2235-2244.e1DOI: (10.1016/j.jtcvs.2013.11.041) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions