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Cross or Not to Cross-Dilemma of the Pulmonary Arteries

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Abstract

We aimed to assess the frequency of criss-cross pulmonary arteries and associated intracardiac and vascular anomalies in patients who underwent CT angiography due to suspected congenital heart disease or vascular anomaly at our hospital. We retrospectively evaluated the CT angiography images of 355 patients aged 0–18 years between April 2018 and December 2022. The presence of the criss-cross pulmonary artery anomaly was assessed. Additionally, in patients with a criss-cross pulmonary artery anomaly, accompanying branch pulmonary artery anomalies, aortic arch anomalies, and other vascular-cardiac anomalies were also evaluated. A total of 331 patients’ images were evaluated. Criss-cross pulmonary artery anomaly was present in 57 patients (17.2%). Pulmonary artery branch anomaly was present in 16, aortic arch anomaly in 40 patients (70%) with criss-cross pulmonary artery anomaly, while associated intracardiac pathology (by echocardiography) was detected in 43 patients (75.4%). The frequency of criss-cross pulmonary artery was found to be significantly higher in patients with any aortic arch anomaly (p = 0.01). This study represents one of the largest series of patients with criss-cross pulmonary artery anomalies. Our results suggests that it may be more common than previously recognized and potentially overlooked. It is crucial to consider the presence of this anomaly in patients with complex aortic arch anomalies or cardiac pathologies, as it may have implications for surgical approaches and potential complications. Increased awareness of this anomaly among cardiologists and radiologists is necessary for accurate diagnosis and appropriate management.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pediatric Radiology, Van Training and Research Hospital, Van, Turkey

    Derya Bako

  2. Department of Pediatric Cardiology, Ankara Training and Research Hospital, Ankara, Turkey

    Yasemin Nuran Dönmez

  3. Department of Radiology, Van Training and Research Hospital, Van, Turkey

    Ulaş Yalım Uncu

  4. Department of Neonatology, University of Health Sciences, İzmir Dr. Behçet Uz Health Research Center for Pediatric Diseases and Surgery, İzmir, Turkey

    Ezgi Yangın Ergon

  5. Department of Pediatric Radiology, University of Health Sciences, İzmir Dr. Behçet Uz Health Research Center for Pediatric Diseases and Surgery, İzmir, Turkey

    Sinan Genç

  6. Department of Pediatrics, Van Training and Research Hospital, Van, Turkey

    Zerrin Karakuş Epçaçan

  7. Department of Pediatric Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Şafak Alpat

  8. Department of Pediatric Cardiology, Van Training and Research Hospital, Van, Turkey

    Serdar Epçaçan

Authors
  1. Derya Bako
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  2. Yasemin Nuran Dönmez
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  3. Ulaş Yalım Uncu
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  4. Ezgi Yangın Ergon
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  5. Sinan Genç
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  6. Zerrin Karakuş Epçaçan
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  7. Şafak Alpat
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  8. Serdar Epçaçan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DB, YND, and UYU. The first draft of the manuscript was written by DB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Derya Bako.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval for this study was obtained from Van Regional Training and Research Hospital, on 01/04/2023; approval number: 2023/01-09.

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Bako, D., Dönmez, Y.N., Uncu, U.Y. et al. Cross or Not to Cross-Dilemma of the Pulmonary Arteries. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03393-6

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  • DOI: https://doi.org/10.1007/s00246-023-03393-6

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