Abstract
We reviewed our surgical experience with anomalous origin of one pulmonary artery from the ascending aorta (AOPA). From 1989 to 2012, 12 children (five neonates) aged 3–734 days (mean 152 ± 222) with AOPA underwent operations. Eight patients had right AOPA, and four patients had left AOPA. The majority of the patients had elevated right ventricular pressure, with 58 % (7 of 12) demonstrating suprasystemic right ventricular pressure. Surgery was performed by direct anastomosis (group 1) in seven patients and by employing an autologous patch (group 2) in five patients. There were two postoperative mortalities caused by heart failure and pulmonary hypertensive crisis. The mean follow-up duration was 12.6 ± 8 years. Catheterization showed that the right ventricle-to-systemic pressure ratio decreased following operation (preoperative vs. postoperative; 1.13 ± 0.19 vs. 0.48 ± 0.03, p = 0.043). There was no difference in the perfusion of the affected lung as measured by the final lung perfusion scan, between the two groups (group 1 vs. group 2; 50.0 ± 10.3 vs. 42.7 ± 28.7 %, p = 0.158). Two patients required reoperations for pulmonary regurgitation and pulmonary artery stenosis. There were two catheter-based interventions. At 20 years, survival by the Kaplan–Meier was 91.7 ± 8.0 %, freedom from reoperation was 80.0 ± 17.9 %, and freedom from catheter intervention was 80.8 ± 12.2 %. Early repair of AOPA improves right ventricular pressure and overall hemodynamics with excellent survival and low risk of reintervention. The type of surgical repair did not significantly affect the long-term outcomes (measured via lung perfusion scan).
Similar content being viewed by others
References
Abu-Sulaiman RM, Hashmi A, McCrindle BW, Williams WG, Freedom RM (1998) Anomalous origin of one pulmonary artery from the ascending aorta: 36 years’ experience from one centre. Cardiol Young 8(4):449–454
Aru GM, English WP, Gaymes CH, Heath BJ (2001) Origin of the left pulmonary artery from the aorta: embryologic considerations. Ann Thorac Surg 71:1008–1010
Bergwerrf M, Verberne ME, DeRuiter MC, Poelmann RE, Gitten- berger-de-Groot AC (1998) Neural crest cell contribution to the developing circulatory system: implications for vascular morphology? Circ Res 82:221–231
Boonsera PW, Talsma M, Ebels T (1992) Interruption of the aortic arch, distal aortopulmonary window, arterial duct and aortic origin of right pulmonary artery in a neonate: report of a case successfully repaired in one-stage operation. Int J Cardiol 34:108–110
Di Eusanio G, Mazzola A, Gregorini R, Di Manici G, Esposito GP, Procaccini B (1989) Anomalous origin of right pulmonary artery from the ascending aorta. J Cardiovasc Surg (Torino) 30:709–712
Dodo H, Alejos JC, Perloff JK, Laks H, Drinkwater DC, Williams RG (1995) Anomalous origin of the left main pulmonary artery from the ascending aorta associated with DiGeorge syndrome. Am J Cardiol 75:1294–1295
Fong LV, Anderson RH, Siewers RD, Trento A, Park S (1989) Anomalous origin of one pulmonary artery from the ascending aorta: a review of echocardiographic, catheter, and morphological features. Br Heart J 62:389–395
Fraentzel O (1868) Ein fall von abnormer communication der aorta mit der arteria pulmonalis. Virchows Arch Pathol Ana 43:420–426
Fucci C, di Carlo DC, Di Donato R, Marino B, Calcaterra G, Martelletti C (1989) Anomalous origin of the right pulmonary artery from the ascending aorta: repair without cardiopulmonary bypass. Int J Cardiol 23:309–313
Gerlis LM, Ho SY, Smith A, Anderson RH (1990) The site of origin of nonconfluent pulmonary arteries from a common arterial trunk or from the ascending aorta: its morphological significance. Am J Cardiovasc Pathol 3:115–120
Griffiths SP, Levine OR, Andersen DH (1962) Aortic origin of the right pulmonary artery. Circulation 25:73–84
Jacobs ML (2000) Congenital heart surgery nomenclature and database project: truncus arteriosus. Ann Thorac Surg 69(4 suppl):S50–S55
Jacobs JP, Quintessenza JA, Gaynor JW, Burke RP, Mavroudis C (2000) Congenital heart surgery nomenclature and database project: aorto-pulmonary window. Ann Thorac Surg 69(4 suppl):S44–S49
Johnson MC, Watson MS, Strauss AW, Spray TL (1995) Anomalous origin of the right pulmonary artery from the aorta and CATCH 22 syndrome. Ann Thorac Surg 60:681–683
Kajihara N, Imoto Y, Sakamoto M et al (2008) Surgical results of anomalous origin of the right pulmonary artery from the ascending aorta including reoperation for infrequent complications. Ann Thorac Surg 85:1407–1411
Keane JF, Maltz D, Bernhard WF, Corwin RD, Nadas AS (1974) Anomalous origin of one pulmonary artery from the ascending aorta: diagnostic, physiological and surgical considerations. Circulation 50:588–594
Kirkpatrick SE, Girod DA, King H (1967) Aortic origin of the right pulmo- nary artery. Surgical repair without a graft. Circulation 36:777–782
Nakamura Y, Yasui H, Kado H, Yonenaga K, Shiokawa Y, Tokunaga S (1991) Anomalous origin of the right pulmonary artery from the ascending aorta. Ann Thorac Surg 52:1285–1291
Nathan M, Rimmer D, Piercey G et al (2007) Early repair of hemitruncus: excellent early and late outcomes. J Thorac Cardiovasc Surg 133:1329–1335
Penkoske PA, Castaneda AR, Fyler DC, Van Praagh R (1983) Origin of pulmonary artery branch from ascending aorta. Primary surgical repair in infancy. J Thorac Cardiovasc Surg 85:537–545
Prifti E, Crucean A, Bonacchi M et al (2003) Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta. Eur J Cardiothorac Surg 24:21–27
Takahashi K, Kido S, Hoshino K, Oqawa K, Ohashi H, Fukushima Y (1995) Frequency of a 22q11 deletion in patients with conotruncal cardiac malformations: a prospective study. Eur J Pediatr 154:878–881
Van Son J, Hanley FL (1996) Use of autogenous aortic and main pulmonary artery flaps for repair of anomalous origin of the right pulmonary artery from the ascending aorta. J Thorac Cardiovasc Surg 111:675–676
Yamaki S, Suzuki Y, Ishizawa E, Kaqawa Y, Horiuchi T, Sato T (1983) Isolated aortic origin of right pulmonary artery. Report of a case with special reference to pulmonary vascular disease in the left and right lungs. Chest 83:575–578
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cho, S., Kim, WH., Choi, E.S. et al. Surgical Results of Anomalous Origin of One Pulmonary Artery Branch from the Ascending Aorta. Pediatr Cardiol 36, 1532–1538 (2015). https://doi.org/10.1007/s00246-015-1197-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-015-1197-2