Great Artery and Other Vascular Abnormalities

  • Wanda C. Miller-HanceEmail author


Echocardiography is the diagnostic modality of choice in the initial evaluation and serial assessment of most types of pediatric heart disease. The anomalies of a congenital nature that most often affect the great arteries and related vascular structures are frequently first suspected and identified by high-resolution imaging provided by transthoracic echocardiography. Technological advances made during the last several decades allow for complementary noninvasive imaging modalities to be applied when further characterization of these congenital cardiovascular malformations or variants is required. Transesophageal echocardiography (TEE) plays a limited diagnostic role in these anomalies but nonetheless provides major contributions in the care of affected patients. In the intraoperative setting, TEE is able to confirm the presence of selected abnormal vascular structure(s) or connection(s). More importantly, TEE facilitates the detailed evaluation of associated defects, provides for intraoperative monitoring, and allows for assessment of the surgical intervention(s). This chapter discusses the most frequently encountered great artery and vascular anomalies of a congenital nature, focusing on the applications of TEE in the evaluation of these lesions.


Great artery anomalies Vascular anomalies Patent ductus arteriosus Aortopulmonary window Pulmonary artery anomalies Anomalous origin of a branch pulmonary artery from the aorta Pulmonary artery sling Anomalous origin of the left pulmonary artery from the right pulmonary artery Aortic arch anomalies Coarctation of the aorta Interrupted aortic arch 

Supplementary material

Video 13.1

Patent ductus arteriosus. Upper esophageal pulmonary artery long axis video demonstrating left-to-right shunting across a patent ductus arteriosus (PDA, arrow). AO aorta, PA main pulmonary artery (MOV 564 kb)

Video 13.2

Patent ductus arteriosus. Mid esophageal right ventricular inflow-outflow view depicts flow (blue signal) across a patent ductus arteriosus (PDA) into main pulmonary artery (MPA). AO aorta (MOV 2137 kb) (255 kb)
Video 13.3 Patent ductus arteriosus. Upper esophageal aortic arch short axis view demonstrating aliased flow (between the arrows) corresponding to a restrictive patent ductus arteriosus. Ao aorta, PA pulmonary artery (Reproduced with permission from Russell et al. [131]) (MOV 254 kb)
Video 13.4

Tricuspid regurgitation. Color Doppler interrogation of the tricuspid valve in two different planes demonstrates moderate regurgitation and a peak velocity of the regurgitant jet that reaches 4 m per second. This jet velocity predicts an elevated right ventricular and pulmonary artery systolic pressure in this infant. Ao aorta, LA left atrium, LV left ventricle, RA right atrium, RV right ventricle (MOV 5116 kb)

Video 13.5

Left heart dilation resulting from a patent ductus arteriosus. Mid esophageal four chamber view obtained in a patient with a ductus arteriosus and left to right shunting. The left sided structures are dilated, particularly the left atrium, due to the volume overload. A tricuspid valve aneurysm is seen without evidence of ventricular level shunting. LA left atrium, LV left ventricle, RA right atrium, RV right ventricle (MOV 1821 kb)

Video 13.6

Aortopulmonary window. Mid esophageal aortic valve short axis view in infant with an aortopulmonary (AP) window. Note the echocardiographic drop out in the region between the arterial roots (arrow), corresponding to faulty aortopulmonary septation, and the shunting by color Doppler. AO aorta, PA pulmonary artery (MOV 2696 kb)

Video 13.7

Aortopulmonary window. View of the ascending aorta obtained at the upper esophageal level depicting an aortopulmonary (AP) window (arrow). The spectral Doppler tracing across the right pulmonary artery displays continuous forward flow during diastole as a result of the abnormal aortopulmonary connection. AO aorta, PA pulmonary artery, RV right ventricle (MOV 1311 kb)

Video 13.8

Aortopulmonary window. Postoperative transesophageal echocardiogram in the mid esophageal ascending aortic long axis view depicts the bright region along the wall of the ascending aorta (arrow) corresponding to the pericardial patch placed to obliterate the abnormal communication. Color Doppler interrogation across the right pulmonary artery does not suggest concerning obstruction. Ao aorta, MPA main pulmonary artery, RPA right pulmonary artery (MOV 404 kb)

Video 13.9

Pulmonary artery sling. Upper esophageal pulmonary artery long axis view of a pulmonary artery sling in an infant. The abnormal takeoff of the left pulmonary artery from the right pulmonary artery is seen. Note the absence of the normal main pulmonary artery bifurcation, which should be seen in a more proximal relationship to the pulmonary valve. The course of the anomalous vessel with respect to the trachea (asterisk) is noted. AO aorta, LPA left pulmonary artery, MPA main pulmonary artery, RPA right pulmonary artery (MOV 1548 kb)

Video 13.10

Pulmonary artery sling. Color Doppler image of the same cross-section depicted in Video 13.9 obtained in a zoom mode. Note flow into the left pulmonary artery (LPA) as it arises from the right pulmonary artery (RPA). AO aorta, MPA main pulmonary artery (MOV 1163 kb)

Video 13.11

Main pulmonary artery bifurcation. Normal branching of the main pulmonary artery (MPA) into the right (RPA) and left (LPA) pulmonary arteries as imaged from the upper esophageal pulmonary artery long axis view. AO aorta (MOV 241 kb)

Video 13.12

Main pulmonary artery bifurcation. Modified deep transgastric long axis image obtained in an infant with double outlet right ventricle and a subaortic ventricular septal defect to demonstrate the normal pulmonary artery bifurcation as seen in cross-section from this window. AO aorta, LA left atrium, LPA left pulmonary artery, RA right atrium, RPA right pulmonary artery (MOV 1685 kb)

Video 13.13

Aortic origin of right pulmonary artery. Upper esophageal pulmonary artery long axis view displaying only the left pulmonary artery (LPA) as it arises from the main pulmonary artery (MPA). Note the absence of the normal pulmonary artery confluence in this patient, due to anomalous origin of the right pulmonary artery from the aorta (AO) (MOV 806 kb)

Video 13.14

Aortic origin of right pulmonary artery. Long axis plane imaging using a biplane transesophageal probe displaying anomalous origin of the right pulmonary artery (RPA) from the aorta (AO). LA left atrium, RA right atrium, RV right ventricle (MOV 3526 kb)

Video 13.15

Aortic origin of right pulmonary artery. Transverse plane sweep in same patient as depicted in Video 13.14 demonstrating anomalous origin of the right pulmonary artery (RPA) from the aorta (AO) by two-dimensional and color Doppler imaging. A catheter is seen in the superior vena cava. MPA main pulmonary artery, RA right atrium (MOV 4886 kb)

Video 13.16

Anomalous origin of right pulmonary artery. Mid esophageal ascending aortic long axis view displaying anomalous origin of right pulmonary artery from the ascending aorta (AO). Note the more distal origin of the anomalous vessel (arrow) as compared to that seen in the patient shown in Videos 13.14 and 13.15. Flow into the anomalous pulmonary artery is demonstrated by color and spectral Doppler interrogation. A perimembranous ventricular septal defect is briefly seen in this video. PA main pulmonary artery (MOV 2438 kb)

Video 13.17

Coarctation of the aorta. Mid esophageal descending aorta long axis view depicting narrowing at the level of the thoracic descending aorta (arrow) consistent with coarctation of the aorta. (Reproduced with permission from Russell et al. [131]) (MOV 468 kb)

Video 13.18

Coarctation of the aorta. Sweep obtained from the upper esophageal window (upper esophageal short axis view) demonstrating the aortic arch in short axis (Arch), a large patent ductus arteriosus (PDA) and the left pulmonary artery (LPA). As the probe is slightly advanced and rotated to the left, the descending aorta (AoDT) is displayed longitudinally; the LPA is again seen in this view. A discrete area of narrowing is noted (arrow) corresponding to a coarctation. Color Doppler imaging displays turbulent flow across the region of obstruction (MPG 10322 kb)

Video 13.19

Interrupted aortic arch. Two-dimensional mid esophageal four-chamber view and corresponding color flow mapping in an infant with interrupted aortic arch demonstrating a large posteriorly malaligned ventricular septal defect, hypoplastic subaortic region, aortic annulus, and ascending aorta. AO aorta, LA left atrium, RV right ventricle, LV left ventricle (MOV 1549 kb)

Video 13.20

Interrupted aortic arch. Mid esophageal aortic valve long axis view obtained from the same infant as shown in Video 13.19, demonstrating the ventricular septal defect and marked discrepancy in the sizes of the arterial roots. AO aorta, PA main pulmonary artery (MOV 875 kb)

Video 13.21

Interrupted aortic arch. Deep transgastric long axis image from the same patient as shown in Videos 13.19 and 13.20 demonstrating the extent of the ventricular septal defect and subaortic narrowing. AO aorta, LA left ventricle, LV left ventricle RA right atrium, RV right ventricle (MOV 2006 kb)

Video 13.22

Interrupted aortic arch. Mid esophageal ascending aortic short axis view demonstrates a severely hypoplastic ascending aorta (AO). Note the dilated pulmonary artery (PA) (MOV 1522 kb)

Video 13.23

Interrupted aortic arch. Intraoperative images from the mid esophageal four-chamber view following aortic arch advancement, aortic (AO) augmentation, subaortic resection, and closure of the ventricular septal defect (VSD) in the infant with interrupted aortic arch shown in previous videos. Note the large pericardial VSD patch and the relatively small subaortic area, aortic annulus, and aortic root. In the presence of moderately decreased left ventricular systolic function, no significant gradient was recorded across the left ventricular outflow tract. Note that an adequate spectral Doppler tracing could be obtained of the outflow tract in this particular TEE view. LA left atrium, LV left ventricle, RV right ventricle (MOV 3414 kb)

Video 13.24

Interrupted aortic arch. The same findings noted in Video 13.23 following surgical intervention are confirmed in the mid esophageal long axis view. Trace intermittent aortic regurgitation is seen. AO aorta, LA left atrium, LV left ventricle, PA main pulmonary artery, RV right ventricle, VSD ventricular septal defect (MOV 1514 kb)

Video 13.25

Interrupted aortic arch. Postoperative, mid esophageal, four-chamber view demonstrating a dilated left ventricle (LV) with markedly decreased systolic function in the same infant depicted in prior videos. Moderate mitral valve regurgitation is also seen. AO aorta, LA left atrium, VSD ventricular septal defect (MOV 1408 kb)


  1. 1.
    Knight L, Edwards JE. Right aortic arch. Types and associated cardiac anomalies. Circulation. 1974;50:1047–51.PubMedGoogle Scholar
  2. 2.
    Mugge A, Daniel WG, Lichtlen PR. Imaging of patent ductus arteriosus by transesophageal color-coded Doppler echocardiography. J Clin Ultrasound. 1991;19:128–9.PubMedGoogle Scholar
  3. 3.
    Szulc M, Ritter SB. Patent ductus arteriosus in an infant with atrioventricular septal defect and pulmonary hypertension: diagnosis by transesophageal color flow echocardiography. J Am Soc Echocardiogr. 1991;4:194–8.PubMedGoogle Scholar
  4. 4.
    Takenaka K, Sakamoto T, Shiota T, et al. Diagnosis of patent ductus arteriosus in adults by biplane transesophageal color Doppler flow mapping. Am J Cardiol. 1991;68:691–3.PubMedGoogle Scholar
  5. 5.
    Shyu KG, Lai LP, Lin SC, et al. Diagnostic accuracy of transesophageal echocardiography for detecting patent ductus arteriosus in adolescents and adults. Chest. 1995;108:1201–5.PubMedGoogle Scholar
  6. 6.
    Andrade A, Vargas-Barron J, Rijlaarsdam M, et al. Utility of transesophageal echocardiography in the examination of adult patients with patent ductus arteriosus. Am Heart J. 1995;130:543–6.PubMedGoogle Scholar
  7. 7.
    Krauss D, Weinert L, Lang RM. The role of multiplane transesophageal echocardiography in diagnosing PDA in an adult. Echocardiography. 1996;13:95–8.PubMedGoogle Scholar
  8. 8.
    Chang ST, Hung KC, Hsieh IC, et al. Evaluation of shunt flow by multiplane transesophageal echocardiography in adult patients with isolated patent ductus arteriosus. J Am Soc Echocardiogr. 2002;15:1367–73.PubMedGoogle Scholar
  9. 9.
    Tumbarello R, Sanna A, Cardu G, et al. Usefulness of transesophageal echocardiography in the pediatric catheterization laboratory. Am J Cardiol. 1993;71:1321–5.PubMedGoogle Scholar
  10. 10.
    Chuang YC, Yin WH, Hsiung MC, et al. Successful transcatheter closure of a residual patent ductus arteriosus with complex anatomy after surgical ligation using an amplatzer ductal occluder guided by live three-dimensional transesophageal echocardiography. Echocardiography. 2011;28:E101–3.PubMedGoogle Scholar
  11. 11.
    Marek T, Zelizko M, Kautzner J. Images in cardiovascular medicine. Real-time 3-dimensional transesophageal echocardiography imaging: adult patent ductus arteriosus before and after transcatheter closure. Circulation. 2009;120:e92–3.PubMedGoogle Scholar
  12. 12.
    Wang KY, Hsieh KS, Yang MW, et al. The use of transesophageal echocardiography to evaluate the effectiveness of patent ductus arteriosus ligation. Echocardiography. 1993;10:53–7.PubMedGoogle Scholar
  13. 13.
    Lavoie J, Burrows FA, Gentles TL, et al. Transoesophageal echocardiography detects residual ductal flow during video-assisted thoracoscopic patent ductus arteriosus interruption. Can J Anaesth. 1994;41:310–3.PubMedGoogle Scholar
  14. 14.
    Lavoie J, Javorski JJ, Donahue K, et al. Detection of residual flow by transesophageal echocardiography during video-assisted thoracoscopic patent ductus arteriosus interruption. Anesth Analg. 1995;80:1071–5.PubMedGoogle Scholar
  15. 15.
    Shiota T, Omoto R, Cobanoglu A, et al. Usefulness of transesophageal imaging of flow convergence region in the operating room for evaluating isolated patent ductus arteriosus. Am J Cardiol. 1997;80:1108–12.PubMedGoogle Scholar
  16. 16.
    Ho AC, Tan PP, Yang MW, et al. The use of multiplane transesophageal echocardiography to evaluate residual patent ductus arteriosus during video-assisted thoracoscopy in adults. Surg Endosc. 1999;13:975–9.PubMedGoogle Scholar
  17. 17.
    Hatle L, Anglesen B. Pulsed and continuous wave Doppler in diagnosis and assessment of various heart lesions. In: Hatle L, Anglesen B, editors. Doppler ultrasound in cardiology. Physical principles and clinical applications. Philadelphia: Lea & Febiger; 1985. p. 97–292.Google Scholar
  18. 18.
    Hiraishi S, Horiguchi Y, Misawa H, et al. Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus. Circulation. 1987;75:1146–53.PubMedGoogle Scholar
  19. 19.
    Cloez JL, Isaaz K, Pernot C. Pulsed Doppler flow characteristics of ductus arteriosus in infants with associated congenital anomalies of the heart or great arteries. Am J Cardiol. 1986;57:845–51.PubMedGoogle Scholar
  20. 20.
    Shiraishi H, Yanagisawa M. Bidirectional flow through the ductus arteriosus in normal newborns: evaluation by Doppler color flow imaging. Pediatr Cardiol. 1991;12:201–5.PubMedGoogle Scholar
  21. 21.
    Serwer GA, Armstrong BE, Anderson PA. Nonivasive detection of retrograde descending aortic flow in infants using continuous wave doppler ultrasonography. Implications for diagnosis of aortic run-off lesions. J Pediatr. 1980;97:394–400.PubMedGoogle Scholar
  22. 22.
    Musewe NN, Smallhorn JF, Benson LN, et al. Validation of Doppler-derived pulmonary arterial pressure in patients with ductus arteriosus under different hemodynamic states. Circulation. 1987;76:1081–91.PubMedGoogle Scholar
  23. 23.
    Snider AR. The ductus arteriosus: a window for assessment of pulmonary artery pressures? J Am Coll Cardiol. 1990;15:457–8.PubMedGoogle Scholar
  24. 24.
    Marx GR, Allen HD, Goldberg SJ. Doppler echocardiographic estimation of systolic pulmonary artery pressure in patients with aortic-pulmonary shunts. J Am Coll Cardiol. 1986;7:880–5.PubMedGoogle Scholar
  25. 25.
    Milan A, Magnino C, Veglio F. Echocardiographic indexes for the non-invasive evaluation of pulmonary hemodynamics. J Am Soc Echocardiogr. 2010;23:225–39; quiz 332–4.PubMedGoogle Scholar
  26. 26.
    Neufeld HN, Lester RG, Adams PJ, et al. Aorticopulmonary septal defect. Am J Cardiol. 1962;9:12–25.PubMedGoogle Scholar
  27. 27.
    Mori K, Ando M, Takao A, et al. Distal type of aortopulmonary window. Report of 4 cases. Br Heart J. 1978;40:681–9.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Kutsche LM, Van Mierop LH. Anatomy and pathogenesis of aorticopulmonary septal defect. Am J Cardiol. 1987;59:443–7.PubMedGoogle Scholar
  29. 29.
    Richardson JV, Doty DB, Rossi NP, et al. The spectrum of anomalies of aortopulmonary septation. J Thorac Cardiovasc Surg. 1979;78:21–7.PubMedGoogle Scholar
  30. 30.
    Ho SY, Gerlis LM, Anderson C, et al. The morphology of aortopulmonary windows with regard to their classification and morphogenesis. Cardiol Young. 1994;4:146–55.Google Scholar
  31. 31.
    Murin P, Sinzobahamvya N, Blaschczok HC, et al. Aortopulmonary window associated with interrupted aortic arch: report of surgical repair of eight cases and review of literature. Thorac Cardiovasc Surg. 2012;60:215–20.PubMedGoogle Scholar
  32. 32.
    Pace Napoleone C, Oppido G, Angeli E, et al. Aortopulmonary window and anomalous coronary artery: an exceptional association. Ann Thorac Surg. 2011;91:1272–4.PubMedGoogle Scholar
  33. 33.
    Stamato T, Benson LN, Smallhorn JF, et al. Transcatheter closure of an aortopulmonary window with a modified double umbrella occluder system. Cathet Cardiovasc Diagn. 1995;35:165–7.PubMedGoogle Scholar
  34. 34.
    Tulloh RM, Rigby ML. Transcatheter umbrella closure of aorto-pulmonary window. Heart. 1997;77:479–80.PubMedGoogle Scholar
  35. 35.
    Jureidini SB, Spadaro JJ, Rao PS. Successful transcatheter closure with the buttoned device of aortopulmonary window in an adult. Am J Cardiol. 1998;81:371–2.PubMedGoogle Scholar
  36. 36.
    Srivastava A, Radha AS. Transcatheter closure of a large aortopulmonary window with severe pulmonary arterial hypertension beyond infancy. J Invasive Cardiol. 2012;24:E24–6.PubMedGoogle Scholar
  37. 37.
    Doty DB, Richardson JV, Falkovsky GE, et al. Aortopulmonary septal defect: hemodynamics, angiography, and operation. Ann Thorac Surg. 1981;32:244–50.PubMedGoogle Scholar
  38. 38.
    Hew CC, Bacha EA, Zurakowski D, et al. Optimal surgical approach for repair of aortopulmonary window. Cardiol Young. 2001;11:385–90.PubMedGoogle Scholar
  39. 39.
    Jonas RA. Patent ductus arteriosus, aortopulmonary window, sinus of valsalva fistula, aortoventricular tunnel. In: Jonas RA, editor. Comprehensive surgical management of congenital heart disease. New York: Arnold; 2004. p. 195–9.Google Scholar
  40. 40.
    Rice MJ, Seward JB, Hagler DJ, et al. Visualization of aortopulmonary window by two-dimensional echocardiography. Mayo Clin Proc. 1982;57:482–7.PubMedGoogle Scholar
  41. 41.
    Smallhorn JF, Anderson RH, Macartney FJ. Two dimensional echocardiographic assessment of communications between ascending aorta and pulmonary trunk or individual pulmonary arteries. Br Heart J. 1982;47:563–72.PubMedCentralPubMedGoogle Scholar
  42. 42.
    Lau KC, Calcaterra G, Miller GA, et al. Aorto-pulmonary window. J Cardiovasc Surg (Torino). 1982;23:21–7.Google Scholar
  43. 43.
    Alboliras ET, Chin AJ, Barber G, et al. Detection of aortopulmonary window by pulsed and color Doppler echocardiography. Am Heart J. 1988;115:900–2.PubMedGoogle Scholar
  44. 44.
    Balaji S, Burch M, Sullivan ID. Accuracy of cross-sectional echocardiography in diagnosis of aortopulmonary window. Am J Cardiol. 1991;67:650–3.PubMedGoogle Scholar
  45. 45.
    Mahle WT, Kreeger J, Silverman NH. Echocardiography of the aortopulmonary window, aorto-ventricular tunnels, and aneurysm of the sinuses of Valsalva. Cardiol Young. 2010;20 Suppl 3:100–6.PubMedGoogle Scholar
  46. 46.
    Singh A, Mehmood F, Romp RL, et al. Live/Real time three-dimensional transthoracic echocardiographic assessment of aortopulmonary window. Echocardiography. 2008;25:96–9.PubMedGoogle Scholar
  47. 47.
    Samdarshi TE, Morrow WR, Nanda NC, et al. Transesophageal echocardiography in aortopulmonary communications. Echocardiography. 1991;8:383–95.PubMedGoogle Scholar
  48. 48.
    Barnes ME, Mitchell ME, Tweddell JS. Aortopulmonary window. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14:67–74.PubMedGoogle Scholar
  49. 49.
    Contro S, Miller RA, White H, et al. Bronchial obstruction due to pulmonary artery anomalies. I. Vascular sling. Circulation. 1958;17:418–23.PubMedGoogle Scholar
  50. 50.
    Castaneda AR. Pulmonary artery sling. Ann Thorac Surg. 1979;28:210–1.PubMedGoogle Scholar
  51. 51.
    Adam MP, Schelley S, Gallagher R, et al. Clinical features and management issues in Mowat-Wilson syndrome. Am J Med Genet A. 2006;140:2730–41.PubMedGoogle Scholar
  52. 52.
    Strenge S, Heinritz W, Zweier C, et al. Pulmonary artery sling and congenital tracheal stenosis in another patient with Mowat-Wilson syndrome. Am J Med Genet A. 2007;143A:1528–30.PubMedGoogle Scholar
  53. 53.
    Backer CL, Russell HM, Kaushal S, et al. Pulmonary artery sling: current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2012;143:144–51.PubMedGoogle Scholar
  54. 54.
    Newman B, Meza MP, Towbin RB, et al. Left pulmonary artery sling: diagnosis and delineation of associated tracheobronchial anomalies with MR. Pediatr Radiol. 1996;26:661–8.PubMedGoogle Scholar
  55. 55.
    Sade RM, Rosenthal A, Fellows K, et al. Pulmonary artery sling. J Thorac Cardiovasc Surg. 1975;69:333–46.PubMedGoogle Scholar
  56. 56.
    Berdon WE, Baker DH, Wung JT, et al. Complete cartilage-ring tracheal stenosis associated with anomalous left pulmonary artery: the ring-sling complex. Radiology. 1984;152:57–64.PubMedGoogle Scholar
  57. 57.
    Gikonyo BM, Jue KL, Edwards JE. Pulmonary vascular sling: report of seven cases and review of the literature. Pediatr Cardiol. 1989;10:81–9.PubMedGoogle Scholar
  58. 58.
    Binet JP, Longlois J. Aortic arch anomalies in children and infants. J Thorac Cardiovasc Surg. 1977;73:248–52.PubMedGoogle Scholar
  59. 59.
    Backer CL. Vascular rings, slings, and tracheal rings. Mayo Clin Proc. 1993;68:1131–3.PubMedGoogle Scholar
  60. 60.
    Zhong YM, Jaffe RB, Zhu M, et al. CT assessment of tracheobronchial anomaly in left pulmonary artery sling. Pediatr Radiol. 2010;40:1755–62.PubMedGoogle Scholar
  61. 61.
    Backer CL, Mavroudis C, Dunham ME, et al. Pulmonary artery sling: results with median sternotomy, cardiopulmonary bypass, and reimplantation. Ann Thorac Surg. 1999;67:1738–44; discussion 1744–5.PubMedGoogle Scholar
  62. 62.
    Jonas RA, Spevak PJ, McGill T, et al. Pulmonary artery sling: primary repair by tracheal resection in infancy. J Thorac Cardiovasc Surg. 1989;97:548–50.PubMedGoogle Scholar
  63. 63.
    Fiore AC, Brown JW, Weber TR, et al. Surgical treatment of pulmonary artery sling and tracheal stenosis. Ann Thorac Surg. 2005;79:38–46; discussion 38–46.PubMedGoogle Scholar
  64. 64.
    Oshima Y, Yamaguchi M, Yoshimura N, et al. Management of pulmonary artery sling associated with tracheal stenosis. Ann Thorac Surg. 2008;86:1334–8.PubMedGoogle Scholar
  65. 65.
    Huang SC, Wu ET, Wang CC, et al. Surgical management of pulmonary artery sling: trachea diameter and outcomes with or without tracheoplasty. Pediatr Pulmonol. 2012;47:903–8.PubMedGoogle Scholar
  66. 66.
    McCray P, Grandgeorge S, Smith W, et al. Cine CT diagnosis of pulmonary artery sling. Pediatr Radiol. 1986;16:508–10.PubMedGoogle Scholar
  67. 67.
    Yeager SB, Chin AJ, Sanders SP. Two-dimensional echocardiographic diagnosis of pulmonary artery sling in infancy. J Am Coll Cardiol. 1986;7:625–9.PubMedGoogle Scholar
  68. 68.
    Gnanapragasam JP, Houston AB, Jamieson MP. Pulmonary artery sling: definitive diagnosis by colour Doppler flow mapping avoiding cardiac catheterisation. Br Heart J. 1990;63:251–2.PubMedCentralPubMedGoogle Scholar
  69. 69.
    Murdison KA, Andrews BA, Chin AJ. Ultrasonographic display of complex vascular rings. J Am Coll Cardiol. 1990;15:1645–53.PubMedGoogle Scholar
  70. 70.
    Lillehei CW, Colan S. Echocardiography in the preoperative evaluation of vascular rings. J Pediatr Surg. 1992;27:1118–20; discussion 1120–1.PubMedGoogle Scholar
  71. 71.
    van Son JA, Julsrud PR, Hagler DJ, et al. Imaging strategies for vascular rings. Ann Thorac Surg. 1994;57:604–10.PubMedGoogle Scholar
  72. 72.
    Backer CL. Diagnostic issues and indications for surgery in patients with pulmonary artery sling. Circulation. 1998;98:188–9.PubMedGoogle Scholar
  73. 73.
    Lee KH, Yoon CS, Choe KO, et al. Use of imaging for assessing anatomical relationships of tracheobronchial anomalies associated with left pulmonary artery sling. Pediatr Radiol. 2001;31:269–78.PubMedGoogle Scholar
  74. 74.
    Newman B, Cho Y. Left pulmonary artery sling—anatomy and imaging. Semin Ultrasound CT MR. 2010;31:158–70.PubMedGoogle Scholar
  75. 75.
    Erickson LC, Cocalis MW, George L. Partial anomalous left pulmonary artery: new evidence on the development of the pulmonary artery sling. Pediatr Cardiol. 1996;17:319–21.PubMedGoogle Scholar
  76. 76.
    Tateishi A, Kawada M. Partial form of a pulmonary artery sling. Ann Thorac Surg. 2009;87:965.PubMedGoogle Scholar
  77. 77.
    Nakajima H, Satomi G, Nakazawa M, et al. Color Doppler and transesophageal echocardiography of vascular sling. Heart Vessels. 1992;7:99–103.PubMedGoogle Scholar
  78. 78.
    Lin CR, Tsai SK, Wang MJ, et al. Airway management and transesophageal echocardiographic monitoring for pulmonary artery sling. J Formos Med Assoc. 1999;98:863–5.PubMedGoogle Scholar
  79. 79.
    Kutsche LM, Van Mierop LH. Anomalous origin of a pulmonary artery from the ascending aorta: associated anomalies and pathogenesis. Am J Cardiol. 1988;61:850–6.PubMedGoogle Scholar
  80. 80.
    Edasery B, Sharma M, Vaddigiri V, et al. Hemitruncus presenting in an adult. A case report. Angiology. 1996;47:1023–6.PubMedGoogle Scholar
  81. 81.
    Aru GM, English WP, Gaymes CH, et al. Origin of the left pulmonary artery from the aorta: embryologic considerations. Ann Thorac Surg. 2001;71:1008–10.PubMedGoogle Scholar
  82. 82.
    Nakamura Y, Yasui H, Kado H, et al. Anomalous origin of the right pulmonary artery from the ascending aorta. Ann Thorac Surg. 1991;52:1285–91.PubMedGoogle Scholar
  83. 83.
    Sotomora RF, Edwards JE. Anatomic identification of so-called absent pulmonary artery. Circulation. 1978;57:624–33.PubMedGoogle Scholar
  84. 84.
    Wu QY, Yang XB. Anomalous origin of the pulmonary artery from the right coronary artery. Ann Thorac Surg. 2001;72:1396–8.PubMedGoogle Scholar
  85. 85.
    Presbitero P, Bull C, Haworth SG, et al. Absent or occult pulmonary artery. Br Heart J. 1984;52:178–85.PubMedCentralPubMedGoogle Scholar
  86. 86.
    McCaffrey F. Around pediheart: absent pulmonary artery. Pediatr Cardiol. 2001;22:332.PubMedGoogle Scholar
  87. 87.
    Pfefferkorn JR, Loser H, Pech G, et al. Absent pulmonary artery. A hint to its embryogenesis. Pediatr Cardiol. 1982;3:283–6.PubMedGoogle Scholar
  88. 88.
    Apostolopoulou SC, Kelekis NL, Brountzos EN, et al. “Absent” pulmonary artery in one adult and five pediatric patients: imaging, embryology, and therapeutic implications. AJR Am J Roentgenol. 2002;179:1253–60.PubMedGoogle Scholar
  89. 89.
    Apostolopoulou SC, Kelekis NL. Anomalous origin of pulmonary artery from the innominate artery. Pediatr Cardiol. 2004;25:565.PubMedGoogle Scholar
  90. 90.
    Prifti E, Bonacchi M, Murzi B, et al. Anomalous origin of the left pulmonary artery from the aorta. Our experience and literature review. Heart Vessels. 2003;18:79–84.PubMedGoogle Scholar
  91. 91.
    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;26:762–6.PubMedGoogle Scholar
  92. 92.
    Morgan JR. Left pulmonary artery from ascending aorta in tetralogy of Fallot. Circulation. 1972;45:653–7.PubMedGoogle Scholar
  93. 93.
    Fontana GP, Spach MS, Effmann EL, et al. Origin of the right pulmonary artery from the ascending aorta. Ann Surg. 1987;206:102–13.PubMedGoogle Scholar
  94. 94.
    Santos MA, Azevedo VM. Anomalous origin of a pulmonary artery from the ascending aorta: surgical repair resolving pulmonary arterial hypertension. Arq Bras Cardiol. 2004;83(503–7):498–502.Google Scholar
  95. 95.
    Fong LV, Anderson RH, Siewers RD, et al. Anomalous origin of one pulmonary artery from the ascending aorta: a review of echocardiographic, catheter, and morphological features. Br Heart J. 1989;62:389–95.PubMedCentralPubMedGoogle Scholar
  96. 96.
    Penkoske PA, Castaneda AR, Fyler DC, et al. Origin of pulmonary artery branch from ascending aorta. Primary surgical repair in infancy. J Thorac Cardiovasc Surg. 1983;85:537–45.PubMedGoogle Scholar
  97. 97.
    Mee RB. Surgical repair of hemitruncus: principles and techniques. J Card Surg. 1987;2:247–56.PubMedGoogle Scholar
  98. 98.
    Nathan M, Rimmer D, Piercey G, et al. Early repair of hemitruncus: excellent early and late outcomes. J Thorac Cardiovasc Surg. 2007;133:1329–35.PubMedGoogle Scholar
  99. 99.
    Prifti E, Bonacchi M, Murzi B, et al. Anomalous origin of the right pulmonary artery from the ascending aorta. J Card Surg. 2004;19:103–12.PubMedGoogle Scholar
  100. 100.
    Ishizawa E, Horiuchi T, Tadokoro M, et al. Diagnosis and surgical treatment of “angiographically absent pulmonary artery syndrome”. Tohoku J Exp Med. 1978;125:1–9.PubMedGoogle Scholar
  101. 101.
    Moreno-Cabral RJ, McNamara JJ, Reddy VJ, et al. Unilateral absent pulmonary artery: surgical repair with a new technique. J Thorac Cardiovasc Surg. 1991;102:463–5.PubMedGoogle Scholar
  102. 102.
    Duncan WJ, Freedom RM, Olley PM, et al. Two-dimensional echocardiographic identification of hemitruncus: anomalous origin of one pulmonary artery from ascending aorta with the other pulmonary artery arising normally from right ventricle. Am Heart J. 1981;102:892–6.PubMedGoogle Scholar
  103. 103.
    Warnes CA. Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart. 2003;89:965–6.PubMedGoogle Scholar
  104. 104.
    Connolly HM, Jr H, Brown RDJ, et al. Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc. 2003;78:1491–9.PubMedGoogle Scholar
  105. 105.
    Shone JD, Sellers RD, Anderson RC, et al. The developmental complex of “parachute mitral valve,” supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Am J Cardiol. 1963;11:714–25.PubMedGoogle Scholar
  106. 106.
    Kenny D, Hijazi ZM. Coarctation of the aorta: from fetal life to adulthood. Cardiol J. 2011;18:487–95.PubMedGoogle Scholar
  107. 107.
    Duffy CI, Plehn JF. Transesophageal echocardiographic assessment of aortic coarctation using color, flow-directed Doppler sampling. Chest. 1994;105:286–8.PubMedGoogle Scholar
  108. 108.
    Engvall J, Sjoqvist L, Nylander E, et al. Biplane transoesophageal echocardiography, transthoracic Doppler, and magnetic resonance imaging in the assessment of coarctation of the aorta. Eur Heart J. 1995;16:1399–409.PubMedGoogle Scholar
  109. 109.
    Trehan VK, Bhardwaj S, Rastogi P, et al. Multiplane transoesophageal echocardiography in an adult with coarctation of aorta. Indian Heart J. 1996;48:707–9.PubMedGoogle Scholar
  110. 110.
    Skinner JR, Bexton R, Wren C. Aortic coarctation endarteritis and aneurysm: diagnosis by transoesophageal echocardiography. Int J Cardiol. 1992;34:216–8.PubMedGoogle Scholar
  111. 111.
    Thwaites BK, Stamatos JM, Crowl FD, et al. Transesophageal echocardiographic diagnosis of intraaortic thrombus during coarctation repair. Anesthesiology. 1992;76:638–9.PubMedGoogle Scholar
  112. 112.
    Chatrath R, Hagler DJ. Improved imaging of aortic coarctation using an intracardiac probe for transesophageal echocardiography. Tex Heart Inst J. 2004;31:194–5.PubMedCentralPubMedGoogle Scholar
  113. 113.
    Kinsara A, Chan KL. Noninvasive imaging modalities in coarctation of the aorta. Chest. 2004;126:1016–8.PubMedGoogle Scholar
  114. 114.
    Stern H, Erbel R, Schreiner G, et al. Coarctation of the aorta: quantitative analysis by transesophageal echocardiography. Echocardiography. 1987;4:387–95.Google Scholar
  115. 115.
    Gopal AS, Arora NS, Vardanian S, et al. Utility of transesophageal echocardiography for the characterization of cardiovascular anomalies associated with Turner’s syndrome. J Am Soc Echocardiogr. 2001;14:60–2.PubMedGoogle Scholar
  116. 116.
    Rudolph AM, Heymann MA, Spitznas U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol. 1972;30:514–25.PubMedGoogle Scholar
  117. 117.
    Loffredo CA, Ferencz C, Wilson PD, et al. Interrupted aortic arch: an epidemiologic study. Teratology. 2000;61:368–75.PubMedGoogle Scholar
  118. 118.
    Celoria GC, Patton RB. Congenital absence of the aortic arch. Am Heart J. 1959;58:407–13.PubMedGoogle Scholar
  119. 119.
    Powell CB, Stone FM, Atkins DL, et al. Operative mortality and frequency of coexistent anomalies in interruption of the aortic arch. Am J Cardiol. 1997;79:1147–8.PubMedGoogle Scholar
  120. 120.
    Ramaswamy P, Lytrivi ID, Thanjan MT, et al. Frequency of aberrant subclavian artery, arch laterality, and associated intracardiac anomalies detected by echocardiography. Am J Cardiol. 2008;101:677–82.PubMedGoogle Scholar
  121. 121.
    Schreiber C, Eicken A, Vogt M, et al. Repair of interrupted aortic arch: results after more than 20 years. Ann Thorac Surg. 2000;70:1896–9; discussion 1899–900.PubMedGoogle Scholar
  122. 122.
    Tchervenkov CI, Jacobs JP, Sharma K, et al. Interrupted aortic arch: surgical decision making. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005:92–102.Google Scholar
  123. 123.
    Flint JD, Gentles TL, MacCormick J, et al. Outcomes using predominantly single-stage approach to interrupted aortic arch and associated defects. Ann Thorac Surg. 2010;89:564–9.PubMedGoogle Scholar
  124. 124.
    Dillman JR, Yarram SG, D’Amico AR, et al. Interrupted aortic arch: spectrum of MRI findings. AJR Am J Roentgenol. 2008;190:1467–74.PubMedGoogle Scholar
  125. 125.
    Geva T, Hornberger LK, Sanders SP, et al. Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch. J Am Coll Cardiol. 1993;22:1953–60.PubMedGoogle Scholar
  126. 126.
    Jacobs ML, Rychik J, Murphy JD, et al. Results of Norwood’s operation for lesions other than hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 1995;110:1555–61; discussion 1561–2.PubMedGoogle Scholar
  127. 127.
    Rychik J, Murdison KA, Chin AJ, et al. Surgical management of severe aortic outflow obstruction in lesions other than the hypoplastic left heart syndrome: use of a pulmonary artery to aorta anastomosis. J Am Coll Cardiol. 1991;18:809–16.PubMedGoogle Scholar
  128. 128.
    Apfel HD, Levenbraun J, Quaegebeur JM, et al. Usefulness of preoperative echocardiography in predicting left ventricular outflow obstruction after primary repair of interrupted aortic arch with ventricular septal defect. Am J Cardiol. 1998;82:470–3.PubMedGoogle Scholar
  129. 129.
    Russell HM, Forsberg K, Backer CL, et al. Outcomes of radial incision of the tricuspid valve for ventricular septal defect closure. Ann Thorac Surg. 2011;92:685–90; discussion 690.PubMedGoogle Scholar
  130. 130.
    Hillman HD, Mavroudis C, Backer CL. Patent ductus ateriousus. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 223–33.Google Scholar
  131. 131.
    Russell IA, Rouine-Rapp K, Stratmann G, Miller-Hance WC. Congenital heart disease in the adult: a review with internet-accessible transesophageal echocardiographic images. Anesth Analg. 2006;102(3):694–723.PubMedGoogle Scholar
  132. 132.
    Cahalan MK. Intraoperative transesophageal echocardiography: an interactive text and atlas. New York: Churchill Livingstone Interactive Publication; 1996.Google Scholar
  133. 133.
    Gaynor WJ. Aortopulmonary window and aortic origin of a pulmonary artery. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 353–60.Google Scholar
  134. 134.
    Backer CL, Mavroudis C. Vascular rings and pulmonary artery sling. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 234–50.Google Scholar
  135. 135.
    Backer CL, Mavroudis C. Coarctation of the aorta. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 251–72.Google Scholar
  136. 136.
    Jonas RA. Interrupted aortic arch. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 273–82.Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Divisions of Pediatric Anesthesiology and Pediatric Cardiology, Departments of Pediatrics and AnesthesiologyTexas Children’s Hospital, Baylor College of MedicineHoustonUSA

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