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Cardiothoracic and Vascular
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
Occurs due to the failure of formation of the sixth aortic arch. Blood to the left lung arises from an aberrant left pulmonary artery that arises from the right pulmonary artery. The vessel passes between the trachea and oesophagus and causes narrowing of the trachea in a caudal direction. Associated with other anomalies (e.g. patent ductus arteriosus).
Vascular rings
Published in Prem Puri, Newborn Surgery, 2017
Benjamin O. Bierbach, John Mark Redmond, Christopher Hart
Typically, the left pulmonary artery arises directly from the right pulmonary artery and passes leftward between the trachea and the esophagus (Figure 39.4).8 The ligamentum arteriosum passes posteriorly from the origin of the right pulmonary artery, where it arises from the main pulmonary artery to the undersurface of the aortic arch, thus creating a vascular ring surrounding the trachea but not the esophagus. The left pulmonary artery is often relatively hypoplastic. In contrast, the right pulmonary artery appears larger than normal and almost like a direct extension of the main pulmonary artery. The small calibre of the left pulmonary artery may explain the high incidence of anastomotic problems that have been observed in the past with attempts to reimplant the vessel at the main pulmonary artery.
Monochorionic Twin Discordance for Horseshoe Lung and Tricuspid Atresia
Published in Fetal and Pediatric Pathology, 2022
Marina Sousa Gomes, José Monterroso, Otília Brandão, Carla Ramalho
Despite maceration due to 6 weeks of intra-uterine retention, the autopsy of the female fetus confirmed some anomalies previously seen by ultrasound and identified others. A complex heart malformation was confirmed: dextrorotation, partial anomalous systemic venous return (hypoplastic right superior vena cava, persistent left superior vena cava draining to the right atrium via the coronary sinus, inferior vena cava draining to the coronary sinus and azygos vein draining into left superior vena cava), hypoplastic right pulmonary vein draining into the left atrium, small right atrium and normal left atrium, atrial septal defect, tricuspid atresia, and right ventricle without inlet chamber with a small outlet chamber (Figure 2). The left main pulmonary artery emerges from this small chamber. The right pulmonary artery emerged from the left artery just before entering the lung hilum. The pulmonary artery and its bronchial relationship on the left were normal. There was a horseshoe lung with hypoplasia of the right lung (Figure 3). There was a unilateral right cleft lip and palate. A normal left kidney and a small right pelvic kidney were identified (Figure 4). The placental examination confirmed a monochorionic gestation, with a paraseptal insertion of the umbilical cord in the abnormal fetus and marginal insertion of the umbilical cord in the normal fetus. The karyotype of the abnormal fetus, obtained from an amniotic fluid sample, was 46, XX.
Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve – German experience
Published in Expert Review of Medical Devices, 2019
Anja Lehner, Tsvetina Dashkalova, Sarah Ulrich, Silvia Fernandez Rodriguez, Guido Mandilaras, Andre Jakob, Robert Dalla-Pozza, Marcus Fischer, Heike Schneider, Gleb Tarusinov, Christoph Kampmann, Michael Hofbeck, Ingo Dähnert, Majed Kanaan, Nikolaus A. Haas
From 01/2015 to 12/2017, 56 TPVR procedures with the Edwards Sapien 3 valve were reported by 7 heart centers in Germany (for detailed demographics see Table 1). Patient age ranged between 4 and 82 years and weight between 11,8 and 114 kg. In this patient cohort, more patients were female (60,7%) with a majority of an underlying diagnosis of Tetralogy of Fallot (53,6%). Indication for TPVR was stated with PR as leading problem in 48% of patients, in 14% with PS as leading problem and in 34% with both (PS ≥ 20 mmHg RVOT gradient and PR ≥ moderate); residual 4% underwent TPVR due to right ventricular impairment but PS < 20 mmHg RVOT gradient and trivial/mild PI. Patients were status post-RVOT reconstruction with a transannular patch plasty in 32% (n = 18). Conduits were found in 50% of patients (n = 28). Biplane angiography of the RVOT before intervention revealed a minimal diameter at the proximal RVOT of 26,9 mm (SD 7,9), minimal diameter or ‘waist’ of the RVOT of 19,6 mm (SD 5,1; range 8–31 mm) and a distal minimal diameter of 23,8 mm (SD 8,9); lateral measurements were 25,8 mm (SD 7,9), 19,2 mm (SD 5,2; range 9,5–30 mm) and 23,5 mm (SD 9,5) respectively. Prestenting was also used to relieve RVOT stenosis where necessary. Additional procedures performed to the proximal left or right pulmonary artery were mentioned in 10 cases, of these were predominantly previous patch plasty or additional stent placement during prestenting procedures.
Comparative study between multi-detector computed tomography and echocardiography in evaluation of congenital vascular rings
Published in Alexandria Journal of Medicine, 2018
Manal Hamisa, Fatma Elsharawy, Wafaa Elsherbeny, Suzan Bayoumy
All patients underwent echocardiography using (vivid 7, GE, Hortin Norway using probe 5S MHZ), patients under 4 years were sedated using chloral hydrate (1 mg/kg), patients were examined in reclining position and complete study for cardiac structure were done. The transducer is positioned at first at suprasternal notch, starting show downward angulation then sweep upward to allow identification of aortic arch position and its relation to trachea and branching of great vessels of head and neck. In left aortic arch, the first branch heads to the right and then bifurcates into right subclavian and right common carotid arteries. While in (right aortic arch with mirror-image branching) the first branch was seen to head to the left and then bifurcates into left subclavian and left common carotid arteries. An (aberrant subclavian artery) should be suspected if the first branch does not bifurcate. In (double aortic arch) if both archs are patent so we can detected them in transverse suprasternal view. From parasternal short axis- views at level of bifurcation of pulmonary artery and at supra sternal view, echocardiography can reveal continuation of pulmonary trunk to right and when we cannot see the origin of left pulmonary artery we must suggest either absence or aberrant origin of left pulmonary artery. Pulmonary sling is seen when the origin of left pulmonary artery arises from the right pulmonary artery, it is suggested when pulmonary trunk is followed to the right side. However information taken by echocardiography examination is inadequate, and also evaluation of the anatomy of the airways is difficult by ultrasound.