Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-27T12:24:04.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Crossed pulmonary arteries with hypoplasia of the transverse aortic arch

Published online by Cambridge University Press:  18 June 2014

Lazaro E. Hernandez ,
Robert H. Anderson ,
Eric Hoggard ,
James D. St. Louis  and
Charles W. Shepard
Lazaro E. Hernandez*
Affiliation:
Department of Pediatrics, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
Robert H. Anderson
Affiliation:
Institute of Medical Genetics, Newcastle University, Newcastle-upon-Tyne, United Kingdom
Eric Hoggard
Affiliation:
Department of Radiology, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
James D. St. Louis
Affiliation:
Department of Cardiothoracic Surgery, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
Charles W. Shepard
Affiliation:
Department of Pediatrics, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
*
Correspondence to: Dr L. E. Hernandez, MD, East Building, Room MB 560, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America. Tel: 612-626-2755; Fax: 612-626-2467; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The entity of crossed pulmonary arteries was first described by Jue, Lockman, and Edwards in 1966, in a patient with trisomy 18. Since then, several series have been described, both in terms of the isolated anatomic variant, or its association with other intracardiac or extracardiac anomalies. We describe a rare association that has previously not been reported.

Methods and results

Institutional Review Board approval for a retrospective chart review was obtained. Over the period 2011 through 2013, we have encountered six patients in whom the crossed origins of the pulmonary arteries from the pulmonary trunk were associated with hypoplasia of the transverse aortic arch, an association that, to the best of our knowledge, has previously not been reported. In all of the patients, the isthmic component of the aortic arch was inserted in an end-to-side manner into the ductal arch, with additional discrete coarctation in half of the patients.

Conclusion

To the best of our knowledge, no cases of crossed pulmonary arteries have been described in association with hypoplasia of the transverse aortic arch. We draw comparisons between the cases with exclusively tubular hypoplasia, and those with the added problem of the more typical isthmic variant of aortic coarctation. In all cases, the ability to reconstruct cross-sectional images added significantly to the diagnosis and understanding of these complex lesions. These findings have specific surgical implications, which are discussed.

Keywords

Crossed pulmonary arteriesaortic arch hypoplasiacoarctation of the aorta
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 718 - 724
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jue, KL, Lockman, IA, Edwards, JE. Anomalous origins of pulmonary arteries from pulmonary trunk (crossed pulmonary arteries). Am Heart J 1966; 71: 807–812.CrossRefGoogle Scholar
2. Becker, AE, Becker, MJ, Edwards, JE. Malposition of pulmonary arteries (crossed pulmonary arteries) in persistent truncus arteriosus. Am J Roentgenol Radium Ther Nucl Med 1970; 110: 509–514.CrossRefGoogle ScholarPubMed
3. Chaturvedi, R, Mikailian, H, Freedom, RM. Crossed pulmonary arteries in tetralogy of Fallot. Cardiol Young 2005; 15: 537.CrossRefGoogle ScholarPubMed
4. Recto, MR, Parness, IA, Gelb, BD, Lopez, L, Lai, WW. Clinical implications and possible association of malposition of the branch pulmonary arteries with DiGeorge syndrome and microdeletion of chromosomal region 22q11. Am J Cardiol 1997; 80: 1624–1627.CrossRefGoogle ScholarPubMed
5. Cuturilo, G, Drakulic, D, Krstic, A, et al. The role of modern imaging techniques in the diagnosis of malposition of the branch pulmonary arteries and possible association with microdeletion 22q11.2. Cardiol Young 2012; 23: 181–188.CrossRefGoogle ScholarPubMed
6. Brown, JW, Roedefeld, MD, Ruzmetov, M. Transverse aortic arch obstruction: when to go from the front. Pediatr Card Surg Annu 2009: 66–69.Google ScholarPubMed
7. Siripornpitak, S, Pornkul, R, Khowsathit, P, Layangool, T, Promphan, W, Pongpanich, B. Cardiac CT angiography in children with congenital heart disease. Eur J Radiol 2013; 82: 1067–1082.CrossRefGoogle ScholarPubMed
8. Kim, JE, Newman, B. Evaluation of a radiation dose reduction strategy for pediatric chest CT. Am J Roentgenol 2010; 194: 1188–1193.CrossRefGoogle ScholarPubMed
9. Goske, MJ, Applegate, KE, Boylan, J, et al. The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 2008; 38: 265–269.CrossRefGoogle ScholarPubMed
10. Anderson, RH, Chaudhry, B, Mohun, TJ, et al. Normal and abnormal development of the intrapericardial arterial trunks in humans and mice. Card Res 2012; 95: 108–115.CrossRefGoogle ScholarPubMed
11. Bajolle, F, Zaffran, S, Kelly, RG. Rotation of the myocardial wall of the outflow tract is implicated in the normal positioning of the great arteries. Circ Res 2006; 98: 421–428.CrossRefGoogle ScholarPubMed
12. Lacour-Gayet, F, Bruniaux, J, Serraf, A, et al. Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty patients. J Thorac Cardiovascular Surg 1990; 100: 808–816.CrossRefGoogle Scholar
13. Zimmerman, FJ, Berdusis, K, Wright, KL, Alboliras, ET. Echocardiographic diagnosis of anomalous origins of the pulmonary arteries from the pulmonary trunk (crossed pulmonary arteries). Am Heart J 1997; 133: 257–260.CrossRefGoogle ScholarPubMed
14. Xiong, Y, Gan, HJ, Liu, T, Tao, F, Wang, HF, Wu, Y. Prenatal diagnosis of crossed pulmonary arteries. Ultrasound Obstet Gynecol 2010; 36: 776–778.CrossRefGoogle ScholarPubMed
15. Brand, M, Sommer, M, Achenbach, S, et al. X-ray induced DNA double-strand breaks in coronary CT angiography: comparison of sequential, low-pitch helical and high-pitch helical data acquisition. Eur J Radiol 2012; 81: e357–e362.CrossRefGoogle ScholarPubMed
16. Miglioretti, DL, Johnson, E, Williams, A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013: 1–8.Google Scholar
17. Ou, P, Celermajer, DS, Marini, D, et al. Safety and accuracy of 64-slice computed tomography coronary angiography in children after the arterial switch operation for transposition of the great arteries. JACC Cardiovasc Imaging 2008; 1: 331–339.CrossRefGoogle ScholarPubMed
18. Achenbach, S, Goroll, T, Seltmann, M, et al. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging 2011; 4: 328–337.CrossRefGoogle ScholarPubMed
19. Goo, HW, Seo, DM, Yun, TJ, et al. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings. Pediatr Radiol 2009; 39: 265–273.CrossRefGoogle ScholarPubMed
20. Thomas, KE, Wang, B. Age-specific effective doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol 2008; 38: 645–656.CrossRefGoogle Scholar
21. Safety-Xray and CT exams. RadiologyInfo.org. 2013; 10: 3–7.Google Scholar
22. Verdun, RF, Bochud, F, Gunddinchet, F, Aroua, A, Schnyder, P, Meuli, R. Quality initiatives radiation risk: what you should know to tell your patient. Radiographics 2008; 28: 1807–1816.CrossRefGoogle ScholarPubMed
23. Langley, SM, Sunstrom, RE, Reed, RD, Rekito, AJ, Gerrah, R. The neonatal hypoplastic aortic arch: decisions and more decisions. Pediatr Card Surg Ann 2013; 16: 43–51.Google ScholarPubMed
24. Shepard, CW, Kochilas, LK, Rosengart, RM, et al. Repair of major congenital cardiac defects in low-birth-weight infants: is delay warranted? J Thorac Cardiovasc Surg 2010; 140: 1104–1109.CrossRefGoogle ScholarPubMed
25. Piluiko, VV, Poynter, JA, Nemeh, H, et al. Efficacy of intraluminal pulmonary artery banding. J Thorac Cardiovasc Surg 2005; 129: 544–550.CrossRefGoogle ScholarPubMed
26. Ho, SY, Anderson, RH. Coarctation, tubular hypoplasia, and the ductus arteriosus. Br Heart J 1979; 41: 268–274.CrossRefGoogle ScholarPubMed
27. Russell, GA, Berry, PJ, Watterson, K, Dhasmana, JP, Wisheart, JD. Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 1991; 102: 596–601.CrossRefGoogle ScholarPubMed
28. Rakhra, SS, Lee, M, Iyengar, AJ. Poor outcomes after surgery or coarctation repair with hypoplastic arch warrants more extensive initial surgery and close long-term follow-up. Interac Cardiov Thor Surg 2012; 16: 31–36.CrossRefGoogle ScholarPubMed
29. Siwik, ES, Everman, D, Morrison, S. Images in cardiology: crossed pulmonary arteries, ventricular septal defect, and chromosome 22q11 deletion. Heart 2002; 88: 88.CrossRefGoogle ScholarPubMed