Isolated unilateral absence of a pulmonary artery: a case report and review of the literature.
OBJECTIVE
The purpose of the present study was to determine the symptomatology, diagnostic procedures, and therapeutic strategies of patients with an isolated unilateral absence of a pulmonary artery (UAPA).


BACKGROUND
Isolated UAPA is a rare anomaly. Some case reports exist, but the best diagnostic and therapeutic approaches to these patients remain unclear.


METHODS
A retrospective analysis was made of 108 cases reported between 1978 and 2000. The database of the National Library of Medicine (MEDLINE) was used to identify cases that were published in any language from 1978 onward.


RESULTS
Of the 108 patients identified, 14 were asymptomatic. The median age was 14 years (range, 0.1 to 58 years). Most patients had symptoms such as frequent pulmonary infections (37%), dyspnea or limited exercise tolerance (40%), or hemoptysis (20%). Pulmonary hypertension was present in 44% of the patients. Surgical procedures were performed in 17% of patients, and the overall mortality rate was 7%.


CONCLUSIONS
Only a few patients with isolated UAPA remain asymptomatic during follow-up. The diagnosis can be made by chest radiograph, echocardiography, CT scan, and MRI. Hilar arteries can be shown by cardiac catheterization and pulmonary venous wedge angiography. This is important since revascularization may improve pulmonary hypertension. The avoidance of high altitudes and pregnancy may further improve outcomes.
Ten Harkel
A Derk Jan
AD
Department of Pediatric Cardiology, Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands. Tenharkel@alkg.azr.nl
Blom
Nico A
NA
Ottenkamp
Jaap
J
D000293:Adolescent; D000328:Adult; D000790:Angiocardiography / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate