Anomalous origin of the right pulmonary artery from the ascending aorta.
OBJECTIVE
The aim was to review our experience with the surgical repair of the anomalous origin of the right pulmonary artery (AORPA) from the aorta.


METHODS
Between January 1991 and March 2001, five patients with AORPA underwent surgical correction. One patient presented isolated AOPA from the aorta. Implantation of the anomalous PA to the main PA trunk was performed by (1). direct anatomosis employing an autologous pericardial patch in two patients; (2). using an aortic flap in two patients with AORPA; and (3). using an aortic and pulmonary flaps in another patient. The mean follow-up time was 27 months.


RESULTS
One patient died due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in patient 4, that was managed by intravenous prostacyclin. The same patient necessitated mechanical ventilation for 11 days. The mean residual gradient for all survivors was 9.5 +/- 4 mmHg. The postoperative Tc-99 m scintigraphy demonstrated 72 +/- 4.5(%) lung perfusion. At follow-up the survival was 100%. None of the followed patients required reoperation.


CONCLUSIONS
The AORPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. The techniques employing autologous tissues for enlarging and lengthening the AORPA seem to be associated with better results in terms of postoperative restenosis.
Prifti
Edvin
E
Department of Pediatric Cardiac Surgery, "G Pasquinucci" Hospital, Massa, Italy.
Bonacchi
Massimo
M
Murzi
Bruno
B
Crucean
Adrian
A
Leacche
Marzia
M
Bernabei
Massimo
M
Bartolozzi
Fabio
F
Nathan
Nadia S
NS
Vanini
Vittorio
V
D000714:Anastomosis, Surgical; D001011:Aorta / Q000002:abnormalities* / Q000601:surgery; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome