Morphologic substrates for first-branch pulmonary arterial hypoplasia in transposition of the great arteries.
BACKGROUND
Distal right-sided outflow obstruction remains a problem after arterial switch operation. We studied the anatomical features of the pulmonary trunk (PT) and its branches that are susceptible to right and left pulmonary arterial (RPA and LPA) hypoplasia in transposition of the great arteries (TGA).


METHODS
One hundred and one angiograms of TGA performed between 1981 and 1996 were viewed, and Polaroid photos were taken at end-systole. The diameters of RPA, LPA, PT, duct, ascending aorta, and angles between PA and PT were measured, and the ductal flow direction was recorded.


RESULTS
Forty-eight cases (47.5%) had a PA/PT diameter ratio (both PAs had same size) below 0.49. A smaller PA/PT was significantly related to posterior inclination of the proximal PT [narrower right (r = 0.50, p < 0.00001) and left (r = 0.48, p < 0.00001) PA-PT angle in lateral view] and a larger duct (r = 0.37, p < 0.0001). Eighteen patients had a follow-up angiogram after a mean period of 8.5 months. Those with a closed duct had evident PA growth (n = 12, 0.51 +/- 0.09 to 0.74 +/- 0.17, p < 0.0001), but four patients with an attenuated duct had no significant change (0.58 +/- 0.06 to 0.68 +/- 0.08, p = NS), and one with a persistent large duct had even regression of PA/PT (0.36-0.19). The direction of ductal flow was toward the aorta during early systole on cineangiogram.


CONCLUSIONS
First-branch PA hypoplasia, which is frequently seen in TGA, was related to the right-to-left shunt through a duct resulting in hemodynamic starvation, and to posterior inclination of the proximal PT in this setting. Natural regression of the duct facilitated PA growth.
Chen
Ming-Ren
MR
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medicine, Taipei, Taiwan.
Wu
Shye-Jao
SJ
Chiu
Ing-Sh
IS
Wang
Jou-Kou
JK
Wu
Mei-Hwan
MH
Lue
Hung-Chi
HC
D019412:Anatomy, Cross-Sectional; D000792:Angiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010781:Photography; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery