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Subtype of pulmonary artery sling with ventricular septal defect

Published online by Cambridge University Press:  23 June 2011

Dai Asada ,
Tatsujiro Oka  and
Kenji Hamaoka
Dai Asada
Affiliation:
Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Tatsujiro Oka*
Affiliation:
Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kenji Hamaoka
Affiliation:
Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
*
Correspondence to: Dr T. Oka, MD, PhD, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 802-8566, Japan. Tel: +81 75 251 5832; Fax: +81 75 251 5833; E-mail: okatastu@koto.kpu-m.ac.jp
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Abstract

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Keywords

Three-dimensional computed tomographydevelopmentcongenital cardiac disease

Information

Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 21 , Issue 5 , 09 September 2011 , pp. 587
Copyright
Copyright © Cambridge University Press 2011

Pulmonary artery sling, known as anomalous left pulmonary artery from the right artery, is a vascular anomaly in which the left pulmonary artery arises aberrantly from the proximal part of the right pulmonary artery and courses posterior to the trachea to reach the left hilum.Reference Kirklin and Barrett-Boyes1 We report an intriguing case with a “subtype” of pulmonary arterial sling diagnosed by three-dimensional computed tomographic angiography.

A female infant was born at 40 weeks’ gestation weighing 2734 grams. Echocardiographic examination revealed a ventricular septum defect, as well as high “take-off” of the left pulmonary artery. We performed three-dimensional computed tomographic angiography to clarify potential bronchial stenosis instead of no breathing problem, which revealed the patient's proximal pulmonary arteries (Fig 1a) to exist with a relatively large distance from the pulmonary trunk (figs, circle) to the left distal pulmonary artery (figs, diamond), as well showing original pulmonary artery sling (Fig 1b), as compared with normal arteries (Fig 1c). We performed a catheterisation examination and found no pressure gradient between the proximal left pulmonary artery and main trunk. Normally, the distal pulmonary arteries arise from their respective lung buds and join the proximal pulmonary arteries, which have formed from the left sixth aortic arch. We hypothesised that a pulmonary artery sling may occur when the proximal part of the left sixth aortic arch fails to develop its normal connections to the left lung bud (yellow part) and a “collateral” compensatory vessel from either the right (Fig 1d, green arrow) or the main pulmonary trunk thereby develops (Fig 1d, blue arrow).

Figure 1

Three-dimensional computed tomographic angiography ((a) this case; (b) original pulmonary arterial sling; (c) normal position), (d): diagram showing normal aortic arch development at 5 weeks (upper) and maturity (lower). Roman numerals indicate the embryonic aortic arches. The grey zone is normally involuted, the red zone shows the patent ductus arteriosus. Ao, aorta; PA, pulmonary artery.

References

1.Kirklin, JW, Barrett-Boyes, BG. Cardiac Surgery, 2nd edn. Churchill Livingstone, New York, 1995: 1374–1380.Google Scholar
Figure 0

Figure 1 Three-dimensional computed tomographic angiography ((a) this case; (b) original pulmonary arterial sling; (c) normal position), (d): diagram showing normal aortic arch development at 5 weeks (upper) and maturity (lower). Roman numerals indicate the embryonic aortic arches. The grey zone is normally involuted, the red zone shows the patent ductus arteriosus. Ao, aorta; PA, pulmonary artery.