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Images in Cardiothoracic Medicine and Surgery
Patch closure of right aortic arch with left-sided patent ductus arteriosus
Asian Cardiovascular & Thoracic Annals 0(0) 1–2 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315584128 aan.sagepub.com
Ramachandra Barik1, Ramesh Chandra Mishra2 and Naresh Kumar2
Figure 1. Chest computed tomography showing a right tracheal bronchus (trifurcated trachea).
Figure 3. Anterior aspect of the main pulmonary arteriotomy showing the opening of both branch pulmonary arteries. The patent left ductus arteriosus was closed with a 1-cm bovine pericardial patch. The pulmonary artery incision was closed without injuring the coronary arteries. Arrow 1: Right atrial cannula for cardiopulmonary bypass. Arrow 2: Thread around the dilated proximal leftward anterior pulmonary artery. Arrow 3: Arteriotomy on the anterior aspect of the large left-sided ductus arteriosus which was closed at the pulmonary arterial and aortic ends. Arrow 4: Hypoplastic ascending aorta cannulation site. Arrow 5: Apex of the heart towards the caudal end of the patient. The right and left pulmonary arteries being posterior in location, are not seen here.
A 4-month-old baby girl, born of a nonconsanguineous marriage, was diagnosed at birth with a congenital cardiac defect. All 4 limbs had high-volume pulses (blood pressure 83/25/48 mm Hg), and O2 saturation was 97% without brachiofemoral delay in room air. She had a
Figure 2. Contrast-enhanced computed tomography of the aorta and pulmonary artery, showing the mirror-image hypoplastic right aortic arch (diameter 8 mm; black arrow), dilated main pulmonary artery (1.6 cm; yellow arrow) with normal confluence, left ductus arteriosus (diameter 9 mm; green arrow), connecting the rostral end of the main pulmonary artery and cranial end of the ascending aorta just before the left innominate artery. The ductus is a wide oval window-type, 2-cm cranial to the aortic valve at the aortic opening side.
1 Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, India 2 Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, India
Corresponding author: Ramachandra Barik, MD, DNB, Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, India. Email: [email protected]
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Asian Cardiovascular & Thoracic Annals 0(0) tomography (Figure 1). Echocardiography and contrast-enhanced computed tomography (Figure 2) confirmed a 2-mm subaortic ventricular septal defect, patent foramen ovale, dilated main pulmonary artery, hypoplastic right aortic arch, and bilateral superior venae cavae. A large (9-mm) left patent ductus arteriosus joined the cranial end of the main pulmonary artery and right aortic arch just before the left innominate artery. The ascending aorta was hypoplastic (diameter 8–9 mm). The pulmonary-systemic shunt ratio was 1.9:1 and pulmonary vascular resistance was 1.8 Woods units on echocardiography. A genetic study ruled out 22q11.2 deletion. Under cardiopulmonary bypass, the ductus was closed via a pulmonary arteriotomy (Figure 3). Contrast-enhanced computed tomography on the 10th day after surgery revealed no residual shunt (Figure 4). Funding
Figure 4. Contrast-enhanced computed tomography on the 10th postoperative day, showing the hypoplastic ascending aorta (black arrow). The distal stump of the left ductus arteriosus (yellow arrow) joining the right aortic arch is no longer connected to the main pulmonary artery (not seen).
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
grade III/VI systolic murmur and diastolic rumble in the left infraclavicular area and apex, respectively. A 12-lead electrocardiogram suggested right ventricular pressure overload. Trifurcated trachea was suspected on a chest radiograph and confirmed by computed
Downloaded from aan.sagepub.com at CAMBRIDGE UNIV LIBRARY on June 4, 2016
(AAN)
[1–2] [PREPRINTER stage]
Images in Cardiothoracic Medicine and Surgery
Patch closure of right aortic arch with left-sided patent ductus arteriosus
Asian Cardiovascular & Thoracic Annals 0(0) 1–2 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315584128 aan.sagepub.com
Ramachandra Barik1, Ramesh Chandra Mishra2 and Naresh Kumar2
Figure 1. Chest computed tomography showing a right tracheal bronchus (trifurcated trachea).
Figure 3. Anterior aspect of the main pulmonary arteriotomy showing the opening of both branch pulmonary arteries. The patent left ductus arteriosus was closed with a 1-cm bovine pericardial patch. The pulmonary artery incision was closed without injuring the coronary arteries. Arrow 1: Right atrial cannula for cardiopulmonary bypass. Arrow 2: Thread around the dilated proximal leftward anterior pulmonary artery. Arrow 3: Arteriotomy on the anterior aspect of the large left-sided ductus arteriosus which was closed at the pulmonary arterial and aortic ends. Arrow 4: Hypoplastic ascending aorta cannulation site. Arrow 5: Apex of the heart towards the caudal end of the patient. The right and left pulmonary arteries being posterior in location, are not seen here.
A 4-month-old baby girl, born of a nonconsanguineous marriage, was diagnosed at birth with a congenital cardiac defect. All 4 limbs had high-volume pulses (blood pressure 83/25/48 mm Hg), and O2 saturation was 97% without brachiofemoral delay in room air. She had a
Figure 2. Contrast-enhanced computed tomography of the aorta and pulmonary artery, showing the mirror-image hypoplastic right aortic arch (diameter 8 mm; black arrow), dilated main pulmonary artery (1.6 cm; yellow arrow) with normal confluence, left ductus arteriosus (diameter 9 mm; green arrow), connecting the rostral end of the main pulmonary artery and cranial end of the ascending aorta just before the left innominate artery. The ductus is a wide oval window-type, 2-cm cranial to the aortic valve at the aortic opening side.
1 Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, India 2 Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, India
Corresponding author: Ramachandra Barik, MD, DNB, Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, India. Email: [email protected]
Downloaded from aan.sagepub.com at CAMBRIDGE UNIV LIBRARY on June 4, 2016
XML Template (2015) [29.4.2015–9:46am] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/AANJ/Vol00000/150053/APPFile/SG-AANJ150053.3d
(AAN)
[1–2] [PREPRINTER stage]
2
Asian Cardiovascular & Thoracic Annals 0(0) tomography (Figure 1). Echocardiography and contrast-enhanced computed tomography (Figure 2) confirmed a 2-mm subaortic ventricular septal defect, patent foramen ovale, dilated main pulmonary artery, hypoplastic right aortic arch, and bilateral superior venae cavae. A large (9-mm) left patent ductus arteriosus joined the cranial end of the main pulmonary artery and right aortic arch just before the left innominate artery. The ascending aorta was hypoplastic (diameter 8–9 mm). The pulmonary-systemic shunt ratio was 1.9:1 and pulmonary vascular resistance was 1.8 Woods units on echocardiography. A genetic study ruled out 22q11.2 deletion. Under cardiopulmonary bypass, the ductus was closed via a pulmonary arteriotomy (Figure 3). Contrast-enhanced computed tomography on the 10th day after surgery revealed no residual shunt (Figure 4). Funding
Figure 4. Contrast-enhanced computed tomography on the 10th postoperative day, showing the hypoplastic ascending aorta (black arrow). The distal stump of the left ductus arteriosus (yellow arrow) joining the right aortic arch is no longer connected to the main pulmonary artery (not seen).
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
grade III/VI systolic murmur and diastolic rumble in the left infraclavicular area and apex, respectively. A 12-lead electrocardiogram suggested right ventricular pressure overload. Trifurcated trachea was suspected on a chest radiograph and confirmed by computed
Downloaded from aan.sagepub.com at CAMBRIDGE UNIV LIBRARY on June 4, 2016
