Anomalous origin of one pulmonary artery branch from the aorta. Postoperative outcome and literature review

The aim was to review our experience with the surgical repair of the anomalous origin of one pulmonary branch from the aorta(AOPA). Materials and Method. Between january 1991 and march 2001, 8 patients with AOPA underwent surgical correction. Three patients presented isolated AOPA. Five patients presented AORPA and 3 AOLPA. Implantation of the anomalous PA to the main PA trunk was performed by: I)direct anatomosis in 2 patients with AOLPA; II)interposition of a synthetic graft in one patient with AOLPA; III)employing an autologous pericardial patch in 2 patients with AORPA; IV)using an aortic flap in 3 patients with AORPA. The mean follow-up time was 37.7 months. Results. One patient died postoperatively due to progressive heart failue unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in another patient. Within 2 years after surgery, the residual gradient across the anastomotic site was significantly lower in patients undergoing correction employing adjunctive autoplogous tissues, 9.5±4.6mmHg versus 21±7.2mmHg(p=0.045). in patients undergoing direct anastomosis or interpositioning of a synthetic graft. Similarly, the Tc-99m scintigraphy demonstrated a significantly lower lung perfusion in patients undergoing AOPA implantation without employing autologous tissues for increasing the AOPA length 57±5.6(%) versus 72±4.5(%)(p=0.011). Conclusion. The AOPA 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 AOPA seem to be associated with better results in terms of postoperative restenosis.