Anomalous Origin of the Left Anterior Descending Artery from the Pulmonary Artery
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Abstract:
An extremely rare congenital abnormality is reported in which the anterior descending coronary artery (LAD) originates from the pulmonary trunk. The clinical presentation, angiographic findings, and surgical treatment are discussed. This is the only reported case where surgical treatment included ligation of the LAD with internal mammary artery bypass grafting.Keywords:
Pulmonary Trunk
Presentation (obstetrics)
Abnormality
Left pulmonary artery
肺動脈肉腫は稀で予後不良とされる．症例は60歳，男性．主訴は労作時の息切れ．精査時胸部造影CT及びMRIで左肺動脈を閉塞する腫瘍を認め，肺動脈血管肉腫が疑われた．心臓外科と合同手術の方針となった．体外循環確立後，肺動脈幹を切開した．左主肺動脈を閉塞する腫瘍を認め，肉眼的マージンを確保して左主肺動脈を切除した．肺動脈壁断端の迅速病理診断は3回目で漸く陰性となり，肺動脈幹をウシ心膜で再建した．心囊内で左下肺静脈，続いて左上肺静脈を切離後に体外循環を離脱，その後左肺全摘を施行した．最終病理診断は左肺動脈血管肉腫で肺実質への直接浸潤と肺門リンパ節への転移を認めた．肺動脈の断端は陰性であった．術後補助化学療法は施行せず厳重に経過観察中で，術後10ヵ月現在再発兆候を認めていない．
Pulmonary Trunk
Left pulmonary artery
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Pulmonary Trunk
Left pulmonary artery
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"Truncus arteriosus with isolated origin of left subclavian artery from the pulmonary trunk." Acta Cardiologica, ahead-of-print(ahead-of-print), pp. 1–2 Disclosure statementNo potential conflict of interest was reported by the author(s).
Truncus arteriosus
Truncus
Pulmonary Trunk
Left subclavian artery
Left pulmonary artery
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A pulmonary artery sling is formed when the left pulmonary artery originates from the right pulmonary artery and encircles the distal trachea, coursing between the trachea and esophagus to reach the hilum of the left lung. Pulmonary artery slings are often associated with distal tracheal narrowing, due to either intrinsic stenosis or secondary compression by the anomaly itself. We report a very rare case in which the left superior pulmonary artery originated from the right pulmonary artery and then acted as a sling, the left inferior pulmonary artery originated from the pulmonary trunk.
Left pulmonary artery
Sling (weapon)
Right pulmonary artery
Main Pulmonary Artery
Hilum (anatomy)
Pulmonary Trunk
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Pulmonary Trunk
Left pulmonary artery
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We report a case of a partial anomalous left pulmonary artery sling in an adult patient as an incidental finding on computed tomography. There is a normal bifurcation of the pulmonary trunk into right and left pulmonary arteries with anomalous origin of the left upper lobe pulmonary artery from the right pulmonary artery. The anomalous vessel passes between the trachea and esophagus forming a partial left pulmonary artery sling without airway compression.
Left pulmonary artery
Sling (weapon)
Right pulmonary artery
Pulmonary Trunk
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Background: The inadvertent ligation of the left pulmonary artery (LPA) is a rarely seen surgical complication that has been presented in the literature in a limited number of cases after patent ductus arteriosus (PDA) ligation surgery. Case Report: A PDA closure operation was performed on our patient, a 28-week-old preterm. In the postoperative follow-up, we identified on echocardiography taken on the same postoperative day that the ductus space was still present. On CT angiography, we determined that not only was the ductus space still continuing, but, in addition, ligation of the LPA had been performed inadvertently. An LPA reconstruction operation was performed on the patient 46 days after the first operation. However, owing to severe tissue damage in LPA, LPA reperfusion did not occur in the postoperative period. Conclusion: Although inadvertent ligation of the left pulmonary artery during PDA ligation surgery is rarely seen in patients who have undergone closure surgery, this complication should be kept in mind in the postoperative follow-up period. Patient findings such as physical examination, lung angiography and postoperative echocardiography should be assessed with this in mind.
Ductus arteriosus
Left pulmonary artery
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A 10-day-old boy was transferred to our hospital due to tachypnea. Patent ductus arteriosus (PDA), 4.8 mm in diameter, with small ASD was diagnosed on echocardiography. Surgical ligation of the ductus was performed after failure of three cycles of ibuprofen. However, the ductus remained open on routine postoperative echocardiography on the second postoperative day, and chest CT revealed inadvertent ligation of the left pulmonary artery (LPA) rather than the PDA. Emergent operation successfully reopened the clipped LPA and ligated the ductus on the same (second postoperative) day.<br />Mechanical ventilator support was weaned on postoperative day 21, and the baby was discharged on postoperative day 47 with a normal left lung shadow.
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Objective:Using 16-slice spiral CT to measure the value of normal dimension of pulmonary artery trunk and its main branches.Methods:120 adults performing coronary CTA with no pulmonary arterial pressure and blood flow abnormalities induced by cardiac-pulmonary diseases,were divided into 3 groups according to their age(40y,40~60y,(60y),)with 40 case in each group(20 cases for each gender),and were studied by 16-slice Spiral CT.Images were taken at the end of deep inspiration phase and measurements were done on slices with precise landmarks.All the results were statistically analyzed.Results:Results from measurement of pulmonary artery trunk,left pulmonary artery and right pulmonary artery had shown that there was significant difference between two genders(P0.05).Corresponding to increase of age,the dimension had a trend of increasing gradually,having significant difference in different age group(P0.05).For the dimension of pulmonary artery of right lower lobe,there was no significant difference in different genders,yet there were significant difference between the two groups under 40 and over 60 years of age(P0.05).There were no significant differences between different genders and age group in pulmonary arteries of the other pulmonary lobes(P0.05).Conclusion:Pulmonary artery trunk and its branches can be clearly shown by 16-slice spiral CT.Measurement of the normal dimension of pulmonary artery provides valuable imaging information in the diagnosis of pulmonary arterial diseases and diseases that can produce morphologic change of pulmonary artery.
Pulmonary Trunk
Left pulmonary artery
Main Pulmonary Artery
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Left pulmonary artery
Pulmonary atresia
Pulmonary Trunk
Right pulmonary artery
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