Title : Finding and rehabilitation of absent or concealed pulmonary arteries through PDA stenting
Abstract:
Purpose:
Unilateral absence or occult a pulmonary artery is a well-known congenital heart disease, that may occur in isolation or with cardiac disorders like tetralogy of Fallot.
CT angiography usually shows just a pulmonary artery and perhaps a closed PDA ampulla from the aortic arch that may lead to a hidden pulmonary artery.
These cases, whose investigations have not demonstrated the PA, may spend their life with one lung. So, the hidden pulmonary artery must be found and rehabilitated. We performed cardiac catheterizations for more than 15 cases, some of them will be presented.
Methods:
One of our patients was a 30-day-old boy, 3200 grams, with TOF, who was referred for finding the LPA.
A Pilot coronary guide wire was guided via a retrograde path through the stump of the DA to enter the LPA, and then we passed a coronary balloon 2.5*15 millimeter through the PDA and inflated it as predilation.
Then a coronary stent 3*15 was inflated and the result was amazing
The other case was a 2.5 years old girl with the diagnosis of TOF with absent LPA. CT angiography and cardiac catheterization showed no LPA (Fig 1).
Can we insert a stent into the apparently closed DA at this age of 2.5 years?
We advanced one Asahi Fielder 0.014 guide wire through the pouch entered to the LPA.
Then we inflated a coronary stent size 4*18 into it successfully.
CT angiography of the patient 6 months later showed an acceptable LPA (Fig 2).
The other patient was a 11-month-old boy with the diagnosis of TOF and absent LPA.
CT angiography and cardiac catheterization did not demonstrate LPA. so, he was operated with one lung.
The fourth case is a 3-year-old boy with TOF, whose aortography did not depict any LPA while showing a DA stump. We were to stent the DA, but decided to do pulmonary vein wedge angiography to estimate the distance between the DA diverticulum to the APA.
Luckily, wedge angiography showed an LPA with a suitable diameter, and we stopped the procedure hoping to find it during next cardiac surgery although it is so difficult.
Findings:
Some patients with an absent pulmonary artery may have a hidden pulmonary artery, and performing PDA stenting can rehabilitate the pulmonary artery.
Proceeding to pulmonary vein angiography is highly suggested, and might be very promising.
Result:
Some patients with impression of absent one pulmonary artery might really have no it, but some of them have a closed connection between the DA and the pulmonary artery, and precise aortic arch angiography can lead us to find a stump of DA that predicts connection of it to the adjacent pulmonary artery.
