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Crossed pulmonary arteries with hypoplasia of the transverse aortic arch

Published online by Cambridge University Press:  18 June 2014

Lazaro E. Hernandez ,
Robert H. Anderson ,
Eric Hoggard ,
James D. St. Louis  and
Charles W. Shepard
Lazaro E. Hernandez*
Affiliation:
Department of Pediatrics, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
Robert H. Anderson
Affiliation:
Institute of Medical Genetics, Newcastle University, Newcastle-upon-Tyne, United Kingdom
Eric Hoggard
Affiliation:
Department of Radiology, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
James D. St. Louis
Affiliation:
Department of Cardiothoracic Surgery, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
Charles W. Shepard
Affiliation:
Department of Pediatrics, University of Minnesota, Amplatz Children’s Hospital, Minnesota, United States of America
*
Correspondence to: Dr L. E. Hernandez, MD, East Building, Room MB 560, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America. Tel: 612-626-2755; Fax: 612-626-2467; E-mail: herna426@umn.edu
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Abstract

Background

The entity of crossed pulmonary arteries was first described by Jue, Lockman, and Edwards in 1966, in a patient with trisomy 18. Since then, several series have been described, both in terms of the isolated anatomic variant, or its association with other intracardiac or extracardiac anomalies. We describe a rare association that has previously not been reported.

Methods and results

Institutional Review Board approval for a retrospective chart review was obtained. Over the period 2011 through 2013, we have encountered six patients in whom the crossed origins of the pulmonary arteries from the pulmonary trunk were associated with hypoplasia of the transverse aortic arch, an association that, to the best of our knowledge, has previously not been reported. In all of the patients, the isthmic component of the aortic arch was inserted in an end-to-side manner into the ductal arch, with additional discrete coarctation in half of the patients.

Conclusion

To the best of our knowledge, no cases of crossed pulmonary arteries have been described in association with hypoplasia of the transverse aortic arch. We draw comparisons between the cases with exclusively tubular hypoplasia, and those with the added problem of the more typical isthmic variant of aortic coarctation. In all cases, the ability to reconstruct cross-sectional images added significantly to the diagnosis and understanding of these complex lesions. These findings have specific surgical implications, which are discussed.

Keywords

Crossed pulmonary arteriesaortic arch hypoplasiacoarctation of the aorta
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 718 - 724
Copyright
© Cambridge University Press 2014 

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