Central pulmonary artery anatomy in right ventricular outflow tract obstructions


      We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) and major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus–pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life [Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Syam Sunder KR, James, KJ. Central pulmonary artery anatomy in right ventricular outflow tract obstructions. Indian Heart Journal 1997;49:624 (Abstract) [
      • Harikrishnan S.
      • Tharakan J.
      • Titus T.
      • Bhat A.
      • Sivasankaran S.
      • Bimal F.
      • Syam Sunder K.R.
      • James K.J.
      Central pulmonary artery anatomy in right ventricular outflow tract obstructions.


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        • McGoon D.C.
        • Biard D.K.
        • Davis G.D.
        Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia.
        Circulation. 1975; 52: 109-118
        • Nakata S.
        • Yasuharu I.
        • Takanashi Y.
        • et al.
        A new method for the quantitative standardisation of cross sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow.
        J. Thorac. Cardiovasc. Surg. 1980; 80: 574-581
      1. Kirklin JW, Barett Borgs BJ, editors, Cardiac Surgery, 2nd ed., Churchill Livingstone, New York, 1993. p. 69, p. 949.

        • Jefferson K.
        • Rees S.
        • Somerville J.
        Systemic arterial supply to the lungs in pulmonary atresia and its relation to pulmonary artery development.
        Br. Heart J. 1972; 34: 418-427
        • Santos M.
        • Moll J.M.
        • Drumond C.
        • Araujo B.W.
        • Romao N.
        • Reis B.N.
        Development of the ductus arteriosus in right ventricular outflow tract obstruction.
        Circulation. 1980; 62: 820-822
        • Shimasaki Y.
        • Maehara T.
        • Blackstone E.H.
        • Kirklin J.W.
        • Bargeron L.M.
        The structure of the pulmonary circulation in Tetralogy of Fallot with pulmonary atresia.
        J. Thorac. Cardiovasc. Surg. 1988; 95: 1048-1058
        • Davis G.D.
        • Fulton R.E.
        • Ritter D.G.
        • Mair D.D.
        • McGoon D.C.
        Congenital pulmonary atresia with ventricular septal defect, angiographic and surgical correlates.
        Radiology. 1978; 128: 133-144
        • Rabinovitch M.
        • Herrera De Leon V.
        • Castaneda A.R.
        • Reid L.
        Growth and development of the pulmonary vascular bed in patients with Tetralogy of Fallot with or without pulmonary atresia.
        Circulation. 1984; 64: 123-129
        • Elzenga N.J.
        • Gittenberg De Groot A.C.
        The ductus arteriosus and stenosis of the pulmonary arteries in pulmonary atresia.
        Int. J. Cardiol. 1986; 11: 195-208
        • Anderson R.H.
        • Denne V.A.
        • Del Nido P.
        Surgical anatomy of TOF.
        J. Cardiac Surg. 1991; 6: 665-670
        • Shiela G.
        • Haworth F.
        • McCartney J.
        Growth and development of pulmonary circulation in pulmonary atresia, VSD and MAPCAs.
        Br. Heart J. 1980; 44: 14-24
        • Kirklin J.W.
        • Bargeron Jr., L.M.
        • Pacifico A.D.
        The enlargement of small pulmonary arteries by preliminary palliative operations.
        Circulation. 1977; 56: 612-617
        • Gill C.C.
        • Moodie D.S.
        • McGoon D.C.
        Staged surgical management of pulmonary atresia with dimunitive pulmonary arteries.
        J. Thorac. Cardiovasc. Surg. 1977; 73: 436-442
        • Somerville J.
        Management of pulmonary atresia.
        Br. Heart J. 1970; 32: 641-651
        • Kutsche L.M.
        • Van Mierop L.H.S.
        Pulmonary atresia with and without ventricular septal defect: a different etiology and pathogenesis for the atresia in the two types?.
        Am. J. Cardiol. 1983; 51: 933-938
        • Zuberbuhler J.R.
        • Anderson R.H.
        Morphological variations in pulmonary atresia with intact ventricular septum.
        Br. Heart J. 1979; 41: 281-288
        • McGoon D.C.
        • Fulton R.E.
        • Davis G.D.
        • Ritter D.G.
        • Neill C.A.
        • White R.I.
        Systemic collateral and pulmonary artery stenosis in patients with congenital pulmonary valve atresia and ventricular septal defect.
        Circulation. 1977; 56: 473-479
        • Harikrishnan S.
        • Tharakan J.
        • Titus T.
        • Bhat A.
        • Sivasankaran S.
        • Bimal F.
        • Syam Sunder K.R.
        • James K.J.
        Central pulmonary artery anatomy in right ventricular outflow tract obstructions.
        Ind. Heart J. 1997; 49 (Abstract): 624