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Case Reports
. 2022 Jan-Feb;15(1):53-57.
doi: 10.4103/apc.apc_75_21. Epub 2021 Aug 11.

Hemodynamic rounds: Dilemma in the management of disconnected pulmonary arteries with double arterial ducts

Kothandam Sivakumar  1 , Ashish Ranjan Mohakud  1
Affiliations
Case Reports

Hemodynamic rounds: Dilemma in the management of disconnected pulmonary arteries with double arterial ducts

Kothandam Sivakumar et al. Ann Pediatr Cardiol. 2022 Jan-Feb.

Abstract

Segmental pulmonary arterial hypertension occurs when the right and left pulmonary arteries are nonconfluent and receive blood supply from different sources. High blood pressure confined to limited lung segments may accelerate progression of pulmonary vascular resistance. Calculation of segmental vascular resistance and assessment of operability in such situations are done after integrating catheter hemodynamics, magnetic resonance imaging techniques, or perfusion scintigraphy. When an isolated pulmonary artery perfused by a restrictive ipsilateral arterial duct is associated with a large nonrestrictive contralateral arterial duct connected to the other pulmonary artery, leading to unilateral pulmonary arterial hypertension and features of high vascular resistance, it offers unique challenges to decision-making.

Keywords: Differential lung perfusion; double patent arterial ducts; isolation of pulmonary artery; pulmonary vascular resistance; segmental pulmonary hypertension.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Chest X-ray showing mild cardiomegaly of left ventricular contour, right aortic arch, multiple end-on vessels in the medial two-thirds of the right lung, and lack of vascularity in the lateral one-third of the right lung along with oligemia of the left lung. Electrocardiogram showing right-axis deviation, right ventricular hypertrophy, and fails to demonstrate large left ventricular forces
Figure 2
Figure 2
There is no evidence of left ventricular volume overload in apical four-chamber view (a) and subxiphoid short-axis view (b). The mean pulmonary artery pressure predicted from the peak of the pulmonary regurgitation jet on Doppler (c) was 56 mmHg. Long axial view of the aortic arch (d) showing a large right-sided arterial duct
Figure 3
Figure 3
Suprasternal view (a) demonstrates a LPDA from RAA supplying the isolated LPA). A high parasternal short-axis view (b) with color flow imaging in systole (c) and diastole (d) showing pulmonary trunk (PA) continuing as RPA and a RPDA inserting into the RPA with systolic right-to-left flows and diastolic left-to-right flows. LPDA: Left-sided arterial duct, RAA: Right aortic arch, LPA: Left pulmonary artery, RPA: Right pulmonary artery, RPDA: Right-sided arterial duct
Figure 4
Figure 4
Simultaneous recording of both aortic and right pulmonary artery pressures (a) are almost similar with a 6 mmHg difference between the two vessels. After balloon occlusion of the right-sided arterial duct (b), an increase of aortic pressure and fall of right pulmonary artery pressure was accompanied by a relative bradycardia due to Branham effect
Figure 5
Figure 5
Pulmonary angiogram (a) showing pulmonary trunk (MPA) continuing as a dilated RPA which is dilated in the medial zones and pruned in the lateral zones of right lung. The isolated LPA filled from a left-sided arterial duct (b) arising from the base of LIA. Aortogram (c) showing right aortic arch, a large right-sided tubular arterial duct (RPDA) connecting to the RPA. A complete balloon occlusion of the RPDA (d) is confirmed on an aortogram before assessing the pressures. LPA: Left pulmonary artery, RPA: Right pulmonary artery, LIA: Left innominate artery
See this image and copyright information in PMC

Comment in

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