Ct-diagnosis of anomalous origin of one of the pulmonary artery branches from the aorta (hemitruncus)

Abstract

The anomalous origin of a pulmonary artery branch from the aorta (AOPA), or hemitruncus arteriosus, is a rare congenital cardiac anomaly characterized by the anomalous origin of one of the pulmonary arteries (PA) branches from the ascending aorta and a normal origin of the other PA branch from the right ventricular outflow tract (RVOT).
Objective: to demonstrate the potential of multidetector computed tomography (MDCT) in evaluation of the cardiovascular anatomy of hemitruncus and the concomitant pathology for the planning of surgical treatment of patients.
Material and methods. Between January 2007 and November 2017, in 9 consecutive patients (age range from 2 days to 2 weeks) with hemitruncus arteriosus after previous transthoracic echocardiography (TTE), a non-cardiac-gated, contrast-enhanced multidetector CT (MDCT) was performed, using a 16-slice computer tomograph.
Results. Among 9 patients with hemitruncus arteriosus, only one patient had a distal origin of the right PA from the ascending aorta, all others had proximal origin of the right PA. All patients had concomitant congenital malformations of the cardiovascular system, such as: patent ductus arteriosus (n=9), atrial septal defect (n=1), and aortic arch anomalies including aortic coarctation, aortic arch isthmus hypoplasia (n=2), and vascular rings (n=2). One patient with proximal origin of the right PA was examined after the total surgical correction.
Conclusions. Multidetector computed tomography is a valuable method to evaluate cardiovascular anatomy, lung parenchyma, airways and mediastinum in patients with hemitruncus arteriosus. 3D Reconstructed images are particularly useful for improving the detection of abnormalities, providing accurate measurement of length and volumes for clarification of complex spatial relationship between anomalous mediastinal vessels and adjacent intrathoracic structures.