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Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report.

Prifti E, Ademaj F, Baboci A, Kajo E, Vanini V - J Med Case Rep (2015)

Bottom Line: The anomalous ectatic bronchial artery was successfully occluded by coil embolization.The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course.A coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Surgery Department, Tirana University Medical Center, Tirana, Albania. edvinprifti@hotmail.com.

ABSTRACT

Introduction: Bronchial arteries originate from the descending aorta at the level of the T5-T6 vertebrae following an intrapulmonary course along the major bronchi. When bronchial arteries take off from a vessel other than the descending aorta, the anatomy is defined as an anomalous origin of the bronchial artery.

Case presentation: A 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation. Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation. Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt. Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs. The anomalous ectatic bronchial artery was successfully occluded by coil embolization. The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course.

Conclusion: A coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries. When clinically indicated, catheter-based therapy with coil embolization can be performed to successfully treat anomalous bronchial arteries by reducing as such the pulmonary overflow.

No MeSH data available.


Related in: MedlinePlus

The arrow indicates an abnormal bronchial artery arising from the inferior wall of the left subclavian artery, from which it divides into two branches that give flow to both lungs as bronchial arteries.
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Fig1: The arrow indicates an abnormal bronchial artery arising from the inferior wall of the left subclavian artery, from which it divides into two branches that give flow to both lungs as bronchial arteries.

Mentions: A 3-day-old boy from Kosovo, weighing 2.4kg, was admitted to our hospital with severe dyspnea and cyanosis. Transthoracic echocardiography revealed d-TGA with intact ventricular septum, left aortic arch and a 4mm patent ductus arteriosus. Medical therapy with prostaglandin E1, dopamine, oxygen and antibiotics was initiated. The following day, owing to hemodynamic instability, urgent corrective cardiac surgery was necessitated. The intra-operative findings included the following. The sinus 2, according to the Leiden convention [4], presented two coronary ostia: one giving off a branch as the right coronary artery, and the other one originating at a long left main coronary trunk and passing directly backward in close relation to the pulmonary artery, then curving around its posterior aspect to reach the atrioventricular groove, from whence it bifurcated into the left anterior descending and circumflex arteries. An additional branch originated from sinus 1 as a conal branch, giving rise to the septal branches. Translocation of the coronary arteries was performed. The new pulmonary trunk was reconstructed to avoid compression of the coronary artery and distortion of the great arteries. Immediately after surgery, the patient was unstable hemodynamically, as demonstrated by left ventricular (LV) failure and persistent pulmonary edema requiring inotropic support and mechanical ventilation. Transthoracic echocardiography revealed the presence of an anomalous accelerated Doppler flow localized at the left side of the heart, precisely at the aortic arch level. This Doppler image gave rise to our suspicion of an anomalous shunt between the systemic and pulmonary circulation. The hemodynamic study demonstrated a unique supra-aortic anomalous vessel originating from the left subclavian artery. The anteroposterior projection demonstrated an anomalous vessel originating from the inferior wall of the left subclavian artery, from whence it divided into two branches supplying both lungs as BAs (Figure 1). The anomalous BA originating from the left subclavian artery was the principal cause of a pulmonary hyperperfusion with consequent pulmonary edema and congestive heart failure. There were no BA originating from the T5-T6 segments. The anomalous vessel was successfully occluded proximally to its bifurcation in the catheterization laboratory with a 5-French catheter (Terumo Europe, Leuven, Belgium) and two Gianturco coils 3×3-French (William Cook Europe, Bjæverskov, Denmark) inserted through the left subclavian artery (Figure 2). The closure of this anomalous systemic pulmonary communication was associated with significant improvement of the hemodynamic and clinical status of the newborn, permitting successful extubation and decrease of the inotropic support. The patient’s post-operative course was uneventful, and the baby was discharged to home 30 days later in excellent clinical condition.Figure 1


Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report.

Prifti E, Ademaj F, Baboci A, Kajo E, Vanini V - J Med Case Rep (2015)

The arrow indicates an abnormal bronchial artery arising from the inferior wall of the left subclavian artery, from which it divides into two branches that give flow to both lungs as bronchial arteries.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4375850&req=5

Fig1: The arrow indicates an abnormal bronchial artery arising from the inferior wall of the left subclavian artery, from which it divides into two branches that give flow to both lungs as bronchial arteries.
Mentions: A 3-day-old boy from Kosovo, weighing 2.4kg, was admitted to our hospital with severe dyspnea and cyanosis. Transthoracic echocardiography revealed d-TGA with intact ventricular septum, left aortic arch and a 4mm patent ductus arteriosus. Medical therapy with prostaglandin E1, dopamine, oxygen and antibiotics was initiated. The following day, owing to hemodynamic instability, urgent corrective cardiac surgery was necessitated. The intra-operative findings included the following. The sinus 2, according to the Leiden convention [4], presented two coronary ostia: one giving off a branch as the right coronary artery, and the other one originating at a long left main coronary trunk and passing directly backward in close relation to the pulmonary artery, then curving around its posterior aspect to reach the atrioventricular groove, from whence it bifurcated into the left anterior descending and circumflex arteries. An additional branch originated from sinus 1 as a conal branch, giving rise to the septal branches. Translocation of the coronary arteries was performed. The new pulmonary trunk was reconstructed to avoid compression of the coronary artery and distortion of the great arteries. Immediately after surgery, the patient was unstable hemodynamically, as demonstrated by left ventricular (LV) failure and persistent pulmonary edema requiring inotropic support and mechanical ventilation. Transthoracic echocardiography revealed the presence of an anomalous accelerated Doppler flow localized at the left side of the heart, precisely at the aortic arch level. This Doppler image gave rise to our suspicion of an anomalous shunt between the systemic and pulmonary circulation. The hemodynamic study demonstrated a unique supra-aortic anomalous vessel originating from the left subclavian artery. The anteroposterior projection demonstrated an anomalous vessel originating from the inferior wall of the left subclavian artery, from whence it divided into two branches supplying both lungs as BAs (Figure 1). The anomalous BA originating from the left subclavian artery was the principal cause of a pulmonary hyperperfusion with consequent pulmonary edema and congestive heart failure. There were no BA originating from the T5-T6 segments. The anomalous vessel was successfully occluded proximally to its bifurcation in the catheterization laboratory with a 5-French catheter (Terumo Europe, Leuven, Belgium) and two Gianturco coils 3×3-French (William Cook Europe, Bjæverskov, Denmark) inserted through the left subclavian artery (Figure 2). The closure of this anomalous systemic pulmonary communication was associated with significant improvement of the hemodynamic and clinical status of the newborn, permitting successful extubation and decrease of the inotropic support. The patient’s post-operative course was uneventful, and the baby was discharged to home 30 days later in excellent clinical condition.Figure 1

Bottom Line: The anomalous ectatic bronchial artery was successfully occluded by coil embolization.The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course.A coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Surgery Department, Tirana University Medical Center, Tirana, Albania. edvinprifti@hotmail.com.

ABSTRACT

Introduction: Bronchial arteries originate from the descending aorta at the level of the T5-T6 vertebrae following an intrapulmonary course along the major bronchi. When bronchial arteries take off from a vessel other than the descending aorta, the anatomy is defined as an anomalous origin of the bronchial artery.

Case presentation: A 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation. Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation. Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt. Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs. The anomalous ectatic bronchial artery was successfully occluded by coil embolization. The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course.

Conclusion: A coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries. When clinically indicated, catheter-based therapy with coil embolization can be performed to successfully treat anomalous bronchial arteries by reducing as such the pulmonary overflow.

No MeSH data available.


Related in: MedlinePlus