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Double Outlet Right Ventricle with Anomalous Left Pulmonary Artery Arising from Arterial Duct : Multimodality Imaging for Prepairing A Double-Root Translocation in A Rare Association
Fabio Cuttone1* and Khaled Hadeed2
1 Department of Cardiac Surgery, University Hospital (CHU), Toulouse, France
2Department of Pediatric Cardiology, University Hospital (CHU), Toulouse, France
Submission: December 16, 2019; Published: January 10, 2019
*Corresponding author: Fabio Cuttone, Departimaent of congenital cardiac surgery, Children’s Hospital 330, avenue de Grande-Bretagne TSA 70034 31059 Toulouse, France
How to cite this article:Fabio Cuttone, Khaled Hadeed. Double Outlet Right Ventricle with Anomalous Left Pulmonary Artery Arising from Arterial Duct : Multimodality Imaging for Prepairing A Double-Root Translocation in A Rare Association. J Cardiol & Cardiovasc Ther. 2020; 15(4): 555920. DOI: 10.19080/JOCCT.2019.15.555920
Keywords: Double outlet right ventricle; Aberrant pulmonary artery; Anomalous left pulmonary artery; Double right coronary artery; Coronary anomaly; Multimodality imaging
Abbreviations: LPA: Left Pulmonary Artery; CT: Computed Tomography
Opinion
A newborn with antenatal diagnosis of double outlet right ventricle with malposition of the great arteries and svere subpulmonary stenosis (DORV - MGV - PS) was referred for treatment.
The 2D echocardiogram (Epic, Philips) confirmed the DORV - MGV - PS (Panel A) but the left pulmonary artery (LPA) was not detected. Computed tomography (CT) scan confirmed the echocardiographic diagnosis and further demonstrate the anomalous origin of LPA from a persistent ductus arteriosus (LPA from PDA, Panel B).
Based on CT images, a virtual 3D reconstruction (posterior view, Panel D) was performed and a 3D plastic model (anetrior view, Panel C) created (Mimics Materialise, Belgium). These al lowed better understanding of the spatial relationships between the cardiac and vascular structures (Panel C and D).
LPA unifocalisation (Picture-in-picture Panel A) and right modified Blalock-Tassig shunt were performed as first-stage surgical treatment in neonatal period. Seven months after the first procedure a double-root translocation complete the biventricular repair of DORV – MGV – PS.
The surgical inspection highlited the presence of a double right coronary artery (RCA, Panel E) with an aberrant origin of a large conus branch directly arising from the right sinus of Valsalva. Six months after surgery, the child does well with no residual lesions (Panel F) (Figure 1).
The association between DORV – MGV – PS, LPA from PAD and a double RCA is a very unusual form of DORV. Multimodality imaging with 3D reconstructions associate with a meticulous surgical inspection can be helpful for establishing an accurate diagnosis and performing a durable biventricular repair.
