All issues > Volume 32(12); 1989

Original Article

J Korean Pediatr Soc. 1989;32(12):1678-1685. Published online December 31, 1989.

The Anatomy of Pulmonary Artery Determined by Angiography in Ventricular Septal Defect and Pulmonary Atresia.

Jung Yun Choi¹, Young Hwue Kim¹, Yong Soo Yun¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea

Received: August 23, 1989;  Accepted: October 23, 1989.

Abstract

Thirty seven cases of ventricular septal defect and pulmonary atresia in normally connected heart, diagnosed at Seoul National University Children’s Hospital from October 1987 to May 1989 were studied to determine the source of pulmonary blood flow, pulmonary artery anatomy and their sequential changes. Also was studied the relationship between major aortopulmonary collateral artery (MAPCA) and intra parenchymal pulmonary arteries and central pulmonary artery in appropri- ate cases. Four groups were identified according to the source of pulmonary blood flow. The source was ductus in group 1 (16 cases), ductus and small acquired collateral arteries in group 2 (3 cases), small collateral arteries only in group 3 (2 cases) and MAPCA in group 4 (16 cases). Pulmonary artery was confluent and nearly all the bronchopulmonary segments were connected to the pulmonary artery confluence in all cases of group 1. In group 2, pulmonary artery was disconnected and one pulmonary was connected to ductus and the other pulmonary artery was supplied by small collateral arteries. Both patients of group 3 had confluent pulmonary artery supplied by small collateral arteries only. Thirteen out of 16 cases of group 4 had confluent pulmonary artery. Among 16 cases of group 1, 10 cases had more than one catheterization so that sequential change of gross anatomy of pulmanary antery was observed. No change was found in 3 cases and ductus was closed in 3 cases and pulmonary artery became disconnected in 4 cases. Detailed studies, including selective MAPCA injection, were performed to evaluate group 4, MAPCAs were originated most frequently in descending aorta. Average number of MAPCA to right lung was 2 and that to left lung was 1.7. In general, the size of central pulmonary artery correlated positively with approximate number of bronchopulmonary segment connected to central pulmonary artery. The proportion of diameter of right and left pulmonary artery to diameter of descending aorta was increased significantly after shunt operation regardless of age at operation.

Keywords :Pulmonary artery anatomy, Major Aortopulmonory Collateral Artery