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).
![Click here to view Large Figure 1 Journal of Cardiology & Cardiovascular Therapy](images/JOCCT.MS.ID.555920.G001.png)
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.