Hypoplastic right pulmonary artery and atretic left pulmonary artery

Hypoplastic right pulmonary artery and atretic left pulmonary artery

Hypoplastic right pulmonary artery and atretic left pulmonary artery
Hypoplastic right pulmonary artery and atretic left pulmonary artery

Still frame from pulmonary angiogram showing hypoplastic main pulmonary artery and right pulmonary artery. The upper branch of right pulmonary artery is not visible and so is left pulmonary artery. A small stump of left pulmonary artery is visible. MPA: main pulmonary artery; LPA: left pulmonary artery; RPA: right pulmonary artery. Hypoplasia / atresia of pulmonary arteries can be seen in Tetralogy of Fallot and pulmonary atresia. The pulmonary blood flow in this situation is augmented by major aortopulmonary collateral arteries (MAPCAs). The MAPCAs in this case are illustrated in the previous post. The size of the pulmonary artery and its branches is important while considering definitive repair in Tetralogy of Fallot. If the size is not adequate, the right ventricular pressure will remain elevated after intracardiac repair and lead to right ventricular failure. When the pulmonary arteries are hypoplastic, a preliminary Blalock – Taussig shunt is done to permit growth of the pulmonary arteries by the increased flow. Conventional Blalock – Taussig shunt was an end to side anastomosis of the subclavian artery to the right or left branch of pulmonary artery, usually on the side opposite to that of the aortic arch. This is because the presence of brachiocephalic artery on that side prevents kinking of the subclavian artery when pulled down to the thorax. Currently only modified Blalock – Taussig shunts are being done, in which a Gore-Tex tube is used to create a side to side anastomosis of the subclavian artery to a pulmonary artery.