Feature of the angulation between left pulmonary artery and main pulmonary artery and its relationship to pulmonary artery development in patients with tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAO Rong , CHEN Pengfan , WANG Yue , ZHANG Yuchen , YI Wenqi , HE Mengting , LING Yunfei ,  AN Qi

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

AN Qi, Email: anqi@scu.edu.cn

Keywords：

Tetralogy of Fallot; pulmonary artery; angulation; diameter

DOI：

10.7507/1007-4848.201908045

Video：

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Objective To investigate the feature of the angulation between left pulmonary artery (LPA) and main pulmonary artery (MPA) and its relationship to pulmonary artery development in patients with tetralogy of Fallot (TOF).Methods A total of 101 TOF patients in West China Hospital from 2014 to 2018 were enrolled in a TOF group, including 62 males and 39 females, aged 6.8 (0.3-45.8) years, and another 20 patients without basic cardiac diseases at the same stage were enrolled in a control group, including 10 males and 10 females, aged 6.9 (0.3-54.0) years. Diameters of LPA, right pulmonary artery (RPA) and MPA, the angulation between LPA and MPA (MPA-LPA), McGoon ratio, and Nakata index were measured and compared between the two groups. The relationship between the above data and MPA-LPA angulation was also analyzed.Results The average MPA-LPA angulation was smaller in the TOF group than that in the control group (113.63° vs. 128.45°, P=0.001 8). The MPA Z score was also smaller in the TOF group than that in the control group (0.46 vs. 2.75, P=0.000 4). No relationship was found by correlation analysis between the MPA-LPA angulation and MPA Z score or LPA Z score in the control group (P=0.239 6, 0.114 7) and the TOF group (P=0.759 3, 0.242 7). The McGoon ratios (2.22±0.72, 2.43±0.94, P=0.340 0) and Nakata index (359.3±294.24, 395.52±329.31, P=0.650 0) were not significantly different between the two groups.Conclusion The angulation of LPA-MPA and MPA Z score are smaller in the TOF group than those in the control group. There is no relationship between MPA-LPA angulation and pulmonary artery diameters. The LPA-MPA angulation should not be considered as an influence factor for LPA development and trans-annular patch surgery.

Citation： CAO Rong, CHEN Pengfan, WANG Yue, ZHANG Yuchen, YI Wenqi, HE Mengting, LING Yunfei, AN Qi. Feature of the angulation between left pulmonary artery and main pulmonary artery and its relationship to pulmonary artery development in patients with tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 26-30. doi: 10.7507/1007-4848.201908045 Copy

1.	Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2019, 139(14): e698-e800.
2.	Webb GD, Apitz C, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699): 1462-1471.
3.	Dohlen G, Chaturvedi RR, Benson LN, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart, 2009, 95(2): 142-147.
4.	Sheikh AM, Kazmi U, Syed NH. Variations of pulmonary arteries and other associated defects in tetralogy of Fallot. Springerplus, 2014, 3: 467-471.
5.	Wang Q, Zhao Y, Han L, et al. Pulmonary hypoplasia in fetuses with congenital conotruncal defects. Echocardiography, 2017, 34(12): 1842-1851.
6.	Jang WS, Kim WH, Cho S. Effects of angle correction angioplasty for pulmonary artery stenosis with Tetralogy of Fallot. Ann Thorac Surg, 2016, 103(3): 862-868.
7.	Kim H, Sung SC, Chang YH, et al. Early and midterm outcomes of left pulmonary artery angioplasty using an anterior wall flap of the main pulmonary artery in tetralogy of Fallot repair. J Thorac Cardiovasc Surg, 2014, 148(6): 2597-2601.
8.	Nakata S, Imai Y, Takanashi Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg, 1984, 88(4): 610-619.
9.	Fontan F, Fernandez G, Costa F, et al. The size of the pulmonary arteries and the results of the Fontan operation. J Thorac Cardiovasc Surg, 1989, 98(5): 711-719.
10.	张维敏, 仝志荣, 刘金龙. 法洛四联症肺动脉形态学分析. 国际心血管病杂志, 2017, 44(1): 39-42.
11.	McElhinney DB, Parry AJ, Reddy VM, et al. Left pulmonary artery kinking caused by outflow tract dilatation after transannular patch repair of tetralogy of Fallot. Ann Thorac Surg, 1998, 65(4): 1120-1126.
12.	Zhang W, Liu J, Yan Q, et al. Computational haemodynamic analysis of left pulmonary artery angulation effects on pulmonary blood flow. Interact Cardiovasc Thorac Surg, 2016, 23(4): 519-525.
13.	Cunningham KS, Gotlieb AI. The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest, 2005, 85(1): 9-23.
14.	Farnoush A, Avolio A, Qian Y. Effect of bifurcation angle configuration and ratio of daughter diameters on hemodynamics of bifurcation aneurysms. AJNR Am J Neuroradiol, 2013, 34(2): 391-396.
15.	蔡晓维, 赵俊飞, 刘晓冰, 等. 肺动脉瓣环占比: 法洛四联症根治术跨瓣补片的预测指标. 中国胸心血管外科临床杂志, 2019, 26(4): 316-320.
16.	Lehner A, Schuh A, Herrmann FE, et al. Influence of pulmonary artery size on early outcome after the Fontan operation. Ann Thorac Surg, 2014, 97(4): 1387-1393.

1. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2019, 139(14): e698-e800.
2. Webb GD, Apitz C, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699): 1462-1471.
3. Dohlen G, Chaturvedi RR, Benson LN, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart, 2009, 95(2): 142-147.
4. Sheikh AM, Kazmi U, Syed NH. Variations of pulmonary arteries and other associated defects in tetralogy of Fallot. Springerplus, 2014, 3: 467-471.
5. Wang Q, Zhao Y, Han L, et al. Pulmonary hypoplasia in fetuses with congenital conotruncal defects. Echocardiography, 2017, 34(12): 1842-1851.
6. Jang WS, Kim WH, Cho S. Effects of angle correction angioplasty for pulmonary artery stenosis with Tetralogy of Fallot. Ann Thorac Surg, 2016, 103(3): 862-868.
7. Kim H, Sung SC, Chang YH, et al. Early and midterm outcomes of left pulmonary artery angioplasty using an anterior wall flap of the main pulmonary artery in tetralogy of Fallot repair. J Thorac Cardiovasc Surg, 2014, 148(6): 2597-2601.
8. Nakata S, Imai Y, Takanashi Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg, 1984, 88(4): 610-619.
9. Fontan F, Fernandez G, Costa F, et al. The size of the pulmonary arteries and the results of the Fontan operation. J Thorac Cardiovasc Surg, 1989, 98(5): 711-719.
10. 张维敏, 仝志荣, 刘金龙. 法洛四联症肺动脉形态学分析. 国际心血管病杂志, 2017, 44(1): 39-42.
11. McElhinney DB, Parry AJ, Reddy VM, et al. Left pulmonary artery kinking caused by outflow tract dilatation after transannular patch repair of tetralogy of Fallot. Ann Thorac Surg, 1998, 65(4): 1120-1126.
12. Zhang W, Liu J, Yan Q, et al. Computational haemodynamic analysis of left pulmonary artery angulation effects on pulmonary blood flow. Interact Cardiovasc Thorac Surg, 2016, 23(4): 519-525.
13. Cunningham KS, Gotlieb AI. The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest, 2005, 85(1): 9-23.
14. Farnoush A, Avolio A, Qian Y. Effect of bifurcation angle configuration and ratio of daughter diameters on hemodynamics of bifurcation aneurysms. AJNR Am J Neuroradiol, 2013, 34(2): 391-396.
15. 蔡晓维, 赵俊飞, 刘晓冰, 等. 肺动脉瓣环占比: 法洛四联症根治术跨瓣补片的预测指标. 中国胸心血管外科临床杂志, 2019, 26(4): 316-320.
16. Lehner A, Schuh A, Herrmann FE, et al. Influence of pulmonary artery size on early outcome after the Fontan operation. Ann Thorac Surg, 2014, 97(4): 1387-1393.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Feature of the angulation between left pulmonary artery and main pulmonary artery and its relationship to pulmonary artery development in patients with tetralogy of Fallot

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