Case of the Week #501

Lusine Karapetyan

Affiliation: City hospital named after E.O.Muhin, Moscow, Russia. Email: luskar@mail.ru

Posting Dates:  August 1, 2019 - August 15, 2019

Case report: A 32-year-old G1P0 woman with unremarkable medical history was sent to our unit for second trimester scan at 20 weeks of pregnancy.
First trimester screening was reported to be normal. Our ultrasound revealed the following findings:

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Answer

We present a case of anomalous origin of the right pulmonary artery from the ascending aorta with ventricular septal defect.

Ultrasound revealed the following findings:

  • Images 1-3: 2D images of the fetal heart show right pulmonary artery arising from ascending aorta and ventricular septal defect.
  • Videos 1-6: 2D and STIC images of the fetal heart show right pulmonary artery arising from ascending aorta and ventricular septal defect.

The diagnosis was confirmed after birth.

Discussion

Anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) is a rare and potentially fatal kind of congenital cardiovascular anomaly. It is frequently accompanied with other abnormalities, such as patent ductus arteriosus, Tetralogy of Fallot, atrial septal defect, ventricular septal defect, and aortic arch isthmus hypoplasia.

AORPA is characterized by the early and rapid development of pulmonary hypertension. Without surgical correction, patients are unlikely to survive to adulthood. Once the diagnosis of AORPA is confirmed, the patients should receive surgical treatment as soon as possible.

DIBUJO RPA
Figure 1: illustration showing the anomalous origin of the right pulmonary artery from the ascending aorta. (RA-right atrium; LA-left atrium; RV-right ventricle; LV-left ventricle; PA-main pulmonary artery; Ao-aorta; DA-ductus arteriosus; RPA-right pulmonary artery; LPA-left pulmonary artery)

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