case_images: PMC10243654_01
case_images: Saline contrast echocardiography in parasternal short-axis view (a) and suprasternal view (b) shows no opacification of the RPA indicating a lack of connection of the right PA with the main PA. Transthoracic echocardiography in modified high parasternal short axis (c) and suprasternal view (d) clarified the anomalous origin of the RPA from the left posterolateral aspect of the distal ascending aorta. AAo: Ascending aorta, Inn vein: Innominate vein, LA: Left atrium, LPA: Left pulmonary artery, MPA: Main pulmonary artery, RPA: Right pulmonary artery, SCV: Superior caval vein. Modified with permission from Gupta and Gupta
case_images: APC-16-65-g001.jpg
case_images: PMC10243654_01_APC-16-65-g001.jpg
case_images: apc_98_22-f001
case_images: Saline contrast echocardiography and imaging in the suprasternal view revealed an anomalous origin of the right PA (RPA) from the ascending aorta [Figure 1 and Videos 1 and 2], the details of which are published elsewhere.
case_images: Aortic root angiogram in anteroposterior projection alone (a) and simultaneously with MPA angiogram using 2 catheters and 2 injectors (b) shows an anomalous origin of the RPA from the posteromedial aspect of the ascending aorta close to the MPA. MPA: Main pulmonary artery, RPA: Right pulmonary artery
case_images: APC-16-65-g002.jpg
case_images: PMC10243654_01_APC-16-65-g002.jpg
case_images: apc_98_22-f002
case_images: Saline contrast echocardiography and imaging in the suprasternal view revealed an anomalous origin of the right PA (RPA) from the ascending aorta [Figure 1 and Videos 1 and 2], the details of which are published elsewhere. Cardiac catheterization confirmed the origin of RPA from the left posterior aspect of the ascending aorta adjacent to the main PA (MPA) [Figure 2 and Video 3].
case_images: Rest and exercise Tc99 MAA lung scintigraphy scan 2 months (a and b) and 5 years (c and d) postsurgical repair showing significantly reduced perfusion in the right lung at 2 months (a and b) with improvement at 5-year follow-up study (c and d). On both occasions, compared to the rest scan, the perfusion pattern did not change with exercise
case_images: APC-16-65-g003.jpg
case_images: PMC10243654_01_APC-16-65-g003.jpg
case_images: apc_98_22-f003
case_images: Cardiac catheterization confirmed the origin of RPA from the left posterior aspect of the ascending aorta adjacent to the main PA (MPA) [Figure 2 and Video 3]. Tc99 macroaggregated albumin (MAA) lung perfusion scintigraphy, the right lung received 21% of the lung perfusion, with the remaining 79% going to the left lung [Figure 3]. The flow pattern was the same following 9:50 min of exercise on Bruce protocol achieving 11.30 metabolic equivalents METS. The flow pattern was the same following exercise [Figure 3].
case_images: PA angiogram in anteroposterior projection shows unobstructed flow in the RPA [as seen in Video 4]. PA: Pulmonary artery, RPA: Right pulmonary artery
case_images: APC-16-65-g004.jpg
case_images: PMC10243654_01_APC-16-65-g004.jpg
case_images: apc_98_22-f004
case_images: Cardiac catheterization confirmed unobstructed PA flow with PA pressure measured at 31/7/15 mmHg [Figure 4 and Video 4].