Andersons pediatric cardiology 1276
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (133.91 KB, 3 trang )
rightaorticarch(RAA),anelongatedaorticarchcompressesthedistal
trachea.Thefrontalchestradiograph(A)showsanRAA.Theascending
aortaoccupiesafarleftwardpositionintheuppermediastinum.Magnetic
resonanceimageinaxialtransverseplane(B)showsposterior
displacementandnarrowingofthedistaltrachea.NotethattheRAAis
unusuallyelongatedasitconnectsthefarleftwardascendingaortatothe
descendingaortaontherightside.SCV,Superiorcavalvein.
Absentpulmonaryvalvesyndrome,alsoassociatedwithbronchial
compression,ischaracterizedbyseveredilationofthepulmonaryarteriesinthe
mediastinumandthehilumsofthelungs(Fig.47.31).154,155Itismosttypically
associatedwithtetralogyofFallot,andinmostcasesthearterialductisabsent.
Mostpatientspresentearlyinlifewithsevererespiratorydistressduetothe
bronchialcompressionandtracheobronchomalacia.Thelungsaretypically
hyperinflated,withorwithoutscatteredareasofsegmentalorlobarcollapse.
FIG.47.31 Computedtomogramsshowingmildnarrowingoftheright
ventricularoutflowtract(RVO)bytheanteriorlydeviatedoutletseptum
(OS),aventricularseptaldefect(VSD)(A),andmarkedlydilatedcentral
pulmonaryarteries,consistentwithtetralogyofFallotandabsent
pulmonaryvalvesyndrome.Theleftandrightbronchiarecompressedby
therightandleftpulmonaryarteries(B).Reformattedimagesoftheairway
inthecoronalplane(C)showseverenarrowingoftheleftmainbronchus,
withtrappingofairintheleftlung.LPA,Leftpulmonaryartery;LV,left
ventricle;MPA,mainpulmonaryartery;RPA,rightpulmonaryartery;RV,
rightventricle.
Asinvascularringsandslings,alltheserelatedconditionsneedatailored
surgicalapproachandprocedure.Contrast-enhancedcomputedtomographyis
bestsuitedforinvestigationofcriticallyillpatients,whereasmagneticresonance
imagingcanbeusedinolderandlesssymptomaticpatients.
AnnotatedReferences
EdwardsJE.Anomaliesofthederivativesofthe
aorticarchsystem.MedClinNorthAm.
1948;32:925–948.
Inthisseminalpaper,thepioneercardiac
pathologistJesseE.Edwardsintroduceda
hypotheticalmodelofthedoubleaorticarchthat
explainsthemorphogenesisofmostanomalies.
Dodge-KhatamiA,TulevskiII,HitchcockJF,de
MolBA,BenninkGB.Vascularringsand
pulmonaryarterialsling:fromrespiratory
collapsetosurgicalcure,withemphasison
judiciousimaginginthehi-techera.Cardiol
Young.2002;12:96–104.
Thisreviewpaperpresentsanexcellentoverviewof
themorphology,clinicalmanifestations,
diagnosis,andsurgicalapproachestovarious
vascularringsandthepulmonaryarterialsling.
BackerCL,MavroudisC,RigsbyCK,Holinger
LD.Trendsinvascularringsurgery.JThorac
CardiovascSurg.2005;129:1339–1347.
Thisoriginalpaperreviewshowdiagnostic
imaging,operativetechniques,andclinical
outcomesofvascularringshaveevolvedinthe
past60yearsinalargereferralcenter.
AlsenaidiK,GurofskyR,KaramlouT,Williams
WG,McCrindleBW.Managementand
outcomesofdoubleaorticarchin81patients.
Pediatrics.2006;118:e1336–e1341.
Thisoriginalpaperreviewstheclinical
manifestations,associatedcardiacand
noncardiacanomalies,operativetechniques,
andoutcomesinalargecohortofpatientswith
doubleaorticarch.
YooSJ,MinJY,LeeYH,etal.Fetalsonographic
diagnosisofaorticarchanomalies.Ultrasound
ObstetGynecol.2003;22:535–546.
PatelCR,LaneJR,SpectorML,SmithPC.Fetal
echocardiographicdiagnosisofvascularrings.J
UltrasoundMed.2006;25:251–257.
Thesetwopapersillustratethefetal
echocardiographicfindingsofvarious
anomaliesinvolvingtheaorticarches.Inthe
firstpaper,fetalandpostnatalsonographic
findingsarecorrelatedwithmorphogenetic
mechanisms.
MurdisonKA,AndrewsBA,ChinAJ.
Ultrasonographicdisplayofcomplexvascular
rings.JAmCollCardiol.1990;5:1645–1653.
Thisoriginalpaperillustrateshowasuprasternal
sweepcanassistinechocardiographic
evaluation.
