Visualization of the pulmonary arteries in pseudotruncus by pulmonary vein wedge angiography.
Authors: M R Nihill, C E Mullins, D G McNamara
Journal: Circulation (1978)

Pulmonary venous wedge angiography revealed the anatomy of the mediastinal and parenchymal pulmonary arteries in 22 patients with obstruction of the right ventricular outflow tract, proximal pulmonary arteries or branch pulmonary arteries, when conventional angiographic methods had failed.Nine of these patients had pseudotruncus-type anatomy and had no previous surgery.One pulmonary artery was not visualized in 13 of the 22 patients because of postoperative occlusion in 10, congenital "absence" of the left pulmonary artery in two, and suspected sequestration of the left lower lobe in one.Retrograde pulmonary wedge angiograms were obtained by weding an end-hole catheter in a pulmonary vein and slowly injecting, by hand, 0.2 to 0.45 ml/kg of contrast material followed by a flush of dextrose solution (1-2 ml/kg).In seven of the nine patients without previous surgery, the confluence of the pulmonary arteries in the mediastinum could be seen clearly by this method.Nine patients had a previous systemic-to-pulmonary anastomosis, and only the ipsilateral pulmonary arteries were visualized by aortography.Venous wedge angiography filled the pulmonary arteries of the nonopacified lung up to the point of obstruction in the mediastinum in each patient.Eight patients were able to have a systemic-to-pulmonary shunt because of the visualization of the previously unseen pulmonary arteries.We conclude that pulmonary venous wedge angiography is a valuable adjunct to the current angiographic methods of in- vestigating patients with pulmonary atresia and related conditions.In some cases, it may be the only way to determine the presence of surgically accessible pulmonary arteries.RECENTLY, OPERATIONS have been devised to repair main pulmonary artery atresia associated with ventricular septal defect (pseudotruncus arteriosus), as well as similar conditions in which the pulmonary artery branches are discontinuous with the right ven- tricle."' 2 The diagnosis of pulmonary atresia covers a range of anomalies, including 1) atresia of the right ventricular outflow tract and pulmonary valve; 2) atresia of the proximal main pulmonary artery; 3) atresia of the pulmonary valve and entire pulmonary artery with well-formed right and left branches which are connected at the bifurcation; 4) the same as #3, except that the right and left pulmonary arteries are discontinuous; 5) the same as #4, except for atresia of the proximal portion of either the left or right pulmonary artery, and 6) the same as #4, except for atresia of the proximal portion of both the right and left pulmonary arteries.34 In each of these situations, blood reaches the pulmonary artery branches and the capillary bed of the lung by way of a ductus arteriosus, bronchial arteries or systemic collateral arteries from the descending aorta.Aortic origin of the true pulmonary arteries usually results in systemic pressure in these arteries.In the several forms of pulmonary atresia, however, there is a low pressure and usually a low blood flow in the pulmonary artery distal to the systemic connections.Successful repair or palliation of patients with