Evaluation of malposition of the branch pulmonary arteries using cardiovascular computed tomography angiography.

OBJECTIVES: To analyze 15 cases of malposition of branch pulmonary arteries (MBPA) for the hospital-based prevalence, clinical information, surgical outcome, imaging findings, associated cardiovascular and airway abnormalities on cardiovascular computed tomography angiography (CCTA).

METHODS: We retrospectively searched for patients with MBPA from our database consisting of patients referred for CCTA due to known or suspected congenital heart disease and also from all patients receiving chest computed tomography (CT) during the same time period. We analyzed the hospital-based prevalence, image findings, associated cardiovascular anomalies, airway compression, and recorded the clinical information and surgical outcome.

RESULTS: Our study showed 15 patients with MBPA (hospital-based prevalence: 0.33% among patients with congenital heart disease and 0.06% in all patients receiving chest CT or CCTA). Classic type was more common than lesser type (67% versus 33%). All patients had associated cardiovascular anomalies, including aortic arch abnormalities (80%) and secondary airway compression (33%). Surgery was performed in 67% of cardiovascular anomalies and 60% of airway stenoses.

CONCLUSIONS: MBPA has a hospital-based prevalence of 0.33% among patients with congenital heart disease and 0.06% in all patients receiving either chest CT or CCTA. CCTA can delineate the anatomy of MBPA, associated cardiovascular and airway abnormalities for preoperative evaluation.

KEY POINTS: MBPA has a hospital-based prevalence of 0.33% among congenital heart disease patients. Classic type of MBPA was more common than lesser type. All MBPA patients had associated cardiovascular anomalies, 33% had secondary airway compression. CCTA delineates the anatomy of MBPA, associated cardiovascular and airway abnormalities. CCTA is beneficial in MBPA for preoperative evaluation and planning.