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Bronchial compression by posteriorly displaced ascending aorta in patients with congenital heart disease  Yang Min Kim, MD, Shi-Joon Yoo, MD, Woong Han.

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Presentation on theme: "Bronchial compression by posteriorly displaced ascending aorta in patients with congenital heart disease  Yang Min Kim, MD, Shi-Joon Yoo, MD, Woong Han."— Presentation transcript:

1 Bronchial compression by posteriorly displaced ascending aorta in patients with congenital heart disease  Yang Min Kim, MD, Shi-Joon Yoo, MD, Woong Han Kim, MD, Tae Hoon Kim, MD, Joon Hee Joh, MD, Soo Jin Kim, MD  The Annals of Thoracic Surgery  Volume 73, Issue 3, Pages (March 2002) DOI: /S (01)

2 Fig 1 Reformatted images in an oblique plane perpendicular to right and left main bronchi from 3-month-old boy. Right main bronchus (R) is flattened with decreased anteroposterior dimension and somewhat increased vertical dimension. Left main bronchus (L) is not affected. The Annals of Thoracic Surgery  , DOI: ( /S (01) )

3 Fig 2 Schematic drawing of the axial CT image at the level of the main stem bronchi for measurement of control patients (left panel) and schematic drawing for comparison with patients who have posterior malpositioning of ascending aorta (right panel). (a = depth of retrosternal space [distance between posterior margin of sternum and anterior margin of ascending aorta]; b = aortospinal distance [distance between posterior margin of ascending aorta and anterior margin of spine]; c = interaortic distance [distance between posterior margin of ascending aorta and anterior margin of descending aorta]; d = sternospinal distance [distance between posterior margin of sternum and anterior margin of spine]; AA = ascending aorta; DA = descending aorta; LB = left main bronchus; RPA = right pulmonary artery; Sp = spine; St = sternum.) The Annals of Thoracic Surgery  , DOI: ( /S (01) )

4 Fig 3 Box plot showing differences in indices between patients and control group. (Ao = ascending aortic size divided by sternospinal distance; AS = aortospinal distance index [b/d in Fig 2]; IA = interaortic distance index [c/d in Fig 2]; RS = retrosternal space index [a/d in Fig 2]; 1 = patient group; 2 = control group.) The Annals of Thoracic Surgery  , DOI: ( /S (01) )

5 Fig 4 Computed tomogram from an 8-year-old girl with ventricular septal defect. (A) Transverse CT scan shows posteriorly displaced ascending aorta (AA). Left main bronchus (arrow) is squeezed into narrow space between ascending and descending aortas (DA). A portion of right ventricle (RV) is seen in front of the ascending aorta. (B) Reformatted image along right pulmonary artery shows posteriorly displaced right pulmonary artery (R) by ascending aorta (AA). Right pulmonary artery also passes through interaortic space and is narrowed in an anteroposterior direction (arrow). The Annals of Thoracic Surgery  , DOI: ( /S (01) )

6 Fig 5 Reformatted image from 15-month-old boy with patent ductus arteriosus. Curved planar reformatted image along right bronchus-carina (c)-left bronchus shows diffuse stenosis of left main bronchus (arrow). Ascending aorta (AA) is displaced posteriorly toward descending aorta (DA) and spine (sp). The Annals of Thoracic Surgery  , DOI: ( /S (01) )

7 Fig 6 Three-dimensional images from a 3-month-old boy with double-outlet right ventricle and pulmonary atresia in right aortic arch before (A) and after (B, C, and D) corrective surgery. (A) Anterior view of surface rendered image of central airway before surgery shows flattening of right main bronchus with a somewhat increased vertical dimension (arrow). (B) Anterior view of surface rendered image obtained after surgery shows severe stenosis of right main bronchus and bronchus intermedius. Bronchial lumen is completely obliterated along its medial wall due to kissing of the anterior and posterior walls of the bronchus (asterisk). (C) Maximal intensity projection image in the axial direction. Ascending aorta (AA) is posteriorly displaced, and right middle lung (RM) is herniated to left side in front of ascending aorta. Right pulmonary artery (R) and a major collateral artery (M) to the right lung pass through the space between the ascending and descending aorta (DA). (D) Curved reformatted image along the right bronchus-carina (c)-left bronchus demonstrates that part of the right bronchus (arrow) is compressed between them. Superior segment of right lower lung (RL) is collapsed. The Annals of Thoracic Surgery  , DOI: ( /S (01) )

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