Abstract
The article summarizes world experience with diagnosis and surgical treatment of congenital heart diseases associated
with crisscross pulmonary arteries.
Criss-cross pulmonary arteries are a rare congenital pathology characterized by anomalous origin of the pulmonary
arteries from the pulmonary trunk, when the right and the left pulmonary arteries intercross in their way
to the corresponding (cognominal) lungs. As a rule, the pulmonary arteries are situated at the posterior wall of the
pulmonary trunk, with left pulmonary artery ostium being on the right of and above the right pulmonary artery
ostium.
The available world literature presents 33 cases of criss-cross pulmonary arteries. In 32 cases criss-cross pulmonary
arteries were associated with various congenital cardiovascular diseases, one patient had crisscross pulmonary
arteries without concomitant congenital heart disease. At admission, the median of the age of patients with crisscross
pulmonary arteries was 9 days, in 85% of cases the patients were under 1 year of age.
Anomalous origin and relationship of criss-cross pulmonary arteries do not cause hemodynamic disturbances and
respiratory pathways obstruction, as with this anomaly the left pulmonary artery passes in front of the trachea and
the esophagus.
Unfavorable prognosis of natural course in some patients with crisscross pulmonary arteries is related to frequent
association of this anomaly with complex congenital cardiac and vascular diseases, hereditary and chromosomal
diseases.
With current diagnostic methods intravital diagnosis of criss-cross pulmonary arteries is feasible. Diagnostic tools
for this anomaly include echocardiography, angiocardiography, multislice computed and magnetic resonance
tomography.
World experience with surgical correction of concomitant congenital cardiac and vascular diseases includes
16 patients with criss-cross pulmonary arteries. Eleven of these patients underwent complete repair, in 1 case a bidirectional
cavapulmonary anastomosis has been created. Another 4 patients with complex congenital cardiovascular
diseases underwent the first stage of multistage surgical management. Total hospital mortality was 6.2%
(1/16).
References
Подзолков В. П., Иваницкий А. В., Махачев О. А. и др. Врожденный порок сердца, сочетающийся с criss-cross легочными артериями // Грудная и серд.-сосуд. хир. 1995. №5. С. 74-77.
Babaoglu K., Binnetoglu F. K., Altun G. et al. Echcardiographic and three-dimensional computed tomographic diagnosis of crossed pulmonary arteries: report of three cases // Pediatr. Cardiol. 2010. Vol. 31, № 5. P. 720-722.
Becker A. E., Becker M. J., Edwards J. E. Malposition of pulmonary arteries (crossed pulmonary arteries) in persistent truncus arteriosus // Am. J. Roentgenol. Radium. Ther. Nucl. Med. 1970. Vol. 110, № 3. P. 509-514.
Butto F., Lucas R. V., Edwards J. E. Persistent truncus arteriosus: pathologic anatomy in 54 cases // Pediatr. Cardiol. 1986. Vol. 7, № 2. P. 95-101.
Chaturvedi R., Mikailian H., Freedom R. M. Crossed pulmonary arteries in tetralogy of Fallot // Cardiol. Young. 2005. Vol. 15. P. 537.
Chen B. B., Hsieh H. J., Chiu I. S. et al. Crossed pulmonary arteries: report of two cases with emphasis on tree-dimensional helical computed tomographic imaging // J. Formos. Med. Assoc. 2008. Vol. 107, № 3. P. 265-269.
Collett R. W., Edwards Y. E. Persistent truncus arteriosus. A classification according to anatomic subtypes // Surg. Chin. North Am. 1949. Vol. 29. P. 1245.
Ho S. Y., Wilcox B. R., Anderson R. H., Lincoln J. C. R. Interrupted aortic arch - anatomical features of surgical significance // Thorac. Cardiovasc. Surgeon. 1983. Vol. 31. P. 199-205.
Jue K. L., Lockman L. A., Edwards J. E. Anomalous origins of pulmonary arteries from pulmonary trunk («crossed pulmonary arteries»): observation in a case with 18 trisomy syndrome // Am. Heart Journal. 1966. Vol. 71, № 6. P. 807-812.
Koca B., Oztunз F., Yalзin Y. Crossed pulmonary arteries in conjunction with tetralogy of Fallot // Turk. Kardiyoloji Dernegi arsivi Turk. Kardiyoloji Derneginin yayin organidir. 2011. Vol. 39, № 6. P. 499-500.
Miyahara Y., Kataoka K., Kawada M. Crossed pulmonary arteries associated with interruption of aortic arch on threedimensional computed tomographic imaging // Ann. Thorac. Surg. 2011. Vol. 91. P. 929.
Recto M. R., Parness I. A., Gelb B. D. et al. Clinical implications and possible association of malposition of the branch pulmonary arteries with DiGeorge syndrome and microdeletion of chromosomal region 22q11 // Am. J. Cardiology. 1997. Vol. 80. P. 1624-1627.
Shunmugasundaram P., Bijual S., Titus T., Tharakan J. A. Criss-cross pulmonary artery with double aortic arch: an unusual association // Pediatr. Cardiol. 2012. Vol. 33, № 5. P. 857-858.
Sivakumar K., Prasad R., Francis E. Crossed pulmonary arteries // Cardiol. Young. 2007. Vol. 17. P. 572-573.
Siwik E. S., Everman D., Morrison S. Crossed pulmonary arteries, ventricular septal defect, and chromosome 22q11 deletion // Heart. 2002. Vol. 88. P. 88.
Van Praagh R., Van Praagh S. The anatomy of common aortic- pulmonary trunk (Truncus Arteriosus communis) and its embryonic implications. A study of 57 necropsy cases // Am. J. Cardiol. 1965. Vol. 16. P. 406-425.
Van Praagh R., Bernhard W. F., Parisi L. F., Fyler D. C. Interrupted aortic arch: surgical treatment // Am. J. Cardiol. 1971. Vol. 27. P. 200-211.
Wells T. R., Takahashi M., Landing B. H. et al. Branching patterns of right pulmonary artery in cardiovascular anomalies // Pediatr. Pathol. 1993. Vol. 13, № 2. P. 213-223.
Wolf W. J., Casta A., Nichols M. Anomalous origin and malposition of the pulmonary arteries (criss-cross pulmonary arteries) associated with complex congenital heart disease // Pediatr. Cardiol. 1986. Vol. 6. P. 287-291.
Xiong Y., Gan H. J., Liu T. et al. Prenatal diagnosis of crossed pulmonary arteries // Ultrasound Obstet. Gynecol. 2010. Vol. 36, № 6. P. 776-777.
Zimmerman F. J., Berdusis K., Wright K. L., Alboliras E. T. Echocardiographic diagnosis of anomalous origins of the pulmonary arteries from the pulmonary trunk (crossed pulmonary arteries) // Am. Heart. J. 1997. Vol. 133. P. 257-262.
