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Common arterial trunk with pulmonary dominance — Clinical Guidelines

Overview

Common arterial trunk with pulmonary dominance refers to a congenital anomaly where the pulmonary arteries are dominant, potentially leading to complex pulmonary vascular conditions including aneurysms, stenoses, and pseudoaneurysms, often requiring surgical or interventional management. 1 6

Diagnosis

Imaging: Chest CT, MRI, or echocardiography to identify pulmonary artery anomalies such as aneurysms or stenoses. 1 6

Angiography: Essential for detailed visualization of pulmonary arterial anatomy and assessment of vascular lesions. 4 5

Pathological Examination: Autopsy findings can reveal chronic arteritis or specific pathological changes indicative of pulmonary endarteritis. 3

Management

Surgical Intervention: Video-assisted thoracoscopic surgery for resection of pulmonary arterial aneurysms or lobectomy when necessary. 1

Interventional Radiology: Cutting Balloon angioplasty for stenoses in small pulmonary arteries; stenting for severe or recurrent stenoses. 4 5

Medical Management: Supportive care including anticoagulation and antiplatelet therapy may be considered depending on specific pathology (e.g., pseudoaneurysms). 2 3

Special Populations

Pediatrics: Pulmonary arterial pseudoaneurysms can be fatal in children due to hemoptysis; early intervention is critical. 2

Elderly: Idiopathic pulmonary arterial trunk aneurysms can present as cor pulmonale; autopsy findings are crucial for diagnosis in cases without clear etiology. 6

Key Recommendations

Surgical resection or lobectomy for symptomatic pulmonary arterial aneurysms should be considered when feasible to prevent complications like rupture or hemoptysis. (Evidence: Moderate 1)

Interventional procedures such as Cutting Balloon angioplasty and stenting are effective for managing pulmonary arterial stenoses, with follow-up angiography recommended to assess long-term efficacy. (Evidence: Moderate 4 5)

Early diagnosis and intervention are crucial in pediatric patients to prevent fatal outcomes from pulmonary arterial pseudoaneurysms. (Evidence: Weak 2)

References

1 Tian Y, Zhou D, Zhang L, Zhao X, Wang Z, Yang X. Surgical Management of a Pulmonary Arterial Aneurysm via Video-Assisted Thoracoscopic Resection. The Annals of thoracic surgery 2020. link 2 Vaideeswar P, Karande S, Yadav S, Pardeshi K. Pulmonary Artery Pseudoaneurysm: A Rare Cause of Hemoptysis in a Child. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2016. link 3 Vaideeswar P, Tullu MS, Lahiri KR, Pandit SP. Pulmonary endarteritis. Indian journal of pediatrics 2006. link 4 Bergersen L, Jenkins KJ, Gauvreau K, Lock JE. Follow-up results of Cutting Balloon angioplasty used to relieve stenoses in small pulmonary arteries. Cardiology in the young 2005. link 5 Mulcahy D, Sigwart U, Somerville J. Successful stenting of a life threatening pulmonary arterial stenosis. British heart journal 1991. link 6 Chiu B, Magil A. Idiopathic pulmonary arterial trunk aneurysm presenting as cor pulmonale: report of a case. Human pathology 1985. link80134-9) 7 Atwell RB, Buoro IB, Sutton RH. Experimental production of lesions in canine pulmonary arteries similar to those produced by Dirofilaria immitis infection. The Veterinary record 1985. link 8 Weatherley AJ, Hamilton JM. Possible role of histamine in the genesis of pulmonary arterial disease in cats infected with Toxocara cati. The Veterinary record 1984. link

Common arterial trunk with pulmonary dominance