Anatomic identification of so-called absent pulmonary artery.

A postmortem study was done on 18 cases in which, clinically, there was "absence" of one or both pulmonary arteries.When no channel led from the right ventricle to a pulmonary artery, the involved vessel was said to be absent.Classic examples of pseudotruncus arteriosus were not included, nor were the usual varieties of persistent truncus arteriosus.In seven of 18 cases the pulmonary trunk was patent and gave rise either to the left or right pulmonary artery.In this group, with the ex- ception of one case of agenesis of the left lung and left pulmonary artery, the absent artery was present and arose from the ascending aorta or aortic arch, the latter modes of origin considered to be "distal ductal origin."IN THE CLINICIAN'S STUDY of cyanotic or acyanotic patients with cardiovascular disease, there appears an oc- casional instance in which angiographic study of the lesser circulation indicates that one or both pulmonary arteries fail to be supplied by the right ventricle.'Such arteries are sometimes designated as "absent."Further study may in- dicate either that the "absent" artery or arteries originate from the systemic arterial system or that no such origin is demonstrable.2In the latter instance, the "absent" artery may be considered in fact to be absent.Recent studies using roentgenologic subtraction technique by Drs.Richard E. Fulton and George D. Davis,3 and Donald G. Ritter and others4 of the Mayo Clinic group have indicated that when in ordinary studies a pulmonary artery is considered to be truly absent, it is in fact present and patent at the pulmonary hilus.Such a situation identifies the potential for the es- tablishment, by surgical means, of a channel from the right ventricle to the "absent" pulmonary artery or arteries.With this hypothesis as a background, we studied from the Cardiovascular Registry of the United Hospitals-Miller Division the 18 specimens in which there was "absence" of one or both pulmonary arteries and in which the heart, thoracic aorta and lungs had been saved.Not included in this series were classical cases of the tetralogy of Fallot with pulmonary atresia localized either to the right ventricular in- fundibulum or the level of the pulmonary valve while the pulmonary trunk above valve level was patent (so-called pseudotruncus arteriosus).Our autopsy studies showed that, with one exception,