PMC9353628_01
Contrast-enhanced CT of the chest and three-dimensional cardiac computed tomography angiography: (A) Atrial septal defect location, ~9 mm in size (blue arrow). (B-D) The right pulmonary artery (red arrow) and right superior pulmonary vein are hypoplastic (white arrow). LA, left atrium; LPA, left pulmonary artery; LPV, left pulmonary vein; LV, left ventricle; RA, right atrium; RPA, right pulmonary artery; RSPV, right superior pulmonary vein; RV, right ventricle.
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F1
CT showed a 9 mm defect in the atrial septum (Figure 1A), a significantly small right pulmonary artery (~5 mm) and a significantly small right superior pulmonary vein (Figures 1B-D), a small and sparsely branched right lung, and the venous of sequestration lung return to the hepatic vein (Figure 2). Considering the patient's young age and inability to tolerate cardiac and pulmonary surgery, isolated pulmonary embolism and atrial septal occlusion were performed under general anesthesia.
Contrast-enhanced CT of the chest: contrast-enhanced CT shows the isolated pulmonary venous draining (red arrow) into the hepatic vein (blue arrow).
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F2
CT showed a 9 mm defect in the atrial septum (Figure 1A), a significantly small right pulmonary artery (~5 mm) and a significantly small right superior pulmonary vein (Figures 1B-D), a small and sparsely branched right lung, and the venous of sequestration lung return to the hepatic vein (Figure 2). Considering the patient's young age and inability to tolerate cardiac and pulmonary surgery, isolated pulmonary embolism and atrial septal occlusion were performed under general anesthesia.
CT 3D reconstruction and Aortic DSA: (A,B) A isolates the pulmonary supplying artery (blue arrow) and the renal artery (red arrow) to the abdominal aorta, and isolates the pulmonary supplying artery by approximately 4 mm. (C) Nine platinum coils were placed in the isolated pulmonary supplying artery (blue arrow), and no contrast agent entered the distal end of the infarct (red arrow). (D) Placement of atrial septal defect occluder (green arrow) under co-guided echocardiography (yellow arrow) and DSA. DAO, decending aorta; RLL, right lower lobe.
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F3
Digital subtraction angiography (DSA) and CT 3D reconstruction (Supplementary Video) showed an abnormal blood vessel branching from the right renal artery opening (~4 mm; Figures 3A-C), and arching toward the right lower lung for blood supply. Under transthoracic ultrasound guidance, a 14 mm atrial septal occluder was placed through the delivery sheath and ascertained to be adequately fixed, with no residual shunt and intact valvular apparatus (Figure 3D).