Partial Anomalous Left Pulmonary Artery Anterior Versus Posterior Types: A Systematic Review

Area of Science:

• Medical Imaging
• Pediatric Cardiology
• Thoracic Surgery

Background:

• Partial anomalous left pulmonary artery (PALPA) is a rare congenital anomaly.
• Understanding the anatomical variations and clinical implications of PALPA is crucial for diagnosis and management.
• The relationship between the anomalous vessel's course and tracheobronchial tree compression requires further investigation.

Purpose of the Study:

• To investigate the features of partial anomalous left pulmonary artery (PALPA).
• To compare anterior versus posterior anomalous vessel courses in relation to the tracheobronchial tree.
• To determine if the course of the anomalous vessel influences airway compression and clinical presentation.

Main Methods:

• Retrospective analysis of 35 PALPA cases (33 from literature, 2 from institutional files).
• Data collected included age, sex, medical history, co-occurring anomalies, vessel course, and respiratory symptoms.
• Statistical analysis using independent samples t-test and Fisher's exact test.

Main Results:

• PALPA cases were more frequently anterior than posterior.
• Posterior PALPA cases exhibited a significantly higher prevalence of respiratory symptoms (60%) compared to anterior cases (20%; p=0.032).
• No significant differences were found in age, tracheobronchial anomalies, non-cardiac/non-tracheobronchial anomalies, or Kabuki syndrome prevalence between anterior and posterior types.

Conclusions:

• The course of the anomalous vessel in PALPA is not significantly associated with age or other anomalies.
• Respiratory symptoms represent the only statistically significant difference between anterior and posterior PALPA.
• Posteriorly coursing anomalous vessels in PALPA are more likely to be associated with respiratory symptoms.