Bifurcation or periphery: Where should aberrant arteries in pulmonary sequestration be divided?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Imaging

Background:

• Pulmonary sequestration involves aberrant arteries, with debate on optimal surgical division points.
• Dividing aberrant arteries at the bifurcation is often preferred to prevent postoperative aneurysm and fetal bleeding.

Observation:

• A 35-year-old woman presented with persistent cough and was diagnosed with right lower lobe pulmonary sequestration.
• Enhanced computed tomography (CT) revealed an aberrant artery originating from the left gastric artery supplying the sequestration.
• The aberrant artery was divided at the pulmonary ligament level, followed by right lower lobectomy.

Findings:

• Postoperative enhanced CT at four months showed spontaneous occlusion of the residual aberrant artery.
• This case challenges the necessity of dividing aberrant arteries strictly at the bifurcation in pulmonary sequestration.

Implications:

• Resection at the pulmonary ligament level may be a safe and effective alternative for managing aberrant arteries in pulmonary sequestration.
• Further research may identify specific patient characteristics that allow for less extensive arterial resection, simplifying surgical procedures and potentially reducing complications.