Malpositioning of Pulmonary Artery Branches

[mshanson]

Our daughter had an echo which states that PA branches are confluent, however the RPA is more anterior than LPA, and are unable to obtain both branch PA's in same plane. No PDA. Slightly elevated cardiac apex noted.

What is the significance of the RPA being more anterior than her LPA.. or is there any?

[Jeffrey R Boris, M.D.]

Your daughter is young enough and small enough that a transthoracic (normal) echo should easily find this.

[mshanson]

Is this something that would be picked up on a normal echo, or would a transesopheogeal echo be better at making sure this is not the case?

[Jeffrey R Boris, M.D.]

Dear MSHanson,

As long as the pulmonary arteries are confluent and there is no compression of any structures in the chest (airway, esophagus, etc.), then this should not cause any significant problems.  Sometimes we can see one branch pulmonary artery arising from the other, in which case it can lead to what is called a pulmonary artery sling.  This is where the airway on the side of the aberrant pulmonary artery can be wrapped by it, which can obstruct it.  I would recommend ensuring that this not the case with your daughter.