Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta with Aortic Coarctation

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Two neonates were treated for a combination of a distal type of anomalous origin of the right pulmonary artery from the ascending aorta and aortic coarctation. Aortic arch reconstruction was performed using an extended aortic arch anastomosis in both cases. In the first case, the right pulmonary artery was reconstructed by a direct anastomosis behind the ascending aorta. Early reoperation for graft interposition was required to treat stenosis at the proximal right pulmonary artery due to a residual ductal tissue there. In the second case, such ductal tissues were sufficiently resected at the initial repair, and the right pulmonary artery was reconstructed using an artificial graft anterior to the ascending aorta. As aortic arch reconstruction for aortic coarctation reduces the space posterior to the ascending aorta, an appropriate route should be considered sensibly for the right pulmonary artery to be reconstructed.