ABC | Volume 114, Nº4, Suplement, April 2020

Clinicoradiological Correlation Atik et al. Origin of right pulmonary artery from ascending aorta and pulmonary atresia in an adult Arq Bras Cardiol 2020; 114(4Suppl.1):43-46 Differential diagnosis: Other heart diseases that accompany interventricular communication and pulmonary atresia show other features that differentiate them in the usual complementary exams, such as the double inlet left or right ventricle, in atrioventricular valve atresia, corrected transposition of the great arteries and in rarer diseases. The contrasts in the two pulmonary circulations, more marked on the right and reduced on the left, could orient towards the presence of stenosis on this side and hyperflow due to collateral circulation on the other side. However, in this condition there would be a clear continuous murmur, mainly at the right back. Thus, origin of the right pulmonary artery from the ascending aorta could be clinically considered, even before the anatomical diagnosis. Figure 1 – Chest X-ray showing enlarged cardiac area with left ventricular dominance and increased pulmonary vascular network in the right hila, with a reduction towards the lower lobe. It is reduced to the left with thinner blood vessels. Electrocardiogram shows right cavity overload and diffuse ventricular repolarization changes. Conduct: Despite the balance of the pulmonary and systemic flows over time, with signs of hypoxemia and myocardial dysfunction, the need to increase pulmonary flow to improve quality of life with better physical tolerance is presumed. In face of the anatomical complexity, right-sided pulmonary artery hypertension and biventricular dysfunction, the consideration of the expectant conduct was not ruled out, despite the development risks involved. Comments: The natural evolution of this patient until the adult age highlights unfavorable elements, related to right- sided pulmonary vascular disease, given the anomalous origin of the right pulmonary artery from the ascending aorta, with clear transmission of systemic blood pressure. Furthermore, 44