From the Guidelines
Confluent pulmonary arteries are a normal anatomical finding, indicating a proper connection between the main pulmonary artery and its branches, allowing for normal blood flow to both lungs. This term is often used in medical reports to confirm the normalcy of the pulmonary arterial anatomy, especially in the context of evaluating congenital heart defects or other conditions that may affect the pulmonary arteries. In the context of pulmonary atresia with VSD, as discussed in the 2010 ESC guidelines for the management of grown-up congenital heart disease 1, confluent pulmonary arteries are one of the patterns of pulmonary artery anatomy, specifically the unifocal type with good size PAs supplied by a PDA. However, the most recent and relevant guidelines for pulmonary hypertension, such as the 2015 ESC/ERS guidelines 1 and the 2017 ACR Appropriateness Criteria for suspected pulmonary hypertension 1, do not directly address the normalcy of confluent pulmonary arteries but focus on the diagnosis and treatment of pulmonary hypertension. Given the information available, the presence of confluent pulmonary arteries is considered a normal finding and does not require treatment, as it represents the expected anatomical state of the pulmonary arteries in healthy individuals. It's essential to note that the term "confluent" in this context refers to the anatomical connection and not the function or pressure within the pulmonary arteries, which are critical factors in diagnosing and managing conditions like pulmonary hypertension. In clinical practice, when a medical report mentions "confluent pulmonary arteries," it is confirming the normal anatomy of the pulmonary arterial system, which is crucial for distinguishing between normal variants and pathological conditions that may require medical or surgical intervention. The key point is that confluent pulmonary arteries are a normal anatomical finding and should not be a cause for concern in the absence of other symptoms or findings suggestive of pulmonary hypertension or other cardiovascular diseases.
From the Research
Definition of Confluent Pulmonary Arteries
- Confluent pulmonary arteries refer to a condition where the pulmonary arteries are connected and form a continuous channel, allowing for blood flow from the right ventricle to the lungs 2, 3, 4, 5.
- This condition is often seen in patients with congenital heart defects, such as tetralogy of Fallot with pulmonary atresia, where the pulmonary arteries may be underdeveloped or absent 3, 5.
Normalcy of Confluent Pulmonary Arteries
- Confluent pulmonary arteries are not always a normal finding, as they can be associated with various congenital heart defects and may require surgical intervention 2, 3, 4, 5.
- However, in some cases, confluent pulmonary arteries may be a normal variant, particularly if they are not associated with any other cardiac anomalies 4.
- The presence of confluent pulmonary arteries can also be influenced by the underlying anatomy of the pulmonary circulation, such as the presence of a main pulmonary trunk or major aortopulmonary collateral arteries 5.
Clinical Significance
- The presence of confluent pulmonary arteries can have important implications for surgical management and outcome in patients with congenital heart defects 2, 3, 4, 5.
- Patients with confluent pulmonary arteries may have a better outcome than those with non-confluent pulmonary arteries, particularly in terms of actuarial survival and freedom from reintervention 2.
- However, the clinical course and disease burden of patients with confluent pulmonary arteries can vary widely, depending on the underlying anatomy and presence of other cardiac anomalies 5.