Helmbrecht et al. was the first to report a case of pulmonary artery dissection (PAD) in 1842 (1). A recent literature review reported 150 cases of patients with PAD (1), but all were concentrated on adults. Here, we report two cases of young infants diagnosed with PAD. Surgical treatment was performed concurrently, and good results were achieved.

PAD was once considered to be a rare disease with a high fatality rate (2). However, reports were all concentrated among adults r, and there was no specific report on PAD in young infants.

The majority of PADs occurs in the presence of medial degeneration with fragmentation of elastic fibers and generalized dilatation of the pulmonary arterial tree caused by chronic pulmonary hypertension (3). In a small number of cases, PAD may occur in the site of local aneurysm formation. Aneurysms are most commonly associated with congenital heart disease that causes persistently high pulmonary flow velocity and pulmonary hypertension, and, especially, hemodynamic changes caused by persistent arterial ducts, leading to increased pulmonary blood flow, increased intravascular pressure, and increased wall stress (3). We reported two patients who were both infants and had no pulmonary hypertension and other underlying diseases. Closed ductus arteriosus was seen during the operation, considering that PAD may be related to continuous acceleration of blood flow at the ductus arteriosus during the fetal period that led to increased intravascular pressure and tearing of the intima. The postoperative pathology shows that the membrane is separating and further confirms this conjecture. The pathological section showed presence of hemosiderin and calcification in the diseased tissue, indicating that the formation of the diseased tissue took a long time. It is further speculated that the formation of PAD may be related to PDA during the fetal period.

Adults with PAD most often present with chest pain, dyspnea, and hemoptysis (2). Unlike in adults, PAD in young infants usually manifests as recurring pneumonia. The two patients we reported came to the hospital for recurring pneumonia. The first infant we reported underwent CT examination. However, because of rare experience in diagnosing PAD in young infants, radiologists finally considered it as a space-occupying lesion, but the nature of the lesion is unclear. At the same time, an MRI examination was also performed to confirm the diagnosis. The final diagnosis of the MRI was hematoma or mural thrombus. However, in the end, the patient was diagnosed with PAD, which was further confirmed by intraoperative findings and postoperative pathology. Although CT is considered the best method for diagnosing PAD (2), for PAD in young infants, MRI can provide more information through a multi-level comparison. At the same time, compared to CT examinations, MRI examinations can avoid the use of contrast agents on young infants.

In our report, the lesions in the two infants were present in the trunk of the pulmonary artery to the start of the left pulmonary artery. For the first infant, the anterior wall of the diseased pulmonary artery was removed, and an autologous pericardial patch was used for pulmonary angioplasty. Although the postoperative review showed that the operation was good, the left pulmonary artery was still narrower than usual. Considering that infants are in the stage of growth and development, PAD compresses the left pulmonary artery, resulting in long-term obstruction of blood flow to the left pulmonary artery, which further affects the development of pulmonary blood vessels. Eventually, it causes irreversible stenosis of the left pulmonary artery. The same procedure used for the first infant was adopted for the second infant. At the same time, we completely freed the left pulmonary artery and used a pericardial patch to expand the left pulmonary artery to the left hilum. The postoperative review revealed that the second patient had no left pulmonary artery stenosis. Because there is no previous report on surgical methods for infants with PAD, our center has reported on a surgical procedure for infants with PAD. We suggest that using an autologous pericardium patch is feasible to expand the pulmonary artery for PAD in young infants. At the same time, for the left and right pulmonary artery branches with lesions, although lesions only exist at the start of the left or the right pulmonary artery, full-segment expansion of the pulmonary artery branch should be performed during surgery to avoid left or right pulmonary stenosis.

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

CR wrote the manuscript. ZY, HY, and LZ helped in the clinical case analysis. All the authors contributed in the care, diagnosis, and treatment of the patients.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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