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European Journal of Cardio-thoracic... Feb 2022Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the...
OBJECTIVES
Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations.
METHODS
From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented.
RESULTS
Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole.
CONCLUSIONS
The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.
Topics: Heart Defects, Congenital; Heart Ventricles; Humans; Pulmonary Artery; Reoperation; Truncus Arteriosus, Persistent
PubMed: 34347066
DOI: 10.1093/ejcts/ezab336 -
European Journal of Cardio-thoracic... Jul 2022We successfully performed left-to-right rotated single lung transplants in 2 patients. For this procedure, the left pulmonary artery of the donor undergoes a U-shaped...
We successfully performed left-to-right rotated single lung transplants in 2 patients. For this procedure, the left pulmonary artery of the donor undergoes a U-shaped turn with A3 at the bottom to anastomose with the recipient's right pulmonary artery in front of the bronchus. It is extremely important to avoid kinking the pulmonary artery at the site of the U-shaped turn.
Topics: Bronchi; Humans; Lung; Lung Transplantation; Pulmonary Artery; Tissue Donors
PubMed: 35894664
DOI: 10.1093/ejcts/ezac369 -
Multimedia Manual of Cardiothoracic... Oct 2021This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port....
This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port. The procedure begins with division of the inferior pulmonary ligament and isolation of the inferior pulmonary vein. This patient has densely adherent interlobar nodes, which are then dissected to demonstrate the interlobar pulmonary artery. Then we proceed to divide the anterior part of the fissure after identifying and safeguarding the lingular branches of the pulmonary artery. This step is followed by the division of the posterior part of the fissure after identification of the posterior branches of the pulmonary artery to the upper lobe. Then we identify the basilar trunk and divide it using endostaplers. Other branches of the interlobar artery are clearly identified, and the apicobasal artery is taken separately. This is followed by division of the inferior pulmonary vein and a systematic mediastinal nodal dissection.
Topics: Humans; Lung; Lung Neoplasms; Pneumonectomy; Pulmonary Artery; Thoracic Surgery, Video-Assisted
PubMed: 34705352
DOI: 10.1510/mmcts.2021.057 -
Clinical Imaging 2016A broad spectrum of pulmonary arterial disorders can be diagnosed on computed tomography (CT). Comprehensive evaluation of the pulmonary arteries requires careful... (Review)
Review
A broad spectrum of pulmonary arterial disorders can be diagnosed on computed tomography (CT). Comprehensive evaluation of the pulmonary arteries requires careful assessment of their configuration, patency, and size. This article presents an organized approach to pulmonary arterial disorders on CT, with particular attention to characteristic CT findings that aid in accurate diagnosis and proper management.
Topics: Algorithms; Humans; Male; Pulmonary Artery; Tomography, X-Ray Computed; Vascular Diseases
PubMed: 27618804
DOI: 10.1016/j.clinimag.2016.08.015 -
Circulation Jan 2015
Review
Topics: Aneurysm; Animals; Humans; Pulmonary Artery
PubMed: 25601950
DOI: 10.1161/CIRCULATIONAHA.114.012907 -
Seminars in Cardiothoracic and Vascular... Dec 2020The superior cavopulmonary connection (SCPC) or "bidirectional Glenn" is an integral, intermediate stage in palliation of single ventricle patients to the Fontan... (Review)
Review
The superior cavopulmonary connection (SCPC) or "bidirectional Glenn" is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.
Topics: Anesthesia; Fontan Procedure; Heart Ventricles; Humans; Pulmonary Artery
PubMed: 32646291
DOI: 10.1177/1089253220939361 -
Antioxidants & Redox Signaling Nov 2019Pulmonary arterial hypertension (PAH) is a progressive disease of the lung vasculature characterized by the proliferation of all vascular wall cell types, including... (Review)
Review
Pulmonary arterial hypertension (PAH) is a progressive disease of the lung vasculature characterized by the proliferation of all vascular wall cell types, including endothelial, smooth muscle, and fibroblasts. The disease rapidly advances into a form with extensive pulmonary vascular remodeling, leading to a rapid increase in pulmonary vascular resistance, which results in right heart failure. Most current research in the PAH field has been focused on the late stage of the disease, largely due to an urgent need for patient treatment options in clinics. Further, the pathobiology of PAH is multifaceted in the advanced disease, and there has been promising recent progress in identifying various pathological pathways related to the late clinical picture. Early stage PAH still requires additional attention from the scientific community, and although the survival of patients with early diagnosis is comparatively higher, the disease develops in patients asymptomatically, making it difficult to identify and treat early. There are several reasons to focus on the early stage of PAH. First, the complexity of late stage disease, owing to multiple pathways being activated in a complex system with intra- and intercellular signaling, leads to an unclear picture of the key contributors to the pathobiology. Second, an understanding of early pathophysiological events can increase the ability to identify PAH patients earlier than what is currently possible. Third, the prompt diagnosis of PAH would allow for the therapy to start earlier, which has proved to be a more successful strategy, and it ensures better survival in PAH patients.
Topics: Animals; Hemolysis; Humans; Inflammation; Oxidative Stress; Pulmonary Arterial Hypertension; Pulmonary Artery; Signal Transduction
PubMed: 31169021
DOI: 10.1089/ars.2018.7673 -
EuroIntervention : Journal of EuroPCR... Oct 2019Pulmonary arterial hypertension is a devastating disease characterised by pulmonary vascular remodelling and right heart failure. Radio-frequency pulmonary artery...
AIMS
Pulmonary arterial hypertension is a devastating disease characterised by pulmonary vascular remodelling and right heart failure. Radio-frequency pulmonary artery denervation (PDN) has improved pulmonary haemodynamics in preclinical and early clinical studies; however, denervation depth is limited. High-frequency non-focused ultrasound can deliver energy to the vessel adventitia, sparing the intima and media. We therefore aimed to investigate the feasibility, safety and efficacy of ultrasound PDN.
METHODS AND RESULTS
Histological examination demonstrated that innervation of human pulmonary arteries is predominantly sympathetic (71%), with >40% of nerves at a depth of >4 mm. Finite element analysis of ultrasound energy distribution and ex vivo studies demonstrated generation of temperatures >47ºC to a depth of 10 mm. In domestic swine, PDN reduced mean pulmonary artery pressure induced by thromboxane A2 in comparison to sham. No adverse events were observed up to 95 days. Histological examination identified structural and immunohistological changes of nerves in PDN-treated animals, with sparing of the intima and media and reduced tyrosine hydroxylase staining 95 days post procedure, indicating persistent alteration of the structure of sympathetic nerves.
CONCLUSIONS
Ultrasound PDN is safe and effective in the preclinical setting, with energy delivery to a depth that would permit targeting sympathetic nerves in humans.
Topics: Animals; Cardiac Output; Catheter Ablation; Denervation; Heart Failure; Humans; Hypertension, Pulmonary; Pulmonary Artery; Swine; Sympathectomy; Sympathetic Nervous System
PubMed: 31062694
DOI: 10.4244/EIJ-D-18-01082 -
Journal of the American College of... Aug 2020
Topics: Denervation; Endarterectomy; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Embolism
PubMed: 32819466
DOI: 10.1016/j.jacc.2020.06.067 -
Clinical Nuclear Medicine Feb 2021A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension...
A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension (>54 mm Hg). A CT pulmonary angiogram showed a filling defect in the pulmonary trunk, right and left pulmonary arteries, raising the possibilities of pulmonary embolism or artery sarcoma. FDG PET/CT was performed for further evaluation and showed low uptake in the pulmonary wall, which supported the diagnosis of pulmonary embolism. Patient was treated with anticoagulants with no changes on repeated CT pulmonary angiogram. Patient underwent surgery, and histopatological examination revealed a pulmonary artery sarcoma.
Topics: Aged; Biological Transport; Fluorodeoxyglucose F18; Humans; Male; Positron Emission Tomography Computed Tomography; Pulmonary Artery; Sarcoma; Vascular Neoplasms
PubMed: 33208613
DOI: 10.1097/RLU.0000000000003376