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General Thoracic and Cardiovascular... Aug 2020A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the...
A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the bilateral pulmonary branch (maximum diameter 6.4 cm) of the artery. Echocardiography revealed moderate pulmonary valve (PV) regurgitation with right ventricle dilatation. Surgery was indicated because of the pulmonary aneurysm and dyspnea on exertion due to moderate PV regurgitation. Intra-operatively, two cusps were found to be normal in shape, whereas a third left-facing cusp was thick and resembled a small ridge. Therefore, we created one neo-cusp with autologous pericardium using a custom-made template and sutured it along a new, predetermined annulus. We then replaced the pulmonary aneurysm with a T-shaped artificial graft. Postoperative echocardiography showed satisfactory movement of the neo-cusp without pulmonary regurgitation and reduced right ventricular size.
Topics: Aneurysm; Echocardiography; Heart Defects, Congenital; Heart Ventricles; Humans; Male; Middle Aged; Pericardium; Pulmonary Artery; Pulmonary Valve; Pulmonary Valve Insufficiency; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32040820
DOI: 10.1007/s11748-020-01315-4 -
The Journal of Thoracic and... Mar 2018Pulmonary artery sarcoma is an exceedingly rare malignancy. There is a lack of consensus regarding its diagnosis and treatment. We reviewed our experience in the... (Comparative Study)
Comparative Study
OBJECTIVE
Pulmonary artery sarcoma is an exceedingly rare malignancy. There is a lack of consensus regarding its diagnosis and treatment. We reviewed our experience in the surgical management of pulmonary artery sarcoma over an 11-year period.
METHODS
From January 2005 to February 2016, 12 patients with pulmonary artery sarcoma (age 51 ± 14 years, 5 male) underwent surgical treatment at our center. Nine patients (75%) exhibited pulmonary trunk involvement on computed tomography angiography. Six patients (50%) were initially misdiagnosed with pulmonary embolism.
RESULTS
Ten patients underwent pulmonary endarterectomy, and 3 of these patients required additional unilateral pneumonectomy. The remaining 2 patients underwent exploratory thoracotomy. One patient (8.3%) died in the hospital. The median length of postoperative intensive care unit and hospital stay were 1 day (range, 1-15 days) and 8 days (range, 5-21 days), respectively. The median postoperative survival of the total series was 18 months. Patients who received postoperative combined chemo- and radiotherapy were associated with improved survival compared with those who had isolated adjuvant therapy or surgery alone (median survival 28 vs 8 months, P = .042).
CONCLUSIONS
Although pulmonary artery sarcoma has a very poor prognosis, surgical treatment offers a chance for symptom relief and better long-term outcome. Aggressive postoperative adjuvant treatment may be necessary to improve survival.
Topics: Adult; Aged; Biopsy; Chemoradiotherapy, Adjuvant; Chemotherapy, Adjuvant; Computed Tomography Angiography; Embolectomy; Endarterectomy; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Pneumonectomy; Postoperative Complications; Pulmonary Artery; Radiotherapy, Adjuvant; Risk Factors; Sarcoma; Thoracotomy; Time Factors; Treatment Outcome; Vascular Neoplasms; Young Adult
PubMed: 29223846
DOI: 10.1016/j.jtcvs.2017.10.101 -
Journal of Cardiac Surgery Apr 2020Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a...
Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.
Topics: Adult; Aneurysm; Coronary Artery Bypass; Coronary Artery Disease; Female; Humans; Hypertension, Pulmonary; Organ Sparing Treatments; Pulmonary Artery; Pulmonary Valve Insufficiency; Plastic Surgery Procedures; Treatment Outcome; Vascular Surgical Procedures
PubMed: 32107796
DOI: 10.1111/jocs.14480 -
World Journal For Pediatric &... Mar 2023Anomalies of the pulmonary origin of the pulmonary arteries are uncommon; however, the true incidence is unknown and may be underestimated. We sought to review our... (Review)
Review
BACKGROUND
Anomalies of the pulmonary origin of the pulmonary arteries are uncommon; however, the true incidence is unknown and may be underestimated. We sought to review our experience with this unusual pathology and examine its surgical implications.
METHODS
We reviewed medical records between 2011 and 2022.
RESULTS
A total of 24 patients were identified. Genetic syndromes were present in 12 patients (50%). The patients were divided into two main groups. Those with septal defects (14 patients,58.3%), and those without (10 patients, 41.7%). Aortic arch hypoplasia with/without coarctation was present in nine patients (37.5%). Pulmonary arterial branch hypoplasia and/or obstruction was present in six patients (25%) with resultant preoperative systemic or suprasystemic right ventricular pressure. Four patients (16.7%) underwent pulmonary artery branch and/or right ventricular outflow tract interventions prior to surgery. All patients underwent surgical interventions for their associated cardiac defects. The crossed pulmonary arteries were uncrossed for those four patients (16.7%) who required concomitant pulmonary arterioplasties and pulmonary arterial branch rehabilitation and who had elevated right ventricular pressures preoperatively. No early or late mortalities. One Alagille's syndrome underwent liver transplant prior to discharge. Late transcatheter interventions were needed in four (16.7%) during the follow-up period, while four patients required repeat aortic arch augmentation for recurrent arch obstruction.
CONCLUSIONS
Anomalous origin of the pulmonary arteries from the pulmonary trunk including crossed pulmonary arteries is an uncommon anomaly that may be underrecognized. It can occur in isolation or in association with other heart defects. Recognition of this malpositional anomaly is important as it has specific surgical and/or transcatheter implications.
Topics: Humans; Infant; Pulmonary Artery; Hypertension, Pulmonary; Heart Defects, Congenital; Aortic Coarctation; Heart Septal Defects
PubMed: 36511245
DOI: 10.1177/21501351221139833 -
The Journal of Thoracic and... Jun 2020Aneurysm of the main pulmonary artery trunk (PAA) is a rare but severe complicating factor in patients suffering from pulmonary arterial hypertension (PAH). Many centers...
BACKGROUND
Aneurysm of the main pulmonary artery trunk (PAA) is a rare but severe complicating factor in patients suffering from pulmonary arterial hypertension (PAH). Many centers consider PAA an indication for a heart-lung transplantation. We aimed to summarize our institutional experience with a lung-only strategy in this complex group of patients.
METHODS
We performed a retrospective single-center analysis of patients with PAH and a severe PAA who underwent lung transplantation between January 1996 and November 2018.
RESULTS
A total of 127 patients with PAH underwent lung transplantation during the study period. Seven patients presented with severe PAA (mean diameter, 70.4 mm). Donor lungs were procured together with the main pulmonary artery (PA). In the recipient, cardiopulmonary bypass with bicaval cannulation was established, and bilateral pneumonectomy together with resection of the entire PA trunk was performed. The right donor lung was implanted, and the attached PA trunk was pulled through behind the superior vena cava and ascending aorta. Anastomosis was performed just above the level of the pulmonary valve. Thereafter, the left lung was implanted by reconnecting the left PA to the main PA trunk. All but 1 patient, who died from sepsis on postoperative day 13, were successfully discharged.
CONCLUSIONS
To the best of our knowledge, this is the largest published experience of patients with PAH and severe PAA who underwent lung transplantation. We show that these patients are eligible for double lung transplantation and do not require heart-lung transplantation.
Topics: Adult; Aneurysm; Arterial Pressure; Female; Humans; Lung Transplantation; Male; Middle Aged; Pulmonary Arterial Hypertension; Pulmonary Artery; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
PubMed: 31780060
DOI: 10.1016/j.jtcvs.2019.09.178 -
General Thoracic and Cardiovascular... Oct 2022Massive pulmonary artery aneurysms, while extremely rare, might require surgical intervention. Most previous cases have been repaired either by pulmonary artery...
Massive pulmonary artery aneurysms, while extremely rare, might require surgical intervention. Most previous cases have been repaired either by pulmonary artery plication or synthetic graft replacement. We report a case of massive pulmonary artery aneurysm that was successfully repaired using an 'overlapping-plasty' technique with the help of 3D image simulation. This specially designed procedure might be useful as a surgical option for pulmonary artery aneurysms.
Topics: Aneurysm; Humans; Imaging, Three-Dimensional; Lung; Pulmonary Artery
PubMed: 35932352
DOI: 10.1007/s11748-022-01853-z -
Spectrochimica Acta. Part A, Molecular... May 2019Decellularized heart valves hold promise for their use as bioscaffolds in cardiovascular surgery. Quality assessment of heart valves after decellularization processing...
Decellularized heart valves hold promise for their use as bioscaffolds in cardiovascular surgery. Quality assessment of heart valves after decellularization processing and/or storage is time consuming and destructive. Fourier transform infrared spectroscopy (FTIR) allows rapid non-invasive assessment of biomolecular structures in tissues. In this study, IR-spectra taken from different layers of the pulmonary artery trunk and leaflet tissues of decellularized porcine heart valves were compared with those of pure collagen and elastin, the main protein components in these tissues. In addition, spectral changes associated with aging and oxidative damage were investigated. Infrared absorbance spectra of the arteria intima and media layer were found to be very similar, whereas distinct differences were observed when compared with spectra of the externa layer. In the latter, the shape of the CH-stretching vibration region (3050-2800 cm) resembled that of pure collagen. Also, pronounced νCOOH and amide-II bands and a relatively high content of α-helical structures in the externa layer indicated the presence of collagen in this layer. The externa layer of the artery appeared to be sensitive to collagenase treatment, whereas the media and intima layer were particularly affected by elastase and not by collagenase treatment. Protein conformational changes after treatment with collagenase were observed in all three layers. Collagenase treatment completely degraded the leaflet tissue sections. Spectra were also collected from scaffolds after 2 and 12 weeks storage at 37 °C, and after induced oxidative damage. Spectral changes related to aging and oxidative damage were particularly evident in the CH-stretching region, whereas the shape of the amide-I band, reflecting the overall protein secondary structure, remained unaltered.
Topics: Animals; Collagen; Elastin; Heart Valves; Pulmonary Artery; Spectroscopy, Fourier Transform Infrared; Swine; Tissue Scaffolds; Tunica Intima
PubMed: 30769156
DOI: 10.1016/j.saa.2019.02.006 -
Acta Radiologica (Stockholm, Sweden :... Jan 2021Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the...
Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-hour and 30-day mortality in patients with acute pulmonary embolism.
BACKGROUND
Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE.
PURPOSE
To search possible CTPA predictors of 24-h and 30-day mortality in PE.
MATERIAL AND METHODS
Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC).
RESULTS
Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, = 0.045).
CONCLUSION
Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.
Topics: Acute Disease; Aged; Computed Tomography Angiography; Contrast Media; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Pulmonary Artery; Pulmonary Embolism; Radiographic Image Enhancement; Retrospective Studies; Severity of Illness Index; Vena Cava, Inferior
PubMed: 32241170
DOI: 10.1177/0284185120912506 -
The International Journal of... Jan 2022Proximal pulmonary artery masses are exceedingly rare, and their diagnosis and therapy are important and challenging for clinicians. This study reviews our experience...
Proximal pulmonary artery masses are exceedingly rare, and their diagnosis and therapy are important and challenging for clinicians. This study reviews our experience exploring the value of a combination of transthoracic echocardiography and contrast echocardiography for the differential diagnosis of proximal pulmonary artery masses. Between January 2018 and June 2021, 44 patients diagnosed with a mass attached to the major pulmonary artery and straddling the bilateral pulmonary arteries or pulmonary valve on transthoracic echocardiography were referred to this study. Contrast echocardiography was performed in 17 patients. Masses were diagnosed based on their site of attachment, shape, size, mobility, hemodynamic consequences on transthoracic echocardiography, and tissue perfusion on contrast echocardiographic perfusion imaging. Pathological data were collected from medical records and analyzed. The most frequent location of proximal pulmonary artery masses was the major pulmonary artery trunk. Twelve patients underwent complete mass resection, whereas nine patients underwent percutaneous pulmonary artery biopsy puncture and had a pathological diagnosis. Another 24 patients were confirmed with the validation methods. Contrast echocardiography has good sensitivity and specificity for differentiating thrombi from pulmonary artery sarcomas (PAS). The mass types were distributed as follows: thrombi (19, 43%), PAS (15, 34%), metastatic tumors (6, 14%), vegetations (3, 7%), and primary benign lesions (1, 2%). The majority of proximal pulmonary artery masses were thrombi or PAS. A combination of transthoracic echocardiography and contrast echocardiography offers advantages in the early identification of proximal pulmonary masses and provides clinically important information about the characteristics of masses, especially for differentiating thrombi from PAS.
Topics: Echocardiography; Humans; Predictive Value of Tests; Pulmonary Artery; Thorax; Thrombosis
PubMed: 34716510
DOI: 10.1007/s10554-021-02427-5 -
The Annals of Thoracic Surgery Feb 2020A patient with main pulmonary artery mass may have severe symptoms and warrants urgent surgical management, whereas in a stable patient with a diagnosis amenable to...
A patient with main pulmonary artery mass may have severe symptoms and warrants urgent surgical management, whereas in a stable patient with a diagnosis amenable to medical treatment, medical management should be started while monitoring the size of the lesion. We report a case in which the patient experienced severe right heart dysfunction due to obstruction of the main pulmonary artery, diagnosed as a probable thrombus, and the patient was taken for urgent surgical excision, later diagnosed as tuberculoma on histopathologic examination.
Topics: Adolescent; Diagnosis, Differential; Echocardiography; Humans; Male; Pulmonary Artery; Stenosis, Pulmonary Artery; Tuberculoma; Tuberculosis, Cardiovascular; Vascular Surgical Procedures
PubMed: 31301274
DOI: 10.1016/j.athoracsur.2019.05.056