-
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 -
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 -
Surgery Today Sep 2020To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL).
PURPOSE
To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL).
METHODS
Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL.
RESULTS
The two-stem type in A was observed in 131 (24.7%) patients and the three-stem type in A was observed in 11 (2.1%) patients. The independent two-stem type in B was observed in four (0.75%) patients. The B with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%).
CONCLUSION
We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.
Topics: Aged; Anatomic Variation; Bronchi; Female; Humans; Imaging, Three-Dimensional; Lung; Male; Pneumonectomy; Pulmonary Artery; Pulmonary Veins; Tomography, X-Ray Computed
PubMed: 32200429
DOI: 10.1007/s00595-020-01991-y -
The Journal of Thoracic and... Feb 2020Pulmonary autograft root dilatation is the major long-term complication after Ross procedure and the leading cause for reoperation. However, the mechanisms underlying...
OBJECTIVE
Pulmonary autograft root dilatation is the major long-term complication after Ross procedure and the leading cause for reoperation. However, the mechanisms underlying dilatation remain to be elucidated. This study analyzed the proteomic changes seen in the dilated pulmonary autograft compared with normal pulmonary artery and aorta tissues.
METHODS
Pulmonary autograft surgical samples were taken from 9 consecutive patients (mean age 37 ± 14; 15-51 years) with mean diameters of 5.2 ± 0.5 cm (4.6-5.8 cm) reoperated 8 to 16 years after Ross procedure. Control pulmonary artery and aorta samples were from 7 age- and sex-matched cardiac donors. Tunicae mediae from all samples were processed for proteomic analysis via 2-dimensional electrophoresis, matrix-assisted-laser-desorption-ionization-time of flight/mass spectrometry, and bioinformatics. The thus-identified putatively relevant proteins were validated via Western immunoblotting.
RESULTS
Pulmonary autograft proteome features differed markedly from control pulmonary arteries, since proteins related to focal adhesions (eg, paxillin), cytoskeleton (eg, vimentin), and metalloprotease-regulating proteoglycans (eg, testican-2) were significantly up-regulated, whereas significant decreases occurred in microfibril-associated glycoprotein1, which controls elastic fiber buildup. Profound changes also occurred in cell-signaling proteins, ie, increases in soluble Jagged-1 fragment and ectodysplasin-2 receptor, and decreases in Notch-1 intracellular domain fragment. Moreover, pulmonary autograft expression levels of Paxillin, Vimentin, Jagged-1 fragment, and Notch1 intracellular domain fragment also differed from those of control aorta.
CONCLUSIONS
This study provides the first description of the specific proteomic features of dilated pulmonary autograft tunica media, which separate them sharply not only from those of control pulmonary artery and aorta but also of aortic aneurysms. These findings suggest that dilated pulmonary autografts undergo a unique maladaptive remodeling process deserving further investigation.
Topics: Adolescent; Adult; Autografts; Cardiac Surgical Procedures; Female; Focal Adhesions; Humans; Male; Middle Aged; Proteome; Proteomics; Pulmonary Artery; Signal Transduction; Transplantation, Autologous; Tunica Media; Vascular Remodeling; Young Adult
PubMed: 31585756
DOI: 10.1016/j.jtcvs.2019.07.083 -
Iranian Journal of Medical Sciences Jul 2022Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector...
BACKGROUND
Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE.
METHODS
In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant.
RESULTS
Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH.
CONCLUSION
We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.
Topics: 4-Aminobenzoic Acid; Acute Disease; Cross-Sectional Studies; Humans; Pulmonary Artery; Pulmonary Embolism; Retrospective Studies
PubMed: 35919084
DOI: 10.30476/IJMS.2021.88058.1926 -
The Journal of Thoracic and... Apr 2022
Topics: Humans; Lung; Pulmonary Artery; Vascular Surgical Procedures
PubMed: 34521511
DOI: 10.1016/j.jtcvs.2021.08.044 -
European Heart Journal Nov 2022
Topics: Humans; Pulmonary Artery; Aneurysm; Fistula; Heart Defects, Congenital; Coronary Artery Disease
PubMed: 35938849
DOI: 10.1093/eurheartj/ehac441 -
Current Problems in Cardiology Jun 2023Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has... (Review)
Review
Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has a median survival nowadays of 6 years, compared to 2.8 years in the 1980s. A pulmonary artery aneurysm (PAA) is the focal dilation of a blood vessel involving all 3 layers of the vessel wall; they have a diameter greater than 4 cm measured in the trunk of the pulmonary artery. PAAs can be classified into proximal (or central) and peripheral. The clinical manifestations of PAA are primarily nonspecific, and most patients remain undiagnosed, even those with large PAA, due to its silent course; however, clinical manifestations occur unless when there are complications such as bronchial or tracheal compression (leading to cough and dyspnea), dissection, or rupture (leading to hemoptysis). PAH is observed in 66% of patients with PAA. PA dissections are usually associated with PAH; 80% of dissections occur in the main pulmonary trunk. Although there is no clear guideline for the best treatment of PAA, surgery is indicated in patients with a pulmonary trunk aneurysm >5.5 cm. It has been observed that patients in the PAH group associated with congenital heart disease tend to develop PAA more commonly. Those with PAH associated with connective tissue disease have a smaller diameter of PA dilation. This report presents a comprehensive review of PAA, discussing critical aspects of the clinical and imaging diagnosis, hemodynamics, and treatment. A comprehensive updated literature review is included; we believe this article will interest cardiopulmonologists.
Topics: Humans; Hypertension, Pulmonary; Pulmonary Artery; Aneurysm
PubMed: 36773948
DOI: 10.1016/j.cpcardiol.2023.101645 -
The Journal of Thoracic and... Nov 2021
Topics: Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Models, Statistical; Pulmonary Artery
PubMed: 33589314
DOI: 10.1016/j.jtcvs.2021.01.018