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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 Computer Assisted Tomography 2020To establish the normal parameters of fetal lung development at different gestational ages and to study their correlation with gestational age, thereby providing...
OBJECTIVE
To establish the normal parameters of fetal lung development at different gestational ages and to study their correlation with gestational age, thereby providing clinicians with a noninvasive method for assessing fetal lung maturity.
METHODS
Two hundred eight cases with pregnancy of 22 to 39 weeks plus 6 days were divided into 18 groups according to gestational age. Ultrasound Doppler was used to measure the relevant parameters of fetal pulmonary development, including right pulmonary left and right diameter, right pulmonary upper and lower diameter, right pulmonary anterior and posterior diameter, right pulmonary area, thoracic area, inner diameter of fetal main pulmonary artery, and Doppler velocity curve parameters of main pulmonary artery: systolic acceleration time (AT), ejection time (ET), AT/ET.
RESULTS
This study establishes normal parameters of lung development at different gestational weeks, draws scatter plots, correlation, and regression analysis of fetal main pulmonary artery AT, ET, AT/ET, and gestational weeks; selects the optimal equation; and analyzes the correlation among right pulmonary left and right diameter, right pulmonary upper and lower diameter, right pulmonary anterior and posterior diameter, right lung diameter, right lung area, thoracic area, and gestational weeks; and draw growth curve. The diameter of main pulmonary artery, AT, and AT/ET increased with the increase of gestational age and were positively correlated with gestational age (r = 0.948, 0.875, 0.810; P = 0.012). Ejection time had no correlation with gestational weeks. There were significant differences in the diameter of main pulmonary artery, AT, AT/ET between different gestational weeks (F = 240.67, 41.137, 23.067; P = 0.024); left and right diameter of right lung, anterior and posterior diameter of right lung, upper and lower diameter of right lung, chest area and right lung area were positively correlated with gestational weeks, and there were significant differences between different gestational weeks (F = 190.85, 105.74, 34.97, 172.33, 35.33, P = 0.018).
CONCLUSIONS
Ultrasound Doppler can be used as a noninvasive detecting equipment to evaluate the growth of fetal lung, thus providing a basis for the evaluation of fetal lung maturity.
Topics: Adult; Female; Humans; Lung; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Third; Pulmonary Artery; Ultrasonography, Prenatal; Young Adult
PubMed: 32345806
DOI: 10.1097/RCT.0000000000001011 -
Journal of Cardiothoracic and Vascular... Nov 2022
Topics: Catheterization, Swan-Ganz; Catheters; Equipment Failure; Humans; Pulmonary Artery
PubMed: 35843773
DOI: 10.1053/j.jvca.2022.06.020 -
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 -
Annals of Saudi Medicine 2019Pulmonary hypertension (PH) is an idiopathic or secondary disorder associated with many systemic illnesses. Long-term survival in PH depends on the severity and...
BACKGROUND
Pulmonary hypertension (PH) is an idiopathic or secondary disorder associated with many systemic illnesses. Long-term survival in PH depends on the severity and functional class. Several new drugs are now available to treat PH, but their impact on clinical outcome and survival are not well established.
OBJECTIVES
Evaluate severity parameters and the impact of current recommended therapy on survival in PH.
DESIGN
Cross-sectional.
SETTINGS
Tertiary care center.
PATIENTS AND METHODS
The study included adult patients who had undergone right heart catheterization since 2012 and were diagnosed with pulmonary hypertension. Survival was recorded after 6 years, at the end of the study. Nine severity variables for PH were assessed including right ventricular size by echocardiogram and pulmonary artery diameter (PA diameter) and the ratio of pulmonary artery diameter to ascending aorta diameter (PA/Ao ratio) by CT.
MAIN OUTCOME MEASURES
Evaluation of severity parameters.
SAMPLE SIZE
30 patients.
RESULTS
Twenty-five patients were positive for 8/9 severity parameters. Eight of 30 (26.6%) patients died. In nonsurvivors, right ventricular size was increased by 25% ( P=.427), pulmonary vascular resistance increased by 29.4% in nonsurvivors ( P=.302), the 6-minute walk distance decreased by 21% ( P=.875), median brain natriuretic peptide increased by 96% ( P=.890), median GGT and alkaline phosphatase were 3 times higher in nonsurvivors ( P=.893 and P=.047, respectively) and PA/Ao was nonsignificantly decreased in nonsurvivors ( P=.373), Survival was decreased by a median of 2.3 years in nonsurvivors.
CONCLUSION
Our study identified a subgroup of PH patients with NYHA functional class III and above with worsening severity indicators who were labeled as a high-risk group. These patients showed continuous deterioration in their clinical status despite escalation of therapy with current guidelines. We recommend these high-risk group patients be referred for early lung transplantation.
LIMITATIONS
Low sample size and only a single center. Needs confirmation with a larger multicenter trial.
CONFLICT OF INTEREST
None.
Topics: Adult; Echocardiography; Female; Humans; Hypertension, Pulmonary; Male; Pulmonary Artery; Severity of Illness Index; Survival Analysis; Treatment Outcome
PubMed: 31804134
DOI: 10.5144/0256-4947.2019.426 -
Journal of Cardiac Surgery Oct 2021Aortopulmonary mismatch (APM) in transposition of the great arteries (TGA) may be accountable for dilatation of neoaortic root and regurgitation of neoaortic valve as...
BACKGROUND
Aortopulmonary mismatch (APM) in transposition of the great arteries (TGA) may be accountable for dilatation of neoaortic root and regurgitation of neoaortic valve as late complications of arterial switch operation (ASO). The manuscript from Arcieri et al. highlights an important aspect of the ASO technique: should we approach APM during ASO and what would be the best strategy to do so?
DISCUSSION
Techniques to approach APM at the time of ASO have been published sporadically and are very rarely employed by surgeons. Reconstruction of the neoaorta is generally achieved by trimming the suture line between the pulmonary root (neoaortic root) and ascending aorta resulting in an abnormal dilated and bulky neoaortic root already at the time of ASO.
CONCLUSION
Reduction of the pulmonary root dimension by ressection of a fragment of the pulmonary artery wall possibly results in a more homogenous neoaorta with consequent better hemodynamics. We believe that approaching APM during ASO will have a compelling positive impact on the late survival of patients with complex TGA.
Topics: Aorta; Arterial Switch Operation; Follow-Up Studies; Humans; Postoperative Complications; Pulmonary Artery; Transposition of Great Vessels
PubMed: 34270121
DOI: 10.1111/jocs.15817 -
The Journal of Thoracic and... Dec 2022
Topics: Humans; Ships; Pulmonary Artery; Catheterization, Swan-Ganz; Catheters
PubMed: 33642105
DOI: 10.1016/j.jtcvs.2021.02.003 -
Surgical and Radiologic Anatomy : SRA Nov 2020Previous studies have shown a correlation between axial pulmonary trunk diameter (PTD) on chest computed tomography (CT) and pulmonary artery pressure. However, it is...
PURPOSE
Previous studies have shown a correlation between axial pulmonary trunk diameter (PTD) on chest computed tomography (CT) and pulmonary artery pressure. However, it is not known whether the PTD slices measured on chest CT have been recorded during the systolic or diastolic phase. The aim of this study was to demonstrate the variations in PTD during the cardiac cycle by measuring coronary CT angiography (CCTA) images.
METHODS
A retrospective analysis was made of 101 patients who underwent CCTA for coronary artery disease assessment. CCTA images were reconstructed during a full cardiac cycle and measurements were taken of the systolic and diastolic PTD and ascending aorta diameter (AAD) from the same slice by two independent observers.
RESULTS
Inter-observer agreement was excellent (intraclass correlation coefficient = 0.99) for all CT measurements. The mean systolic PTD of all patients was 26.3 ± 3.6 mm and the mean diastolic PTD was 22.8 ± 3.2 mm (p < 0.001). The mean difference between systole and diastole was found to be 3.5 ± 1.2 mm for PTD, 1.2 ± 0.7 mm for AAD, and 0.1 ± 0.04 for the PTD/AAD ratio (p values < 0.001). There was no statistical significance of PTD variations according to gender, age, height, weight, body mass index, and body surface area.
CONCLUSION
When an increased PTD is detected in a chest CT compared to normal limits or a previous CT scan, this may be the result of the variation in PTD due to the cardiac cycle.
Topics: Adult; Age Factors; Aged; Aorta; Biological Variation, Population; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Diastole; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Pulmonary Artery; Retrospective Studies; Sex Factors; Systole
PubMed: 32405785
DOI: 10.1007/s00276-020-02493-9 -
European Journal of Cardio-thoracic... May 2022
Topics: Constriction, Pathologic; Heart Defects, Congenital; Humans; Lung; Pulmonary Artery; Tomography, X-Ray Computed; Trachea; Tracheal Stenosis; Treatment Outcome; Vascular Malformations
PubMed: 35201297
DOI: 10.1093/ejcts/ezac127