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Seminars in Thoracic and Cardiovascular... 2021
Topics: Carotid Stenosis; Humans; Pulmonary Artery
PubMed: 33171238
DOI: 10.1053/j.semtcvs.2020.10.010 -
Journal of Cardiothoracic and Vascular... May 2020This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new... (Observational Study)
Observational Study
OBJECTIVE
This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population.
DESIGN
This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019.
SETTING
Weill Cornell Medicine, a single large academic medical center.
PARTICIPANTS
The study comprised 119 patients undergoing elective cardiac surgery.
INTERVENTIONS
Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery.
MEASUREMENTS AND MAIN RESULTS
Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (<35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]).
CONCLUSIONS
PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.
Topics: Cardiac Surgical Procedures; Cardiopulmonary Bypass; Echocardiography; Humans; Pulmonary Artery; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 31653496
DOI: 10.1053/j.jvca.2019.09.023 -
General Thoracic and Cardiovascular... Jan 2023The right B downwards-shifting malformation is rare. This malformation often leads to the following complications: abnormal pulmonary arteries that accompany the...
The right B downwards-shifting malformation is rare. This malformation often leads to the following complications: abnormal pulmonary arteries that accompany the downward-displaced B, and complete fusion of the upper and middle lobes into one lobe, with no horizonal fissure. When performing pulmonary anatomical resection in the right upper or middle lobes in patients with this malformation, careful preoperative planning and surgical technique are required, with which the surgeon should be familiar. Herein, we present the anatomical features necessary for anatomical resection of the right B downwards-shifting malformation based on our technical experiences with anatomic segmentectomy and lobectomy techniques.
Topics: Humans; Pneumonectomy; Lung; Lung Neoplasms; Pulmonary Artery
PubMed: 36301486
DOI: 10.1007/s11748-022-01884-6 -
Asian Journal of Surgery Aug 2023
Topics: Humans; Pulmonary Artery; Aneurysm
PubMed: 36878779
DOI: 10.1016/j.asjsur.2023.02.083 -
Heart, Lung & Circulation Sep 2023This study examined the echocardiographic characteristics of patients with pulmonary artery intimal sarcoma (PAIS) and compared the results with those from computed...
OBJECTIVES
This study examined the echocardiographic characteristics of patients with pulmonary artery intimal sarcoma (PAIS) and compared the results with those from computed tomographic pulmonary angiography (CTPA).
METHOD
Twenty-six (26) patients were diagnosed with PAIS at the current institution during the study period, and 23 were eligible for analysis. Echocardiography and CTPA examinations were performed in all enrolled patients.
RESULTS
The echocardiography results showed that most lesions had expansive growth in the left pulmonary artery (PA); the right PA; or a combination of the left PA, right PA, and main PA, with extension to the pulmonary valve and/or right ventricular outflow tract. These lesions also had distinctive sieve-like echogenic signals. Echocardiography also showed that some lesions had lobulated shapes, were nearly round and echolucent or with calcifications, and moved during imaging. The lesion distribution was similar in CTPA and echocardiography (p=0.361), but CTPA was more sensitive in detection of the complete shape (p=0.023).
CONCLUSIONS
The unique echocardiographic characteristics of PAIS, especially the "sieve sign", could help in the diagnosis of this cancer. Transthoracic echocardiography is a non-invasive technique that appears effective in detecting PAIS.
Topics: Humans; Pulmonary Artery; Lung; Sarcoma; Lung Neoplasms; Echocardiography; Pulmonary Embolism
PubMed: 37355431
DOI: 10.1016/j.hlc.2023.05.013 -
Asian Cardiovascular & Thoracic Annals May 2022We describe a seven-month-old boy with tetralogy of Fallot and an absent left pulmonary artery. Due to the diminutive size of the left pulmonary artery, we performed a...
We describe a seven-month-old boy with tetralogy of Fallot and an absent left pulmonary artery. Due to the diminutive size of the left pulmonary artery, we performed a native tissue left pulmonary artery reconstruction and intrapulmonary artery septation procedure with a left modified Blalock-Taussig shunt. After confirming left pulmonary artery growth, the patient underwent tetralogy of Fallot repair, removal of septation patch, and division of the Blalock-Taussig shunt. Nine months post-surgery, we confirmed his balanced lung perfusion (R/L ratio 6:4). The intrapulmonary artery septation procedure would be suitable for both the resuscitation and reconstruction of the hypoplastic absent pulmonary artery.
Topics: Blalock-Taussig Procedure; Humans; Infant; Male; Pulmonary Artery; Tetralogy of Fallot; Treatment Outcome
PubMed: 33926269
DOI: 10.1177/02184923211013998 -
The Pan African Medical Journal 2020Pulmonary artery hypoplasia is a rare malformation of childhood that is usually associated with cardiac abnormalities. In the absence of these cardiac malformations it...
Pulmonary artery hypoplasia is a rare malformation of childhood that is usually associated with cardiac abnormalities. In the absence of these cardiac malformations it is discovered later when respiratory signs appear. It was a 56-year-old patient who had been referred for dyspnea with cough. The physical examination was normal. Chest X-ray, thoracic computed tomography (CT) scan and echocardiography suggested the diagnosis of hypoplasia of the left pulmonary artery without associated cardiac malformations. The early diagnosis of hypoplasia of the pulmonary artery allows the close follow-up of these patient and the planning of an adequate management.
Topics: Cough; Dyspnea; Echocardiography; Humans; Male; Middle Aged; Pulmonary Artery; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 32774591
DOI: 10.11604/pamj.2020.36.14.22539 -
Asian Cardiovascular & Thoracic Annals Mar 2022Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal...
Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal ductus is absent, the large right ventricular stroke volume dilates the pulmonary trunk leading to pulmonary regurgitation. A proximal extension of the embryonic insult to the entire left sixth arch causes absence of the left pulmonary artery, a common association of absent pulmonary valve syndrome. On the contrary, absence of right pulmonary artery is not reported in absent pulmonary valve syndrome. A rare combination of tetralogy, absent pulmonary valve syndrome and isolation of a hypoplastic right pulmonary artery offered challenges to diagnosis and management.
Topics: Humans; Pulmonary Artery; Pulmonary Atresia; Pulmonary Valve; Tetralogy of Fallot; Treatment Outcome
PubMed: 33789442
DOI: 10.1177/02184923211006309 -
Journal of the College of Physicians... Dec 2022To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary...
OBJECTIVE
To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary artery (mPA) diameter, calculated by computed tomography (CT).
STUDY DESIGN
A descriptive cross-sectional study.
PLACE AND DURATION OF STUDY
Department of Radiology, Balikesir University School of Medicine, Turkey, from February to December 2020.
METHODOLOGY
After excluding the cases with suspected COVID-19 from the cases sent to the Radiology Department for chest CT exams with the mPA included in the cross-sections, the volunteers were evaluated with PW-DUS. The study group consisted of 66 cases. Two radiologists measured the velocity values of the A, S, and D waves in the recorded PW Doppler spectra. HVIs (A/S, A/S+D, A/A+S+D) were calculated. The mPA diameter was calculated in the axial plane from the pulmonary trunk, 1cm proximally to the bifurcation manually on the workstation. The correlation between the HIVs and mPA diameter was evaluated. Interoperator reliability was also analysed.
RESULTS
Thirty-nine males (59%) and 27 (41%) females were included in the study group. The mean HVI values were 0.50 ±0.20, 0.28 ±0.12, and 0.21 ±0.07 for A/S, A/A+S, and A/A+S+D, respectively. The mean mPA diameter was 24.0 ±3.3 mm. Correlation analysis determined that the HVIs were positively correlated with mPA diameter (r=0.730-0.765-0.751, p<0.001). Inter-observer correlation coefficients were found to be compatible between two radiologists.
CONCLUSION
A significant and strong correlation was found between HVIs and mPA diameter. The mPA diameter that reflects the pulmonary artery systolic pressure (PAP) increased as the HVIs increased. Therefore, PW-DUS may be helpful to evaluate PAP as a quantitative method that is cost-effective, easily accessible and radiation-free.
KEY WORDS
Hepatic veins, Pulmonary artery, Multidetector computed tomography, Pulmonary hypertension, Pulsed doppler ultrasonography.
Topics: Humans; Hepatic Veins; Pulmonary Artery; Cross-Sectional Studies; Reproducibility of Results; COVID-19
PubMed: 36474369
DOI: 10.29271/jcpsp.2022.12.1529 -
Cardiology in the Young Sep 2023Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this... (Review)
Review
Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this is multifactorial and related to the anterior shift of the pulmonary trunk during the LeCompte manoeuvre, the complex suture line required to fill the gaps after harvesting the coronary arteries, and the need for patch implantation to maintain a tensionless anastomosis.We reviewed all patients with transposition of the great arteries operated on at our institute between 1991 and 2020 to establish the frequency of pulmonary stenosis during post-operative follow-up, reinterventions, and reoperations related to pulmonary stenosis and its potential risk factors.During the analysed period, we performed 848 arterial switch operations for simple and complex cases of transposition of the great arteries. The overall early mortality was 6.96%, and the late mortality was 2.53%. Among all study groups, 243 (28.66%) patients developed mild pulmonary stenosis, 43 patients (5.07%) developed moderate, and 45 patients (5.31%) developed severe pulmonary stenosis. During follow-up, 21 patients required interventions related to pulmonary stenosis. Pulmonary reconstruction with patches, aortic arch anomalies, and ventricular septal defects associated with transposition of the great arteries were significant risk factors. Nine patients required reoperation because of pulmonary artery stenosis with patch reconstruction of the pulmonary artery, aortic arch anomalies, and aortic cross-clamping time, increasing the risk of reoperation.Pulmonary stenosis in patients with transposition of the great arteries after the arterial switch operation is a common complication. If significant, it occurs early after surgery and is the most frequent reason for post-operative interventions and reoperations.
Topics: Humans; Arterial Switch Operation; Transposition of Great Vessels; Pulmonary Valve Stenosis; Pulmonary Artery; Prognosis; Reoperation; Postoperative Complications; Follow-Up Studies; Treatment Outcome
PubMed: 36040409
DOI: 10.1017/S1047951122002670