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Annals of Emergency Medicine Aug 2021
Topics: Adult; Aorta; Computed Tomography Angiography; Echocardiography; Female; Hemoptysis; Humans; Pulmonary Artery; Thoracotomy
PubMed: 34325868
DOI: 10.1016/j.annemergmed.2021.02.003 -
Journal of Medical Case Reports Apr 2021Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac...
BACKGROUND
Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity.
CASE PRESENTATION
A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 37 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation.
CONCLUSION
There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.
Topics: Adult; Cesarean Section; Female; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Pregnancy; Pulmonary Artery; Pulmonary Atresia
PubMed: 33812372
DOI: 10.1186/s13256-021-02750-4 -
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 -
Annals of the Academy of Medicine,... Mar 2021
Topics: Angioplasty, Balloon; Chronic Disease; Endarterectomy; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Embolism; Singapore
PubMed: 33855327
DOI: 10.47102/annals-acadmedsg.2020126 -
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 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 -
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 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 -
Scientific Reports Nov 2023To facilitate pre-clinical animal and in-silico clinical trials for implantable pulmonary artery pressure sensors, understanding the respective species pulmonary...
To facilitate pre-clinical animal and in-silico clinical trials for implantable pulmonary artery pressure sensors, understanding the respective species pulmonary arteries (PA) anatomy is important. Thus, morphological parameters describing PA of pigs and sheep, which are common animal models, were compared with humans. Retrospective computed tomography data of 41 domestic pigs (82.6 ± 18.8 kg), 14 sheep (49.1 ± 6.9 kg), and 49 patients (76.8 ± 18.2 kg) were used for reconstruction of the subject-specific PA anatomy. 3D surface geometries including main, left, and right PA as well as LPA and RPA side branches were manually reconstructed. Then, specific geometric parameters (length, diameters, taper, bifurcation angle, curvature, and cross-section enlargement) affecting device implantation and post-interventional device effect and efficacy were automatically calculated. For both animal models, significant differences to the human anatomy for most geometric parameters were found, even though the respective parameters' distributions also featured relevant overlap. Out of the two animal models, sheep seem to be better suitable for a preclinical study when considering only PA morphology. Reconstructed geometries are provided as open data for future studies. These findings support planning of preclinical studies and will help to evaluate the results of animal trials.
Topics: Humans; Sheep; Animals; Swine; Pulmonary Artery; Retrospective Studies; Tomography, X-Ray Computed; Sus scrofa; Hypertrophy
PubMed: 37980386
DOI: 10.1038/s41598-023-47532-8