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Clinical Cardiology Aug 1997This five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the... (Review)
Review
This five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part I of this five-part review discusses general concepts of aorta anatomy and aortic dissection.
Topics: Aortic Dissection; Aortic Aneurysm; Aortic Diseases; Arteriosclerosis; Humans; Pulmonary Artery
PubMed: 9259168
DOI: 10.1002/clc.4960200813 -
Multimedia Manual of Cardiothoracic... Oct 2021This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port....
This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port. The procedure begins with division of the inferior pulmonary ligament and isolation of the inferior pulmonary vein. This patient has densely adherent interlobar nodes, which are then dissected to demonstrate the interlobar pulmonary artery. Then we proceed to divide the anterior part of the fissure after identifying and safeguarding the lingular branches of the pulmonary artery. This step is followed by the division of the posterior part of the fissure after identification of the posterior branches of the pulmonary artery to the upper lobe. Then we identify the basilar trunk and divide it using endostaplers. Other branches of the interlobar artery are clearly identified, and the apicobasal artery is taken separately. This is followed by division of the inferior pulmonary vein and a systematic mediastinal nodal dissection.
Topics: Humans; Lung; Lung Neoplasms; Pneumonectomy; Pulmonary Artery; Thoracic Surgery, Video-Assisted
PubMed: 34705352
DOI: 10.1510/mmcts.2021.057 -
Journal of Applied Physiology... May 2011Although the distribution of average fetal pulmonary trunk (PT) blood flow favors the ductus arteriosus (DA) over the lungs, the phasic aspects of this distribution...
Although the distribution of average fetal pulmonary trunk (PT) blood flow favors the ductus arteriosus (DA) over the lungs, the phasic aspects of this distribution during systole and diastole are not well understood. Accordingly, flow profile and wave intensity (WI) analyses were performed at baseline and during brief flow increases accompanying an extrasystole (ES) in 10 anesthetized late-gestation fetal sheep instrumented with PT, DA, and left pulmonary artery (PA) micromanometer catheters and transit-time flow probes. At baseline, 83% of mean PT flow crossed the DA and 17% entered the lungs. However, early systolic flow associated with a forward-running compression wave (FCW(is)) was higher in the PA and predominant DA flow only emerged in midsystole when a large PA backward-running compression wave (BCW(ms)), which reduced PA flow, was transmitted into the DA as a forward-running compression wave (FCW(ms)) that increased flow. Subsequent protodiastolic forward DA flow occurring during pulmonary valve closure was associated with substantial retrograde PA flow, but insignificant PT flow. Conversely, forward DA flow in the remainder of diastole occurred with forward PT but near-zero PA flow. These flow and WI patterns, in conjunction with the results of mathematical modeling, suggest that 1) fetal PT flow preferentially passes into the PA during early systole due to a lower PA-than-DA characteristic impedance, while DA flow predominates in mid- and late systole due to flow effects arising from the PA BCW(ms), and 2) forward DA flow is mainly sustained by reversal of PA flow in protodiastole but discharge of a more central reservoir in diastole.
Topics: Animals; Blood Flow Velocity; Blood Pressure; Ductus Arteriosus; Fetus; Pulmonary Artery; Pulmonary Circulation; Sheep
PubMed: 21393465
DOI: 10.1152/japplphysiol.00038.2011 -
Medical Image Computing and... 2010Congenital heart defect is the primary cause of death in newborns, due to typically complex malformation of the cardiac system. The pulmonary valve and trunk are often...
Congenital heart defect is the primary cause of death in newborns, due to typically complex malformation of the cardiac system. The pulmonary valve and trunk are often affected and require complex clinical management and in most cases surgical or interventional treatment. While minimal invasive methods are emerging, non-invasive imaging-based assessment tools become crucial components in the clinical setting. For advanced evaluation and therapy planning purposes, cardiac Computed Tomography (CT) and cardiac Magnetic Resonance Imaging (cMRI) are important non-invasive investigation techniques with complementary properties. Although, characterized by high temporal resolution, cMRI does not cover the full motion of the pulmonary trunk. The sparse cMRI data acquired in this context include only one 3D scan of the heart in the end-diastolic phase and two 2D planes (long and short axes) over the whole cardiac cycle. In this paper we present a cross-modality framework for the evaluation of the pulmonary trunk, which combines the advantages of both, cardiac CT and cMRI. A patient-specific model is estimated from both modalities using hierarchical learning-based techniques. The pulmonary trunk model is exploited within a novel dynamic regression-based reconstruction to infer the incomplete cMRI temporal information. Extensive experiments performed on 72 cardiac CT and 74 cMRI sequences demonstrated the average speed of 110 seconds and accuracy of 1.4mm for the proposed approach. To the best of our knowledge this is the first dynamic model of the pulmonary trunk and right ventricle outflow track estimated from sparse 4D cMRI data.
Topics: Algorithms; Heart Defects, Congenital; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Pattern Recognition, Automated; Pulmonary Artery; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Tomography, X-Ray Computed
PubMed: 20879263
DOI: 10.1007/978-3-642-15705-9_56 -
Annals of the Royal College of Surgeons... Oct 1975The branchial arch vessels of the human embryo have been studied by histological and radiographic methods and the modelling that occurs during the period Day 25-Day 52... (Review)
Review
The branchial arch vessels of the human embryo have been studied by histological and radiographic methods and the modelling that occurs during the period Day 25-Day 52 postfertilization is described. It has been shown that the myoendocardial reticulum is reamed out by blood flow and it is suggested that hydrodynamic force is the fundamental factor which determines chamber structure of the heart and flow pattern in the outflow tracts and great vessels. The sixth aortic arch vessels contribute tissue to the pulmonary trunk and proximal pulmonary arteries. The 'postbranchial pulmonary arteries' are morphologically distinct and form the pulmonary arteries at the lung hila. The primitive pulmonary plexus around the tips of the developing tracheobronchial primordia is formed from segmental vessels arising from the dorsal aorta. Bronchial arteries can be demonstrated only late in intrauterine life. The numerous bronchopulmonary precapillary anastomoses which are found in the fetus at this time have been demonstrated radiographically.
Topics: Animals; Aorta; Bronchi; Bronchial Arteries; Child, Preschool; Endocardium; Fetal Heart; Heart; Heart Defects, Congenital; Humans; Infant; Pressure; Pulmonary Artery; Pulmonary Circulation
PubMed: 1103698
DOI: No ID Found -
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 -
Annals of the American Thoracic Society Dec 2014Proper and early identification of patients who harbor serious occult illness is the first step in developing a disease-management strategy. Identification of illnesses... (Review)
Review
Proper and early identification of patients who harbor serious occult illness is the first step in developing a disease-management strategy. Identification of illnesses through the use of noninvasive techniques provides assurance of patient safety and is ideal. PA dilation is easily measured noninvasively and is due to a variety of conditions, including pulmonary hypertension (PH). The clinician should be able to thoroughly assess the significance of PA dilation in each individual patient. This involves knowledge of the ability of PA dilation to accurately predict PH, understand the wide differential diagnosis of causes of PA dilation, and reverse its life-threatening complications. We found that although PA dilation is suggestive of PH, data remain inconclusive regarding its ability to accurately predict PH. At this point, data are insufficient to place PA dilation into a PH risk-score equation. Here we review the causes and complications of PA dilation, define normal and abnormal PA measurements, and summarize the data linking its association to PH, while suggesting an algorithm designed to assist clinicians in patient work-up after recognizing PA dilation.
Topics: Cardiac Catheterization; Diagnostic Imaging; Dilatation, Pathologic; Humans; Hypertension, Pulmonary; Magnetic Resonance Angiography; Pulmonary Artery; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 25406836
DOI: 10.1513/AnnalsATS.201406-253PP -
Thorax Mar 1980The appearance of the endothelial pavement pattern was studied in the pulmonary trunk, pulmonary veins, aorta, and inferior vena cava of the rat by means of silver...
The appearance of the endothelial pavement pattern was studied in the pulmonary trunk, pulmonary veins, aorta, and inferior vena cava of the rat by means of silver staining of the cell borders. The endothelial cell in each of the four blood vessels was found to have its own distinctive shape, fusiform and pointed in the direction of blood flow in the case of the aorta and larger and more rectangular in the pulmonary trunk and pulmonary veins. Detailed quantitation of the dimensions and surface area of the endothelial cells in each blood vessel was carried out by a photographic technique. Pulmonary hypertension was induced in one group of rats by feeding them on Crotalaria spectabilis seeds. The endothelial pavement pattern in their pulmonary trunks became disrupted with many of the cells assuming a fusiform shape reminiscent of aortic endothelium. Many small, new endothelial cells formed in the pulmonary trunk suggesting division of cells to line the enlarging blood vessels. In contrast the endothelial cells of the inferior vena cava merely increased in size to cope with the dilatation of this vein.
Topics: Animals; Aorta; Endothelium; Female; Hypertension, Pulmonary; Photomicrography; Pulmonary Artery; Pulmonary Veins; Rats; Vena Cava, Inferior
PubMed: 7385090
DOI: 10.1136/thx.35.3.186 -
European Respiratory Review : An... Dec 2017The pathobiology of pulmonary arterial hypertension (PAH) is complex and incompletely understood. Although three pathogenic pathways have been relatively well... (Review)
Review
The pathobiology of pulmonary arterial hypertension (PAH) is complex and incompletely understood. Although three pathogenic pathways have been relatively well characterised, it is widely accepted that dysfunction in a multitude of other cellular processes is likely to play a critical role in driving the development of PAH. Currently available therapies, which all target one of the three well-characterised pathways, provide significant benefits for patients; however, PAH remains a progressive and ultimately fatal disease. The development of drugs to target alternative pathogenic pathways is, therefore, an attractive proposition and one that may complement existing treatment regimens to improve outcomes for patients. Considerable research has been undertaken to identify the role of the less well-understood pathways and in this review we will highlight some of the key discoveries and the potential for utility as therapeutic targets.
Topics: Animals; Antihypertensive Agents; Arterial Pressure; Disease Progression; Drug Therapy, Combination; Epithelial-Mesenchymal Transition; Humans; Hypertension, Pulmonary; Pulmonary Artery; Risk Factors; Signal Transduction; Vascular Remodeling; Vascular Stiffness
PubMed: 29263173
DOI: 10.1183/16000617.0093-2017 -
Japanese Journal of Radiology Jun 2021To describe the prognostic value of pulmonary artery (PA) trunk enlargement on the admission of in-hospital patients with severe COVID-19 infection by unenhanced CT...
PURPOSE
To describe the prognostic value of pulmonary artery (PA) trunk enlargement on the admission of in-hospital patients with severe COVID-19 infection by unenhanced CT image.
MATERIALS AND METHODS
In-hospital patients confirmed COVID-19 from January 18, 2020, to March 7, 2020, were retrospectively enrolled. PA trunk diameters on admission and death events were collected to calculate the optimum cutoff using a receiver operating characteristic curve. According to the cutoff, the subjects on admission were divided into two groups. Then the in-hospital various parameters were compared between the two groups to assess the predictive value of PA trunk diameter.
RESULTS
In the 180 enrolled in-hospital patients (46.99 ± 14.95 years; 93 (51.7%) female, 14 patients (7.8%) died during their hospitalization. The optimum cutoff PA trunk diameter to predict in-hospital mortality was > 29 mm with a sensitivity of 92.59% and a specificity of 91.11%. Kaplan-Meier survival curves for PA trunk diameter on admission showed that a PA trunk diameter > 29 mm was a significant predictor of subsequent death (log-rank < 0.001, median survival time of PA > 29 mm was 28 days).
CONCLUSION
PA trunk enlargement can be a useful predictive factor for distinguishing between mild and severe COVID-19 disease progression.
Topics: Adult; COVID-19; Dilatation, Pathologic; Female; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; Prognosis; Pulmonary Artery; ROC Curve; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 33751417
DOI: 10.1007/s11604-021-01094-9