Main Trunk Of Pulmonary Artery Research Articles

Thrombus or tumor? A case report of a rare sarcoma entity: intimal sarcoma of the pulmonary arteries

BackgroundTumor embolism is a very rare primary manifestation of cancers and the diagnosis is challenging, especially if located in the pulmonary arteries, where it can mimic nonmalignant pulmonary embolism. Intimal sarcoma is one of the least commonly reported primary tumors of vessels with only a few cases reported worldwide. A typical location of this malignancy is the pulmonary artery. Herein, we present a case report of an intimal sarcoma with primary manifestation in the pulmonary arteries.Case summaryA 53-year-old male initially presented with dyspnea. On imaging, a pulmonary artery embolism was detected and was followed by thrombectomy of the right ventricular outflow tract, main pulmonary artery trunk, and right pulmonary artery after ineffective lysis therapy. Complementary imaging of the chest and abdomen including a PET-CT scan demonstrated no evidence of a primary tumor. Subsequent pathology assessment suggested an intimal sarcoma further confirmed by DNA methylation based molecular analysis. We initiated adjuvant chemotherapy with doxorubicin. Four months after the completion of adjuvant therapy a follow-up scan revealed a local recurrence without distant metastases.DiscussionPrimary pulmonary artery intimal sarcoma (PAS) is an exceedingly rare entity and pathological diagnosis remains challenging. Therefore, the detection of entity-specific molecular alterations is a supporting argument in the diagnostic spectrum. Complete surgical resection is the prognostically most important treatment for intimal cardiac sarcomas. Despite adjuvant chemotherapy, the prognosis of cardiac sarcomas remains very poor. This case of a PAS highlights the difficulty in establishing a diagnosis and the aggressive natural course of the disease.ConclusionIn case of atypical presentation of a pulmonary embolism, a tumor originating from the great vessels should be considered. Molecular pathology techniques support in establishing a reliable diagnosis.

Analysis of characteristics of the location of lower extremity deep vein thrombosis and the site of pulmonary embolism in hospitalized patients

To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis (DVT) and the site of pulmonary embolism in hospitalized patients. The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively. According to the location of lower extremity DVT, the patients were divided into mixed DVT, proximal DVT, and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis. Mixed DVT was referred to the presence of both proximal and distal DVT. According to the involved site of pulmonary artery, pulmonary embolism was divided into three types: main pulmonary artery, left or right pulmonary artery trunk embolism, lobar pulmonary artery embolism and segmental pulmonary artery embolism. The location of lower extremity DVT, the site of pulmonary embolism, the clinical manifestation (shortness of breath, chest tightness, chest pain, hemoptysis, cough, lower limb swelling, lower limb pain, syncope, fever) and risk factors (fracture/trauma, tumor, diabetes, hypertension, atrial fibrillation, infection, surgery, autoimmune diseases, paralysis, pregnancy) of venous thromboembolism (VTE), and the level of D-dimer were analyzed. A total of 209 patients were enrolled finally, including 127 patients with left lower extremity DVT (60.8%) and 82 with right lower extremity DVT (39.2%). Mixed DVT accounted for 39.2%, proximal DVT accounted for 17.3%, and distal DVT accounted for 43.5% (anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%, calf muscular venous thrombosis accounted for 28.7%). The incidences of main pulmonary artery embolism, left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [41.5% (34/82), 38.8% (14/36) vs. 16.2% (5/31), 10.0% (6/60)], with statistically significant differences (all P < 0.05). The incidences of pulmonary segmental artery embolism in the anterior/posterior tibial vein or peroneal vein thrombosis were higher than those in the mixed DVT and proximal DVT [41.9% (13/31) vs. 26.8% (22/82), 30.6% (11/36)], but the difference was not statistically significant (both P > 0.05). The incidences of pulmonary segmental artery embolism in the calf muscular venous thrombosis were significantly higher than those in the mixed DVT and the proximal DVT [66.7% (40/60) vs. 26.8% (22/82), 30.6% (11/36)], and the difference was statistically significant (both P < 0.05). The levels of D-dimer in patients with calf muscular venous thrombosis combined with main pulmonary artery embolism, left or right pulmonary artery trunk embolism were significantly higher than those in patients with calf muscular venous thrombosis combined pulmonary segmental artery embolism (mg/L: 6.08±3.12 vs. 3.66±2.66, P < 0.05). There were no significant differences in D-dimer levels in other patients with DVT combined with pulmonary embolism in different sites. In terms of the clinical manifestations of VTE, the incidences of lower limb swelling in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [54.9% (45/82), vs. 29.0% (9/31), 15.0% (9/60), both P < 0.05], the incidences of lower limb swelling in the proximal DVT were significantly higher than those in the calf muscular venous thrombosis [41.7% (15/63) vs. 15.0% (9/60), P < 0.05], there were no significant difference in the other clinical manifestations among the DVT groups. There was no significant difference in the incidence of VTE risk factors among the groups. The DVT of inpatients mostly occurred in the left lower limb, and the incidence of distal DVT was higher than that of proximal DVT. Mixed DVT and proximal DVT combined with pulmonary embolism mostly occurred in the main pulmonary artery, left or right pulmonary artery trunk, while distal DVT combined with pulmonary embolism mostly occurred in the pulmonary segmental artery. The levels of D-dimer in patients with lower extremity DVT combined with main pulmonary artery or left and right pulmonary artery trunk embolism were higher than those in patients with pulmonary lobe and segmental artery embolism. The incidence of lower extremity swelling in patients with mixed DVT and proximal DVT was higher than that in patients with distal DVT.

Preemptive Bundle Therapy for Subclinical Pulmonary Hypertension After Liver Transplant.

After liver transplant, veno-occlusive disease and infectious complications may result from subclinical pulmonary hypertension. In this retrospective study, we investigated whether our preemptive bundle therapy was effective for subclinical pulmonary hypertension and extrasinusoidal platelet aggregation after liver transplant. After January 2014, nutrition therapy with glutamine, synbiotics, phosphodiesterase 3 inhibitors, prostaglandin E1, prostaglandin I2, closedloop artificial pancreas, and sivelestat has been used to reduce bacterialtranslocation, vascular endothelial cell damage, and extrasinusoidal platelet aggregation, which is administered as preemptive bundle therapy for all livertransplantrecipients. In this study, we evaluated the prognosis of 84 liver transplant recipients who underwent liver transplants through 2018. Subclinical pulmonary hypertension was evaluated in 49 adult liver transplant recipients with an evaluable main pulmonary artery trunk cross-sectional area using enhanced computed tomography in the acute phase after transplant, with 14 of these patients receiving preemptive bundle therapy. Subclinical pulmonary hypertension was reduced in the preemptive bundle therapy group (n = 14) compared with the nontherapy group (n = 35). The preemptive bundle therapy group showed more rapid recovery of platelet, prothrombin time, and bilirubin levels afterlivertransplant compared with the nontherapy group. The prognosis of patients in the preemptive bundle therapy group was significantly better than in the nontherapy group. Extrasinusoidal platelet aggregation was significantly lower in the preemptive bundle therapy group than in the nontherapy group. Preemptive bundle therapy reduced sinusoidal endothelial cell injury, extrasinusoidal platelet aggregation, and subclinical pulmonary hypertension after liver transplant, resulting in good posttransplant recovery.

LARGE SADDLE PULMONARY EMBOLISM WITH RIGHT VENTRICULAR DYSFUNCTION IN AN ASYMPTOMATIC PATIENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Definition of saddle pulmonary embolism (PE) is a visible thromboembolus straddling the bifurcation of the main pulmonary artery trunk. Saddle pulmonary embolism occurs in 5.2% cases in all patients with pulmonary embolism (1). We report an atypical case of an asymptomatic and hemodynamically stable patient with a saddle PE and right ventricular (RV) strain. CASE PRESENTATION: A 65-year-old man with history of schizophrenia, polysubstance abuse on methadone, hepatic fibrosis, lung nodules reported 1 hour of transient chest pain and SOB two days before ER visit. On admission he did not have any symptoms. He denied risk factors for deep venous thrombosis. All vital signs were normal. Clinical examination revealed attenuated pulmonic component of the second heart sound. Electrocardiogram (EKG) revealed new biphasic t-waves in anterior leads. Labs were significant for troponin ultra 0.43 ng/ml. He was initially admitted to CCU for acute myocardial infarction without ST segment elevation in the settings of elevated troponin and new EKG changes of biphasic T waves in anterior leads. Repeated EKG - right axis deviation. Echocardiogram (ECHO- normal left ventricle, RV function was severely reduced and size severely enlarged, abnormal septal motion during diastole and systole consistent with volume and pressure overload and pulmonary pressure of 43 mmHg. CT pulmonary angiography (CTPA) was positive for saddle PE extending into all 5 lobes of the lungs (figure 1). Venous scan of lower extremities revealed deep venous thrombosis of the right popliteal vein. Treatment for PE was initiated with therapeutic dose of anticoagulation therapy. He remained hemodynamically stable and asymptomatic throughout the course and his hospital stay was uneventful and he was discharged on therapeutic dose Apixaban. DISCUSSION: Risk assessment for acute PE includes classification according to hemodynamic instability with patients presenting with hemodynamic instability being high risk for 30 days mortality and requiring reperfusion treatment (systemic thrombolysis or pulmonary embolectomy). Patient with hemodynamic stability but with RV strain on ECHO or CTPA have intermediate high risk and can be treated with parenteral or oral AC and rescue reperfusion if deterioration happens (2). CONCLUSIONS: Conclusion: Patient with RV strain and large saddle PE can remained hemodynamically stable and can adequately be managed with AC therapy. REFERENCE #1: Musani MH. Asymptomatic saddle pulmonary embolism: case report and literature review. Clin Appl Thromb Hemost. 2011 Aug;17(4):337-9. doi: 10.1177/1076029610363588. Epub 2010 Mar 22. PMID: 20308228. REFERENCE #2: Stavros V. Konstantinides, Guy Meyer, Cecilia Becattini, Héctor Bueno, Geert-Jan Geersing, Veli-Pekka Harjola, Menno V. Huisman, Marc Humbert, Catriona Sian Jennings, David Jiménez, Nils Kucher, Irene Marthe Lang, Mareike Lankeit, Roberto Lorusso, Lucia Mazzolai, Nicolas Meneveau, Fionnuala Ní Áinle, Paolo Prandoni, Piotr Pruszczyk, Marc Righini, Adam Torbicki, Eric Van Belle, José Luis Zamorano, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS), European Respiratory Journal 2019; DOI: 10.1183/13993003.01647-2019 DISCLOSURES: no disclosure on file for Moses Bachan; no disclosure on file for Zinobia Khan; No relevant relationships by Mirjana Petrovic Elbaz, source=Web Response No relevant relationships by Robert Siegel, source=Web Response No relevant relationships by Swarnalatha Uday sumathy, source=Web Response

Pulmonary atresia with a ventricular septal defect and left pulmonary artery discontinuity: a case report\xa0

BackgroundUnilateral 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 presentationA 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 376/7 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.ConclusionThere 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.

Bi-ventricular repair of double outlet left ventricle: Experience and review of the literature.

Double-outlet left ventricle (DOLV) is a rare congenital cardiac anomaly. The aorta and the main pulmonary arterial trunk arises predominantly from the left ventricle and is associated with a malaligned ventricular septal defect, various degrees of hypoplasia of the right ventricle, and presence, or absence of pulmonary stenosis. Bi-ventricular repair is the preferred treatment option whenever possible. Multiple techniques for bi-ventricular repair have been described. The best option for DOLV correction is by translocating the pulmonary root from the left ventricle to the right ventricle. In this series, we report four patients who underwent biventricular repair of DOLV with excellent outcomes. This is a retrospective study of four patients who underwent surgical correction of DOLV between January 2014 and December 2018. We collected all patient details from the institute patient record system. Echocardiographic data were obtained from the records. Intraoperative charts were reviewed for further information on the surgical procedure and cardiopulmonary bypass. Postoperative data included survival, functional status, and followup echocardiography. Of the four children, three underwent pulmonary root translocation, and one child underwent a Reparation al etage Ventriculaire (REV) procedure. There was no mortality in our series, and all children are in a stable clinical condition in the recent follow-up, and no re-operations or interventions were required following primary surgical correction. DOLV is anatomically and surgically a challenging subset. Pulmonary root translocation in this anatomy is technically challenging but safe and superior option when compared to other alternative surgical procedures. Pulmonary root translocation can be performed with excellent results, even in infants.

Hemodynamic Characterization Of Pulmonary Artery Hypertension In A Rat

Introduction: Hemodynamic characterization of Pulmonary Artery (PA) hypertension helps to reveal progression of disease of pulmonary vasculature with constrictive remodeling of pulmonary arterioles, leading to right ventricle (RV) dysfunction and right sided HF failure. In this preclinical methodology article, surgical access, controlled mechanical ventilator set up and direct open chest measurements of PA hypertension is described, employing a rat model. Chronic PA injury was induced by single dose of monocrotaline (MCT).&#x0D; Methods &amp; Aims: Setting of controlled mechanical volume ventilation (CMVV) was adjusted to limit its influence on RV preload and LV afterload in the instance of chronic pulmonary disease. Volume-ventilation setting of tidal volume and respiration rate was based on body weight. Isoflurane monoanesthesia was used without any premedication. PA pressures were compared using single and dual pressure catheter at 3-weeks post injury. Initially, single pressure catheter was positioned in the PA to assess data quality, while advanced data comparison (RV and PA pressures) during PA hypertension were made using dual pressure catheter. PA access was performed using “high” RV needle-stab, adjacent to the anatomical area of the PA outflow.&#x0D; Results: Introduction of single pressure catheter was successful and collected data during RV systole and diastole did not produce any major pressure artefacts. Final position in the main PA was guided by using visual cues i.e. distance of pressure sensor on the catheter, accompanied by simultaneous data recording from that location. In case of dual pressure catheter, RV and PA pressure data were successfully collected. During PA hypertension, systolic ranges were (41-52 mmHg) vs. naive (25-30 mmHg); diastolic (21-27 mmHg) vs. (9-14 mmHg); n=4. In PA hypertension, high afterload pressures complicated RV ejection, with PAP cresting about 1mmHg higher than the maximal RVP. During further assessment, RV ejection was complicated by higher PA dicrotic notch pressures, at the end of systole; for hypertension (37-41 mmHg) vs. naïve (16-21mmHg), n=4.&#x0D; Conclusions: This study revealed that good rat pressure data could be collected from the main trunk of PA using an open chest supported by CMVV. In future, hemodynamic influence of respiratory pump in close chest setting and its influence on chronic PA hypertension needs to be analyzed using solid state pressure catheter. To accomplish this, pressure catheter design should be based on rat’s RV and its outflow anatomy.

Establishment of adult right ventricle failure in ovine using a graded, animal-specific pulmonary artery constriction model.

BackgroundRight ventricle failure (RVF) is associated with serious cardiac and pulmonary diseases that contribute significantly to the morbidity and mortality of patients. Currently, the mechanisms of RVF are not fully understood and it is partly due to the lack of large animal models in adult RVF. In this study, we aim to establish a model of RVF in adult ovine and examine the structure and function relations in the RV.MethodsRV pressure overload was induced in adult male sheep by revised pulmonary artery constriction (PAC). Briefly, an adjustable hydraulic occluder was placed around the main pulmonary artery trunk. Then, repeated saline injection was performed at weeks 0, 1, and 4, where the amount of saline was determined in an animal‐specific manner. Healthy, age‐matched male sheep were used as additional controls. Echocardiography was performed bi‐weekly and on week 11 post‐PAC, hemodynamic and biological measurements were obtained.ResultsThis PAC methodology resulted in a marked increase in RV systolic pressure and decreases in stroke volume and tricuspid annular plane systolic excursion, indicating signs of RVF. Significant increases in RV chamber size, wall thickness, and Fulton's index were observed. Cardiomyocyte hypertrophy and collagen accumulation (particularly type III collagen) were evident, and these structural changes were correlated with RV dysfunction.ConclusionIn summary, the animal‐specific, repeated PAC provided a robust approach to induce adult RVF, and this ovine model will offer a useful tool to study the progression and treatment of adult RVF that is translatable to human diseases.

Pulmonary Artery Denervation as an Innovative Treatment for Pulmonary Hypertension With and Without Heart Failure.

Pulmonary hypertension (PH) is categorized into 5 groups based on etiology. The 2 most prevalent forms are pulmonary arterial hypertension (PAH) and PH due to left heart disease (PH-LHD). Therapeutic options do exist for PAH to decrease symptoms and improve functional capacity; however, the mortality rate remains high and clinical improvements are limited. PH-LHD is the most common cause of PH; however, no treatment exists and the use of PAH-therapies is discouraged. Pulmonary artery denervation (PADN) is an innovative catheter-based ablation technique targeting the afferent and efferent fibers of a baroreceptor reflex in the main pulmonary artery (PA) trunk and its bifurcation. This reflex is involved in the elevation of the PA pressure seen in PH. Since 2013, both animal trials and human trials have shown the efficacy of PADN in improving PAH, including improved hemodynamic parameters, increased functional capacity, decreased PA remodeling, and much more. PADN has been shown to decrease the rate of rehospitalization, PH-related complications, and death, and is an overall safe procedure. PADN has also been shown to be effective for PH-LHD. Additional therapeutic mechanisms and benefits of PADN are discussed along with new PADN techniques. PADN has shown efficacy and safety as a potential treatment option for PH.

P701 Usefulness of echocardiography in diagnosis and monitoring in patient with pulmonary embolism during pregnancy, a case report

Abstract Pulmonary embolism is one of the leading causes of maternal mortality despite a low incidence of during pregnancy. We present 32-year-old woman, in the 35 week of first pregnancy, admitted to the Intensive Care Unit with dyspnea, tachycardia, cyanosis. Echocardiography confirmed the presence of embolic material in the main trunk of pulmonary artery, spreading to the right pulmonary artery. D-dimer and troponin T level were elevated, BNP remained within the normal range. The risk in PESI scale was assumed as intermediate high. LMWH therapy was initiated, the patient was constantly monitored. Venous thrombotic disease in lower extremities was excluded by ultrasonography. The treatment was carried out under obstetric supervision. The clinical state gradually improved, the patient was hemodynamically stable. Serial echocardiographic testing, revealed gradual regression of changes in the pulmonary trunk. Normalization of troponins and lowering of BNP levels were observed. The pregnancy was terminated in 39 week, by cesarean section (obstetric indications). The LMWH was continued few days after delivery, as the patient started lactation. She decided to terminate lactation in a first week after delivery so the therapy was switched into rivaroxaban for at least 3 months. Echocardiography after 3 month confirmed lack of changes in pulmonary trunk, the risk of pulmonary hypertension was low. Echocardiography can be a method of choice for confirming and monitoring pulmonary embolism during pregnancy, in a situation of high or intermediate clinical risk and good visualization of changes in pulmonary arteries Abstract P701 Figure. Embolism of pulmonary trunk and RPA

P1802 Prevalence and prognostic significance of pulmonary artery aneurysms in patients with pulmonary artery hypertension

Abstract Background Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH) and can be accompanied by various complications. Objective The aim of the this study is to evaluate the characteristics of cardiac dysfunction and the prognostic impact of PAA by analysing the outcome of patients with PAH complicated by PAA. Methods We performed echocardiography and right-heart catheterization in 130 PAH patients. We measured the maximum dimensions of the main pulmonary artery (MPA) trunk. We evaluated the right ventricular (RV) function and the five-year prognosis of patients with PAA. Results The maximum MPA trunk diameter of &amp;gt;40 mm by echocardiography was defined as PAA. PAA appeared in 32 of the 130 PAH patients (24.6%: Group PAA), other 98 patients were defined as Group non-PAA. Systolic pulmonary artery pressure (76 ±18 vs. 61 ± 21 mmHg, P = 0.0008) and mean right atrial pressure (10.0 ± 8.1 vs. 5.4 ± 3.8 mmHg, P &amp;lt; 0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index was significantly larger (37.3 ± 8.8 vs. 32.3 ± 7.8 mmHg, P = 0.0048), and RV fractional area change (32 ± 8 vs. 36 ± 9 %, P = 0.0176) and RV longitudinal strain amplitude (-16 ±5 vs. -20 ± 6, P = 0.0017) were significantly lower in Group PAA than those in Group non-PAA. During the five-year follow-up period, 20 patients (15%) died. The five-year mortality rate was significantly higher in Group PAA compared to Group non-PAA (30% vs. 10%, P = 0.007). Conclusion In PAH patients with PAA, RV dysfunction was more severe and the prognosis was poor. Assessment of PAA can be a useful index for the extraction of high-risk PAH patients.

Lung transplantation for pulmonary hypertension with giant pulmonary artery aneurysm

BackgroundAneurysm 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. MethodsWe performed a retrospective single-center analysis of patients with PAH and a severe PAA who underwent lung transplantation between January 1996 and November 2018. ResultsA 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. ConclusionsTo 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.

Main pulmonary artery diameter assessment in a large sample of Indian population: a MDCT based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The gold standard for pulmonary artery pressure measurement is right heart catheterization but its invasive nature precludes its routine use. Main pulmonary arterial trunk calibre increase is a strong indicator of underlying pulmonary arterial hypertension. MDCT can accurately measure the diameter of main pulmonary artery. The objective of the study was to establish the normative values of main pulmonary artery caliber using contrast enhanced CT and try to ascertain any significant difference in main pulmonary artery calibers between two genders and correlation of age and main pulmonary artery diameter.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Contrast enhanced CT images of 462 subjects were analysed on a PACS workstation monitor and widest diameter perpendicular to long axis of the main pulmonary artery as seen on reformatted axial image was measured with electronic caliper tool at the level of the main pulmonary artery bifurcation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean main pulmonary artery diameter in females was 22.54±2.19 mm and 23.34±3.06 mm in males. The mean pulmonary artery diameter in males was larger than females with statistically significant difference seen (p&amp;lt;0.05). The correlation coefficient between age of whole sample and their mean main pulmonary artery was found to be 0.1006 with no statistically significant difference.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is a statistically significant difference in the mean main pulmonary artery calibre between males and females with no strong correlation between the age and mean main pulmonary artery calibre. Further studies are warranted to find the complex interaction between main pulmonary artery diameter and sex, age and body mass index.&lt;/p&gt;

Prenatal ultrasonic diagnosis of anomalous origin of one pulmonary artery from the aorta and literature review

Objective To summarize the prenatal ultrasonographic characteristics of anomalous origin of one pulmonary artery from the aorta(AOPA), and describe the diagnostic and clinical outcomes of fetal AOPA. Methods Echocardiographic characteristics of 3 fetuses with AOPA were reviewed. The ultrasonographic features were comparatively analyzed with postpartum autopsy findings. The relevant literature were reviewed and the experience of prenatal diagnosis of AOPA were summarized. Results In 3 cases with AOPA, 2 cases were the proximal type and anomalous origin of right pulmonary artery from the aorta, of them, one was accompanied with coarctation of the aorta, the other was accompanied with aortopulmonary window. One case was the distal type and anomalous origin of left pulmonary artery from the left innominate aorta, it was only associated with mirror right aortic arch and right ductus arteriosus. Ultrasound characteristics were no bifurcation in distal pulmonary artery, main trunk of pulmonary artery extends directly to one branch, the other branch originated from the ascending aorta or left innominate artery. Three cases were confirmed by postpartum autopsy. Conclusions There are some characteristic signs on ultrasonic features of AOPA. Prenatal ultrasound has important value for diagnosis of AOPA. Key words: Echocardiography; Fetus; Anomalous origin of one pulmonary artery from the aorta

Migration of a Temporary Epicardial Pacing Wire to the Main Pulmonary Artery Trunk During the Acute Phase After Cardiac Surgery

Migration of a Temporary Epicardial Pacing Wire to the Main Pulmonary Artery Trunk During the Acute Phase After Cardiac Surgery

Novel aortic arch reconstruction using a modified Norwood procedure based on hypoplastic left heart syndrome-specific anatomical malformations

Postoperative left pulmonary artery (PA) or bronchus compression occasionally follows narrowing of the retroaortic space after the Norwood procedure. We examined hypoplastic left heart syndrome (HLHS)-specific anatomical malformations and hypothesized that a long main pulmonary arterial trunk might contribute to a larger retroaortic space. In this study, we introduced a modified Norwood procedure [pulmonary artery trunk-saving method (PATS)] and evaluated the results. HLHS-specific anatomical malformations were examined using computed tomographic data from 23 consecutive patients who underwent bilateral pulmonary banding. Fourteen patients had HLHS or associated conditions (Group H), and 9 patients had other complex cardiac defects and underwent biventricular repair (Group B). Five consecutive HLHS patients underwent PATS as a modified Norwood operation, and 6 controls underwent a conventional Norwood procedure. We used computed tomography to measure the lengths of the aorta and PA and the angle of both pulmonary branches to evaluate the effect of PATS. Preoperative examination confirmed HLHS-specific right PA branching adjacent to the pulmonary valve and a trend towards a shorter main pulmonary arterial trunk with the conventional Norwood procedure. Also, both right and left pulmonary arterial branching from the dorsal aspect of the main pulmonary arterial trunk and the PA branch angle were minimal in HLHS patients. Postoperative data showed the retroaortic space behind the reconstructed neoaorta was significantly wider in PATS patients than in conventional Norwood patients. Longitudinal measurements (between the aortic arch and pulmonary valve) and sagittal measurements (ascending aorta to descending aorta) were larger in PATS patients, and no left PA or airway obstruction was observed following PATS. PATS resulted in a wider aortopulmonary space without left pulmonary arterial stenosis or bronchus obstruction. HLHS-specific anatomical malformations suggested that PATS may avoid extrinsic compression of the left PA and bronchus by the neoaorta and can be an alternative for HLHS patients.

Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers.

Considering that pneumonectomy itself is a disease, avoidance of pneumonectomy needs to be deliberated. Herein, we evaluated the role of neoadjuvant chemoradiotherapy for avoidance of pneumonectomy in patients with centrally located locally advanced non-small cell lung cancer. Patients who underwent neoadjuvant chemoradiotherapy after being judged to require pneumonectomy by cancer board between 1997 and 2011 were retrospectively evaluated. Twelve patients, including 10 males and 2 females with median age 63.5years, were referred. Clinical stage was IB (1 patient), IIB (2 patients), IIIA (8 patients), and IIIB (1 patient). There were no disease progression after neoadjuvant chemoradiotherapy, and all patients underwent curative resection. For 8 patients, pneumonectomy was avoided, with 3 bronchoplasties and 3 pulmonary arterial angioplasties. We had 4 pneumonectomies: three cases of metastatic enlarged lymph nodes invading either the carina or a more central portion of the pulmonary artery than the left A3 branch or vein which needs incision of the inner pericardium and 1 case with a tumor involving the upper lobe bronchus to the inferior lobe bronchus. There were no postoperative deaths and 1 case of bronchopleural fistula. The 5-year disease-free and overall survival rates were 55.6 and 72.7% without stump or anastomotic recurrence. Neoadjuvant chemoradiotherapy for centrally located NSCLC appeared to be a useful treatment option for avoiding pneumonectomy without impairing curability and safety, especially in highly selected cases without invasion to carina or right-or-left main trunk of pulmonary artery or vein at pretreatment.

Cardiac dysfunction of pulmonary artery aneurysm in patients with pulmonary arterial hypertension

BackgroundPulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH). We evaluated the characteristics of cardiac dysfunction in patients with PAH complicated by PAA. MethodsEchocardiography and right-heart catheterization were performed in 130 PAH patients to measure the maximum dimensions of the main pulmonary artery (MPA) trunk and evaluate right ventricular (RV) and left ventricular (LV) function. ResultsA diameter of >40mm was defined as PAA in the MPA trunk. The maximum MPA diameter was >40mm in 32 of 130 PAH patients (24.6%: Group PAA). Systolic pulmonary artery pressure (68.0±18.5 vs. 58.9±21.6mm Hg, P=0.0354) and pulmonary capillary wedge pressure (10.8±3.9 vs. 7.7±2.6mm Hg, P<0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index (19.6±6.8 vs. 14.9±5.1 cm²/m², P<0.0001), and RV fractional area change (32.3±7.8 vs. 37.3±8.8%, P=0.0048) and RV longitudinal strain (−15.4±5.1 vs. −20.4±6.1, P=0.0012) were significantly lower, and E/e′ was significantly higher (8.1±2.2 vs. 6.7±1.4, P=0.0002) in Group PAA than in Group non-PAA. ConclusionsIn PAH patients with PAA, RV was larger and RV dysfunction was more severe, and LV diastolic dysfunction appeared. It is important to investigate the appearance of PAA and the severity of RV and LV dysfunction in PAH patients with PAA.

Anomalous Bronchial Arteries Originating from a Common Bronchial Arterial Trunk Detected by Trans-Esophageal Echocardiography: A Multi-Faceted Imaging Approach

A 56-year-old male presented to the hospital with fever, chills and malaise. His past medical history included; coronary artery disease status post coronary artery bypass graft surgery, chronic severe mitral regurgitation, monoclonal gammopathy of undetermined significance and chronic portal vein thrombosis. Vital signs demonstrated a blood pressure of 130/70 mmHg, heart rate of 110 bpm and normal temperature. The physical examination was unremarkable except for an apical pan-systolic murmur. Two sets of blood culture revealed Group B streptococci. A transesophageal echocardiogram (TEE) showed mobile vegetation attached to the mitral valve anterior leaflet with severe mitral regurgitation. Additionally, an abnormal continuous turbulent flow with systolic augmentation was noted posterior to the main pulmonary artery trunk. The Peak systolic velocity of this jet was 1.8-2.0 m/s. The high aliasing velocity, the spectral Doppler profile and flow proximity to pulmonary trunk were consistent with an aortic origin of the flow. A cardiac CT angiogram revealed a completely occluded venous graft to the right coronary artery and a patent graft to the obtuse marginal branch. An incidental finding was an anomalous common bronchial artery (BA) trunk arising from the proximal descending thoracic aorta. It gave rise to a large, tortuous right and small left BA. To the best of our knowledge this is the first case report of an anomalous BA detected by TEE. In our patient, two mechanisms may explain the extensive dilatation and tortuosity of the BA system: increased left atrial pressure from chronic severe mitral regurgitation and chronic pulmonary hypertension

The electrocardiographic characteristics of an acute embolism in the pulmonary trunk and the main pulmonary arteries

ObjectivePulmonary embolism (PE) is a common cardiovascular disease that can be easily missed or misdiagnosed. Electrocardiogram (ECG) is valuable in making early diagnoses and performing risk stratification with regard to acute PE. MethodsA total of 147 hospitalized patients diagnosed with acute PE were enrolled in this study and divided into the following 2 groups: main pulmonary artery trunk or main pulmonary artery (MPA) embolism and lobar artery or remote branch embolism. Electrocardiographic abnormalities associated with acute PE were subsequently identified. ResultsElectrocardiographic abnormalities were significantly different between the pulmonary trunk/MPA embolism group and the lobar artery/remote branch embolism group. The incidence of pulmonary trunk/MPA emboli was significantly related to the number of ECG abnormalities (t = −7.086, P = 5.556e-11). Furthermore, the number of ECG abnormalities noted among patients with pulmonary trunk/MPA emboli was 5.276 times greater than the number observed among the lobar artery/remote branch embolism group (P < .001, 95% confidence interval = −6.57 to 3.97). The risk of either moderate or severe right ventricular hypertrophy was increased by 16.18% among patients with either pulmonary trunk or MPA emboli compared with patients with either lobar artery or remote branch emboli (P < .001, 95% confidence interval = −2.76 to 0.876). The correct classification rate was as high as 92.3% when ECG was used to classify the prognosis of PE patients. ConclusionsThe number of ECG abnormalities and the degree of right ventricular hypertrophy as determined via ECG can be used to assess the probability of developing a PE in the pulmonary trunk and MPA. Furthermore, ECGs can assist clinicians with risk stratification.