Compression Of Pulmonary Artery Research Articles

Mediastinal fibrosis as a puzzling presentation: A clinical conundrum in rheumatology: A case report

Granulomatosis with polyangiitis (GPA) is a type of small vessel vasculitis, most commonly involving the respiratory tract and kidneys. It can occasionally present with mass-like lesions at various sites, including the brain, orbit, skin, genitals, retroperitoneum, and mediastinum. Presentation with mediastinal fibrosis is rare and less commonly recognized. The current study presents the case of a mediastinal mass causing pulmonary artery compression and subsequent pulmonary hypertension (PH) that required stenting. Despite inconclusive mediastinal biopsy results, the integration of clinical, radiological, and laboratory findings led to the diagnosis of ANCA-associated vasculitis, highlighting the challenges and necessity of a multi-modal diagnostic approach in real-world clinical scenarios. This case underscores the importance of considering ANCA-associated vasculitis as a potential etiology in patients presenting with mediastinal fibrosis. Early recognition and appropriate management are crucial in optimizing outcomes for patients with this rare and challenging manifestation.

Compression of the left main coronary artery by a pulmonary artery aneurysm – treated with endovascular approach

Pulmonary artery aneurysms (PAAs) are rare with non-specific clinical presentation but may lead to serious complications such as pulmonary artery dissection, rupture and compression of the left main coronary artery (LMCA). Their complications and PAA association with pulmonary hypertension lead to significant morbidity and mortality. The standard treatment strategy is surgical correction of the aneurysm, however percutaneous coronary intervention in patients with clinically significant compression of the LMCA, due to PAA should be considered as a possible treatment approach. In this article, we present a case report of a 73-year-old with polymorbidity, presenting with an acute coronary syndrome, caused by extrinsic compression of the LMCA by PAA. Due to the high surgical risk, we adopted an endovascular approach with stenting of the compressed LMCA with successful restoration of the blood flow and clinical stabilization. In this case, a percutaneous coronary intervention proved to be a safe and effective treatment option for selected patients, who are at high operative risk. 

Perioperative Management of an Adolescent Fontan Patient with Narrowing of the Aortopulmonary Space for Posterior Scoliosis Surgery

Congenital cardiac patients who received neonatal reconstructive aortic arch surgery are at risk of aortopulmonary space narrowing with compression of the left pulmonary artery and left main bronchus (LMB) later in life. We discuss a challenging adolescent single ventricle patient who presented for surgical treatment of a non-idiopathic thoracic scoliosis (posterior spinal fusion) with severe stenosis of the LMB and left pulmonary artery due to a narrow aortopulmonary space. Careful preoperative imaging, evaluation, and decision making resulted in successful surgical treatment and uneventful perioperative course.

Eisenmenger syndrome with left main compression syndrome: a case report

BackgroundLeft main coronary artery disease secondary to pulmonary artery compression related to Eisenmenger syndrome is an under-suspected condition that can cause fatal outcomes if left untreated. It presents with typical angina but is frequently mistaken for pulmonary hypertension (PH) symptoms. It is now recognized as one of the few important causes of angina in PH.Case presentationA 37-year-old man with a history of unoperated atrial septal defect and Eisenmenger syndrome came to the outpatient department with a chief complaint of angina on exertion. Electrocardiogram showed regular sinus rhythm with right axis deviation, right ventricular hypertrophy, deep T-wave inversion in inferior and anterior leads suggestive of ischemia or strain, and incomplete right bundle branch block. Cardiac CT showed compression of the left main coronary artery due to a dilated main pulmonary artery. Therefore, this patient was diagnosed with Eisenmenger syndrome with left main compression due to dilated pulmonary artery. He was treated successfully with IVUS-guided stent implantation. The patient experienced marked improvement in regular activities, with no recurrence of angina symptoms. Angiography 3 months after the procedure revealed good patency of the stent, without significant stenosis.ConclusionsLeft main coronary artery compression is a complication that should be suspected in patients with Eisenmenger syndrome presenting with angina symptoms. Non-invasive modalities are recommended for diagnostic evaluation, but the gold-standard technique remains coronary angiography. The best treatment is not well-established, with either myocardial revascularization or PH treatment, but a left main coronary artery stenting procedure is considered an ideal emergent treatment to provide a better quality of life for patients in this condition.

Ascending aortic extension to increase aortopulmonary space after comprehensive stage II palliation.

Aortic reconstruction at the time of the comprehensive stage II (CSII) procedure can be complicated by compression within the aortopulmonary space resulting in airway or pulmonary artery narrowing. We describe our experience with 2 patients with hypoplastic left heart syndrome and pulmonary artery stenosis after the CSII procedure. Both patients underwent an aortic extension with a Hemashield interposition graft to open up the aortopulmonary space. The patients were discharged from the hospital. In all cases the aortopulmonary space was enlarged, and the pulmonary arteries and airway were free from compression. Aortic extension is an option to be considered in children with pulmonary artery compression who previously had a CSII procedure.

Atypical bilateral ventilation/perfusion mismatches in an asymptomatic patient suffering from metastatic thyroid cancer

BackgroundPulmonary embolism is indicated by ventilation/perfusion (V/P) mismatches in ventilation/perfusion scintigraphy. However, other pathologies may also evoke segmental or lobar mismatches. Thus, diagnosis can be difficult in asymptomatic patients with equivocal clinical presentation.Case presentationWe present a case of multiple bilateral pulmonary ventilation/perfusion mismatches in a poorly differentiated thyroid cancer patient. Exact diagnosis was difficult, as the patient was asymptomatic and pulmonary embolism is commonly unilateral in tumour patients and not typical for thyroid cancer. External pulmonary artery compression by aortic aneurysm, multiple metastases or additional bronchopulmonary malignancies were considered as differential diagnosis. After unilateral pulmonary and hilar metastasectomy, perfusion normalised on the operated side. Pulmonary perfusion defects due to pulmonary artery compression by hilar metastases were finally diagnosed. Pulmonary embolism was deemed unlikely due to the left-sided post-operative normalisation, persistence of right-sided V/P mismatches, and the lack of clinical symptoms.ConclusionPulmonary artery compression may mimic pulmonary artery embolism in lung perfusion scintigraphy and should be considered in bronchopulmonary tumour patients with hilar metastases and unilateral ventilation/perfusion mismatches affecting a complete lobe or even lung. Following the presented case, also bilateral segmental and subsegmental mismatches in patients with hilar metastases from non-bronchopulmonary cancer entities should be carefully evaluated.

Main pulmonary artery compression by a giant aneurysm associated with a coronary-pulmonary artery fistula.

Main pulmonary artery compression by a giant aneurysm associated with a coronary-pulmonary artery fistula.

Extrinsic compression of coronary and pulmonary vasculature.

Coronary artery disease from atherosclerosis induced stenosis remains the leading cause of acute coronary syndrome (ACS) and death worldwide, however extrinsic compression of coronary arteries from adjacent anatomical and pathological structures is an infrequent but important diagnosis to be aware of, especially given the nonspecific symptoms of chest pain that mimic angina in patients with pulmonary hypertension (PHT) and congenital heart disease. Non-invasive CT angiography is an invaluable diagnostic tool for detection of coronary artery compression, pulmonary artery dilatation and pulmonary vascular compression. Although established guidelines are not available for management of left main coronary artery (LMCA) compression syndrome, percutaneous coronary intervention and stent implantation remain a feasible option for the treatment, specifically for patients with a high surgical risk. Treatment of pulmonary vein or artery compression is more varied and determined by etiology. This review article is focused on detailed discussion of extrinsic compression of coronary arteries, mainly the LMCA and brief discussion on pulmonary vasculature compression by surrounding anatomical and pathological entities, with focus on pathophysiology, clinical features, complications and role of imaging in its diagnosis and management.

Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation.

Pulmonary artery (PA) compression by the neoaorta is a serious complication after the Norwood-type palliation (NP) for hypoplastic left heart syndrome. Either excess patch tailoring or limited use of autologous tissue may cause narrowing of the subaortic space. The chimney technique could theoretically provide a wide subaortic space. Twenty-nine patients with both pre- and post-NP computed tomography data available of the 37 consecutive patients who underwent NP in our institution were reviewed. Arch height, arch width, sinus of Valsalva diameter, area under the neoaortic arch and arch angle were measured. These patients were divided according to the neo-arch reconstruction technique, chimney reconstruction technique (CR) or conventional direct reconstruction technique (DR). Median age and weight at NP were 2.1 months and 3.5 kg, respectively. Twenty-two patients underwent previous bilateral PA banding. During NP, 17 CR and 12 DR were performed. Four patients in the DR group developed PA compression. No neoaortic arch dilatation was found in either group. Post-NP arch width, area under the neo-arch and the arch angle were significantly larger in the CR group. Pre-NP arch height was significantly smaller in DR patients with PA compression than in those without. The chimney technique decreased the risk of PA compression and provided a wider subaortic space and a less acute arch angle. This technique had no short-term effect on the neoaortic root. Small preoperative arch height is a potential risk factor for PA compression in DR, and the chimney technique could be an effective solution.

High Glucose Metabolism in the Right Ventricular Myocardium Due to Extrinsic Pulmonary Stenosis by Mediastinal Lymphoma.

Acquired pulmonary stenosis in adults is rare and is usually caused by extrinsic compression from a mediastinal tumor. We present a case of anterior mediastinal Hodgkin lymphoma, who presented with cough and hemoptysis. Compression of the bilateral pulmonary arteries by the mediastinal mass was demonstrated by transthoracic echocardiography and CT pulmonary angiography. FDG PET/CT showed diffusely increased FDG uptake in right ventricular myocardium in addition to lymphomatous involvement of the lymph nodes and spleen.

Arch Repair Technique (Pulmonary Artery Trunk Saving) in the Norwood Procedure

The classic first stage of the Norwood procedure uses a homograft patch enlargement to obtain an unobstructed aorta and coronary arteries due to insufficient native tissue to reconstruct a neo aorta. However, there are some possible disadvantages of the homograft, such as lack of growth, degeneration, calcification, and unavailability. The pulmonary artery trunk saving technique was developed as a no-patch technique to minimize patch augmentation during the reconstruction of the neo aorta in the Norwood procedure. The pulmonary artery trunk was longer and narrowed, to make the left aortopulmonary space wider, to avoid extrinsic compression of the left pulmonary artery and bronchus by the neo aorta. This technique was developed based on the advantages of the anatomy of specific great vessels in patients with hypoplastic left heart syndrome.

671 Myocardial Infarction Due to Left Main Coronary Artery Compression in Eisenmenger’s Syndrome

Compression of the left main coronary artery (LMCA) is increasingly recognised as a cause of angina, myocardial infarction and sudden death in patients with pulmonary hypertension [[1]Gailé N. Saia F. Pallazini M. et al.Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina.JACC. 2017; 69: 2808-28017Crossref Scopus (70) Google Scholar,[2]Demerouti E.A. Manginas A.N. Athanassoupoulos G.D. et al.Complications leading to sudden cardiac death in pulmonary artery hypertension.Resp Care. 2013; 58: 1246-1254Crossref PubMed Scopus (50) Google Scholar]. Here we report a case of myocardial infarction with severe left ventricular dysfunction due to LMCA compression in a patient with Eisenmenger’s Syndrome. A 63-year-old female with Eisenmenger’s Syndrome due to a ventricular septal defect (VSD) and patent ductus arteriosus (PDA) presented with increasing dyspnoea over several weeks. Echocardiography illustrated severe global left ventricular systolic dysfunction (EF 17%), an unrestricted 12mm VSD, dilated and hypertrophied right ventricle with moderate tricuspid and pulmonary regurgitation. Estimated RV systolic pressure was 112mmHg. An ECG was revealed ST-elevation in aVR with widespread ST depression, with an elevated serum troponin of 6.7ug/L (<0.04). The patient had normal coronary angiography 2 years prior. Repeat coronary angiography revealed severe ostial LMCA stenosis due to extrinsic pulmonary artery compression, with the remaining vessels disease free. Percutaneous intervention to the LMCA was performed with a zotarolimus drug eluting stent with excellent angiographic result. Anti-platelets and up-titration of heart failure therapy was initiated. 2 years after discharge, she remains stable with a LVEF of 40% and NHYA Class II symptoms at home with her husband. In patients with pulmonary hypertension, progressive symptoms are often attributed to worsening pulmonary resistance or right heart dysfunction/ischaemia [[1]Gailé N. Saia F. Pallazini M. et al.Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina.JACC. 2017; 69: 2808-28017Crossref Scopus (70) Google Scholar,[3]Gómez A. Bialostozky D. Zajarias A. et al.Right ventricular ischaemia in patients with primary pulmonary hypertension.JACC. 2001; 38: 1137-1142Crossref Scopus (179) Google Scholar]. LMCA compression represents an important and treatable cause of myocardial infarction and LV dysfunction with excellent medium-term outcomes.

P61 CARDIAC TAMPONADE - A SERIOUS COMPLICATION AFTER COLON CONDUIT INTERPOSITION: A CASE REPORT

Abstract Aim Graft redundancy and anastomotic stricture after colon interposition are well-known late complications. Cardiac compression by distended colon conduit is uncommon. There is a few reports in the literature. We present a case of 58-year-old patient with a major dilatation of colon conduit occurred 7 years after esophagectomy and gastrectomy. Case report The patient was admitted to district general hospital with 4-hour history of abdominal pain. Chest X- ray and abdominal computer tomography (CT) scan revealed distended colon conduit, pneumomediastinum, small-bowel ileus and pneumoretroperitoneum. An attempt to insert a nasogastric tube failed and an emergency laparotomy was performed. At operation, a band causing small bowel strangulation and adhesions were divided. The bowel appeared viable and a clear perforation was not found. Resection was not necessery. For next 10 hours, progressing hemodynamic instability and sepsis required intravenous vasoactive medication and orotracheal intubation. Chest CT scan showed massive distention of substernal colon conduit with compression of heart and pulmonary arteries. The patient was referred to our institution. Prompt endoscopy was performed with suction of air and liquid content from colon and nasogastric tube was inserted. The colonic mucosa was viable without necrosis and perforation. Hemodynamics improved immediately after decompression of colonic roll. An exploratory laparotomy revealed fatal extensive ischemia infarction of the bowel and the patient died within 4 hours after surgery. Concluson Extrapericardial cardiac tamponade is a rare complication after substernal esophageal reconstruction and could lead to bowel hypoperfusion or ischemia. Early recognition of symptoms and management with conduit decompression are important.

Emergent radiation therapy to cardiac Ewing's sarcoma with haemodynamic failure due to pulmonary artery compression.

Emergent radiation therapy to cardiac Ewing's sarcoma with haemodynamic failure due to pulmonary artery compression.

Predictors of using extracorporeal membrane oxygenation in lung transplantation

Rationale. Lung transplantation is the only definitive treatment in end-stage pulmonary disease. Extracorporeal membrane oxygenation (ECMO) has been used during surgery in recent years as a replacement for respiratory function; ECMO, however, has some drawbacks: the presence of an extracorporeal circuit, the need for heparinization, potential thrombogenicity that underlies the risks of developing specific complications that worsen the transplantation prognosis. In this regard, it is relevant to study the factors that make it possible to predict the need in intraoperative ECMO in order to avoid its unjustified use.Purpose. To identify predictors for intraoperative use of ECMO in lung transplantation.Material and methods. The medical records of patients who underwent lung transplantation in the Sklifosovsky Research Institute for Emergency Medicine from May 2011 to July 2017 were retrospectively reviewed. Forty nine bilateral lung transplantations were made where 15 patients (30.6%) had lung transplantation performed without ECMO, and 34 (69.4%) underwent lung transplantation and ECMO. A central veno-arterial connection was used in all patients. The study analyzed various factors of patient condition at baseline and identified the most significant of them that enabled to predict the need of ECMO use at surgery with a high degree of probability, avoiding episodes of gas exchange and hemodynamic impairments, the prolongation of surgery, and, therefore, the graft ischemia time.Results. As assessed in this study, pulmonary hypertension was the only predictor of an increased likelihood of using ECMO. The probability of connection to ECMO statistically significantly increased in the patients with systolic pulmonary artery pressure higher 50 mm Hg (p&lt;0.05).Conclusion. The presence of pulmonary hypertension &gt; 50 mm Hg determines the preventive use of ECMO during lung transplantation, which should reduce the number of uncontrolled emergencies during the main stages of surgical intervention; in all other cases, ECMO should be connected basing either on the pulmonary artery compression test results or when indicated.

Pulmonary Artery Aneurysm Causing Left Main Coronary Artery Disease

Pulmonary artery aneurysm is a rare clinical condition but may lead to serious complications such as pulmonary artery dissection, rupture and compression of left main coronary artery. The relation between the pulmonary artery and the adjacent structures should be considered after the diagnosis of the aneurysm. Surgery is suggested in the patients with increased diameter of the pulmonary artery or symptoms caused by the compression to the neighborhood tissues. In this case, we are reporting a 52-year-old female patient with pulmonary artery aneurysm causing the compression of left main coronary artery and presenting with chest pain. Owing to the successful surgical correction of the aneurysm, the compression of the left main coronary artery was removed. Relief of the coronary artery from the compression might be enough to improve symptoms in the patients with pulmonary artery aneurysm.

Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned.

Sinus of Valsalva (SOV) aneurysms are rare and data on operative management are limited. They can cause right ventricular outflow tract or pulmonary artery compression, and rupture may be fatal. In this study, we describe our experience with the repair of 13 SOV aneurysms. All patients who underwent SOV aneurysm repair from May 2001 to December 2017 at our single tertiary referral center were reviewed retrospectively. Thirteen patients (92% male) with a mean age of 60 years underwent repair of an SOV aneurysm; mean aneurysm diameter was 5.9 ± 0.8 cm and four patients (30.7%) presented with rupture into another cardiac chamber. Operative interventions included six Bentall procedures, five patch repairs (one with aortic valve replacement [AVR]), and two primary aneurysm closures both with concomitant AVR. There were no strokes, myocardial infarctions, re-explorations, or deaths in the postoperative period. After an average of 2.25 years, computed tomographic imaging in five patients demonstrated no aneurysm recurrence. Surgery is a safe option for both ruptured and nonruptured SOV aneurysms. A variety of repair strategies may be used. Larger studies are needed.

Pulmonary Artery Compression Facilitates Intersegmental Border Visualization

Intravenous indocyanine green injection is useful for the identification of the intersegmental border by infrared thoracoscopy during anatomic segmentectomy. However, surgeons encounter cases in which visualization of the intersegmental border is difficult. In particular, intravenous indocyanine green fluorescence in the upper lobe is occasionally obscured by to the relatively lesser blood flow in the upper lobe pulmonary arteries. This report describes an interlobar pulmonary artery compression method that is a simple and effective technique for clearly visualizing the intersegmental border through infrared thoracoscopy with intravenous indocyanine green during upper lobe segmentectomy.

Double Compression of Left Atrium and Pulmonary Artery by a Huge Descending Aortic Aneurysm with Intramural Hematoma Mimicking Pulmonary Embolism: A Case Report

Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1 week later with significant improvement. However she remained hypotensive.

Left atrium and pulmonary artery compression due to aortic aneurysm causing heart failure symptoms

Left atrium and pulmonary artery compression due to aortic aneurysm causing heart failure symptoms