Right Pulmonary Artery Diameter Research Articles

NEW ONSET OF PULMONARY HYPERTENSION IN A PATIENT AFFECTED BY RECURRENT LUNG CANCER

Abstract 39 years old non–smoker female patient came to our observation in July 2023 complaining dyspnea on mild exertion. She had a history of lung adenocarcinoma with epidermal growth factor receptor (EGFR) positive for exon 19 deletion treated with left pneumonectomy and ipsilateral hilar mediastinal lymphadenectomy 5 years earlier, and contralateral disease progression currently treated with chemotherapy. Transthoracic echocardiogram showed circumferential prepericardial effusion requiring pericardiocentesis with transient clinical benefit. Indeed, after a month, she presented with worsening dyspnea and echocardiographic evidence of dilated and hypokinetic right ventricle and severe pulmonary hypertension associated with distal right pulmonary artery stenosis secondary to extrinsic compression by the neoplastic mass as shown by the chest CT scan (fig 1). A right heart catheterization confirmed this finding (minimum diameter of right pulmonary artery of 6 mm, maximum systolic pulmonary blood pressure of 99 mmHg) and a palliative stenting of the distal portion of the right pulmonary artery was performed with resolution of the stenosis, reduction of the pulmonary gradient (fig 2 and 3) and resolution of the dyspnea.

Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

BackgroundFollowing on from an earlier study published in 2008 about left pulmonary artery (LPA) flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia (CDH) and the...

Comparison of CT-Determined Pulmonary Artery Diameter among Smokers and Non-smokers: A Cross-sectional Study

Introduction: Tobacco smoking is a common addiction in our society. The toxic chemical compounds present in tobacco smoke cause epithelial damage and inflammation of the airways. Chronic smoking results in the thickening of the pulmonary arterial wall and vasoconstriction, leading to the development of pulmonary arterial hypertension. Hence, measurement of pulmonary artery diameter using Contrast Enhanced Computed Tomography (CECT) may be helpful in the early detection of pulmonary arterial hypertension. Aim: To compare the diameters of the Main Pulmonary Artery (MPA), Right Pulmonary Artery (RPA), and Left Pulmonary Artery (LPA) using CECT thorax in smokers and non-smokers. Materials and Methods: A cross-sectional study was conducted from April 2021 to March 2022 in the department of radiodiagnosis, KS Hegde Hospital, Karnataka, India, consisting of 100 patients referred for CECT thorax in the age group of 18-85 years. They were divided into two groups: smokers and non-smokers, with 50 patients in each group. They were further categorised into three age groups: < 50 years, 50-60 years, and >60 years. The widest diameters of the MPA were measured at the level of bifurcation of the artery and perpendicular to the long axis of the artery. At this level, RPA and LPA diameters were measured at the widest portion on 1.25 mm axial images of the arterial phase. Variation in the pulmonary artery diameter was compared between smokers and non-smokers with respect to age and analysed by unpaired t-test and Pearson correlation. Results: Diameters of MPA, RPA, and LPA were statistically significant (p<0.05) in smokers compared to non-smokers. In smokers, MPA and RPA diameters correlated with age, which was statistically significant (p<0.05). No significant correlation (p>0.05) was shown between age and MPA, RPA, and LPA diameter in non-smokers. The mean MPA diameter showed a significant difference (p<0.05) in all three age groups. Conclusion: The diameter of the pulmonary artery is statistically significant in smokers compared to non-smokers. Hence, assessment of pulmonary artery diameters among smokers using CECT thorax will help to diagnose Pulmonary Hypertension (PH) at an early stage.

Pulmonary Artery Measurements as Postnatal Prognostic Tool in Right Congenital Diaphragmatic Hernia

BackgroundRight-sided congenital diaphragmatic hernia (RCDH) is a rare and often fatal congenital anomaly, primarily attributed to lung hypoplasia, which is associated with small branch pulmonary artery (PA). This study investigated whether postnatal PA measurements obtained through echocardiography are associated with mortality or the extracorporeal membrane oxygenation (ECMO) requirement in neonates with RCDH. MethodsA retrospective study was conducted on neonates with RCDH born between 2008 and 2022. Echocardiography was performed on the day of birth. The diameter of the main PA (MPA) was measured at the maximal dimension, and the diameters of the left PA (LPA) and right PA (RPA) were measured at the bifurcation. The primary outcome was mortality or ECMO requirement. Parameters, including the LPA:MPA ratio, RPA:MPA ratio, Nakata index, McGoon ratio, and ejection fraction (EF), were analyzed and compared with the observed-to-expected lung-to-head ratio (o/e LHR), initial blood gas, and defect size as predictive values. ResultsAmong 39 neonates with RCDH, 25 (64.1 %) survived without ECMO. The non-survivor or ECMO group exhibited lower o/e LHR, reduced EF, smaller LPA and RPA diameters, and larger MPA diameter than survivors. Lower LPA:MPA ratio, Nakata index, McGoon ratio, and higher initial PaCO2 were associated with adverse outcomes. Notably, the LPA:MPA ratio showed the highest predictive capability (area under the curve, 0.983; p < 0.001). ConclusionThe LPA:MPA ratio is a promising postnatal predictor of mortality or ECMO requirement in neonates with RCDH. Additionally, Nakata index, McGoon ratio, and initial PaCO2 are significantly correlated with outcomes. Level of evidenceThis is a level III. Type of StudyPrognostic study.

Abstract 16351: Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography in Pulmonary Arterial Hypertension

Background: A main pulmonary artery (MPA) diameter&gt;25 mm on echocardiography is supportive of the diagnosis of pulmonary hypertension according to the most recent European Society of Cardiology guideline. [1]. The size of the pulmonary artery may however vary according to body size, age and sex and these considerations may be important for diagnostic purposes. Objectives: (1) to derive reference equations for MPA and right pulmonary artery (RPA) size on echocardiography that consider the effect of body size, age and sex; (2) to determine which measure of PA size better classifies pulmonary arterial hypertension (PAH) when compared to controls. Method: 248 healthy males and females were recruited as part of Stanford aging study and 200 patients with PAH have been retrospectively included from the Stanford Adult PH Program. The diameters of the MPA and RPA were measured from the parasternal short axis. The RPA diameter, area, and pulsatility index were measured from the supra sternal notch view. MedCalc Version 20.2018 statistical software program was used for modeling and assessing the variance function. Results: Multivariate regression analysis was used to derive PA size reference equations that consider sex, age, and height. Age retained in all the models and height was the second most influential variable. Using a Z score threshold of 1.96, for the diastolic MPA diameter size yielded an area under the ROC curve (AUC) of 0.91, 87.15% sensitivity and 95.19% specificity to detect PAH. In comparison, the AUC for absolute MPA size &gt;25 mm during diastole and systole yields 0.87 and 0.67, respectively which was significantly different from the z score AUC (Figure-1). Conclusion: Our study develops echocardiography reference equations for PA size accounting for the influence of age, height, and sex that can potentially refine PAH diagnostic algorithms if further validated.

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot.

Right ventricular outflow tract (RVOT) stenting seems to be suggested as a promising treatment option and an alternative to modified Blalock-Taussig shunt (mBTS) in the initial palliation of patients with Fallot-type lesions in recent years. This study sought to assess the effect of RVOT stenting on the growth of the pulmonary artery (PA) in patients with Tetralogy of Fallot (TOF). Retrospective review analyzing 5 patients with Fallot-type congenital heart disease with small pulmonary arteries who underwent palliative with RVOT stenting and 9 patients underwent modified Blalock-Taussig shunt within 9 years period. Differential left PA (LPA) and right PA (RPA) growth was measured by Cardiovascular Computed Tomography Angiography (CTA). RVOT stenting improved arterial oxygen saturation from median of 60% (interquartile range [IQR]: 37% to 79%) to 95% (87.5% to 97.5%) (p = 0.028). The LPA diameter Z-score improved from -2.843 (-3.51-2.037) to -0.78 (-2.3305-0.19) (p = 0.03), the RPA diameter Z-score improved from median -2.843 (-3.51-2.037) to -0.477 (-1.1145-0.459) (p = 0.002), the Mc Goon ratio increased from median 1 (0.8-1.105) to 1.32 (1.25-1.98) (p = 0.017). There were no procedural complications and all 5 patients have undergone final repair in the RVOT stent group. In the mBTS group, the LPA diameter Z-score improved from -1.494 (-2.242-0.6135) to -0.396 (-1.488-1.228) (p = 0.15), the RPA diameter Z-score improved from median -1.328 (-2.036-0.838) to 0.088 (-0.486-1.223) (p = 0.007), and there were 5 patients occur different complications and 4 patients was not attained the standards of final surgical repair. RVOT stenting, compared with mBTS, seems to better promote pulmonary artery growth, improve arterial oxygen saturations, and have less procedure complications in patients with TOF who being absolute contraindicated for primary repair due to high risks.

Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair

BackgroundHybrid procedure with ductal stenting and bilateral pulmonary banding offers a temporary approach in high-risk neonates with complex congenital heart defects aiming biventricular repair. This procedure may also have negative impact concerning post-banding pulmonary stenosis resulting in right ventricular pressure load.MethodsBetween 2010 and 2021 we identified 5 patients with interrupted aortic arch and complex congenital heart defect who underwent hybrid procedure and staged biventricular repair (“hybrid-group”). Other 7 cases with interrupted aortic arch were corrected in the neonatal phase without hybrid procedure (“nonhybrid-group”). Detailed intra- and extracardiac features and surgical procedures were documented as well as pulmonary interventions during follow up. Pulmonary vessel size was assessed by diameter of left and right pulmonary artery in absolute and indexed values. RV pressure was evaluated invasively via catheterization.ResultsSurvival in cases with hybrid procedure and staged biventricular repair was 91% for a follow-up time of 40.7 months (95% CI 26–55 months) and 100% in the non-hybrid-group. Postoperative results concerning left ventricular function showed normal LV dimensions and systolic function without relevant stenosis on distal aortic arch. Hybrid procedure was associated with impaired local pulmonary arterial diameter after debanding resulting in increased right ventricular pressure and need for interventions (number intervention per patient: hybrid group 1.7 ± 0.95, non-hybrid group 0.17 ± 0.41; P 0.003).ConclusionsHybrid procedure in high-risk cases with interrupted aortic arch and staged biventricular repair shows good postoperative results with low perioperative mortality and normal left ventricular function. Due to potential risk of relevant pulmonary stenosis and right ventricular pressure load, follow up examinations must not only focus on left but also on the right heart.Graphical

Relationship Between Endogenous Hydrogen Sulfide and Pulmonary Vascular Indexes on High-Resolution Computed Tomography in Patients with Chronic Obstructive Pulmonary Disease.

ObjectiveTo explore the relationship between endogenous hydrogen sulfide (H2S) and high-resolution computed tomography (HRCT) indexes in pulmonary vascular remodeling.MethodsA total of 94 stable chronic obstructive pulmonary disease (COPD) patients were recruited for the study．Plasma H2S levels were measured using fluorescence probe. Fluorescence quantitative polymerase chain reaction was used to measure H2S synthase cystathionine-γ-lyase (CSE) mRNA and cystathionine-β-synthesis enzyme (CBS) mRNA. The main pulmonary artery diameter (mPAD), axial diagonal mPAD, coronal mPAD, sagittal mPAD, right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD), and ascending aortic diameter (AAD) and the percentage of total cross-sectional area of vessels less than 5 mm2 of total lung area (%CSA <5) on HRCT were measured. Pulmonary arterial systolic pressure (PASP) of echocardiography, blood gas analysis, and routine blood tests were performed. Correlation analysis and multivariate linear regression were performed using SPSS 22.0.ResultsH2S was negatively correlated with mPAD, axial diagonal mPAD, and sagittal mPAD (r = −0.25~−0.32) and positively correlated with PaO2 (r = 0.35). Relative expression of CSE mRNA was positively correlated with PASP, coronal mPAD, sagittal mPAD, white blood cell count (WBC), and neutrophil count (N) (r = 0.30~0.44). The relative expression of CBS mRNA was positively correlated with PASP, WBC, and N (r = 0.34~0.41). In separate models predicting pulmonary vascular indexes, a 1μmol/L increase in H2S predicted lower pulmonary artery diameter (for axial diagonal mPAD, 0.76mm lower; for mPAD/AAD, 0.68mm lower). All P values were less than 0.05.ConclusionEndogenous H2S may be involved in pulmonary vascular remodeling, providing a new method for the diagnosis and treatment of COPD. The generation of H2S may be inhibited by hypoxia, inflammation, etc.

Normative reference values of major thoracic arterial vasculature in Turkiye.

The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender. Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; ≥40 years) and gender (male to female) was evaluated by statistical methods. The Student's t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations. Totally 777 cases between the ages of 18-96 (43.80±15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52±5.13 mm (12-48 mm in range) for AAD, 30.83±5.25 mm (12-52 mm in range) for ARCAD, DAD 21.27±3.57 mm (11-38 mm in range) for DAD; 23.27±4.03 mm (14-40 mm in range) for MPAD, 17.27±3.19 mm (10-30 mm in range) for RPAD, and 17.62±3.06 mm (10-37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females. The diameters of all thoracic main vascular structures are larger in men than in women and increase with age.

Prognostic factors of pulmonary hypertension associated with connective tissue disease: pulmonary artery size measured by chest CT

Pulmonary artery enlargement is a common manifestation of chest CT in patients with pulmonary arterial hypertension (PAH). The exact clinical significance of this phenomenon has not been clarified in connective tissue disease (CTD)-associated PAH (CTD-PAH). We aimed to explore the association between the dilatation of pulmonary artery and prognosis of CTD-PAH patients. We retrospectively investigated 140 CTD-PAH patients diagnosed by echocardiography from 2009 to 2018. A chest multi-slice CT was performed on all the patients. Main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), ascending aorta (AAo) and descending aorta (DAo) diameters were measured. The ratios MPA/AAo and MPA/DAo were also calculated. The primary end point was all-cause mortality. During the observational period of 3.44 (0.23) years, 36 patients were followed to death. Cox univariate proportional hazard analysis showed that age, gender, MPA diameter, LPA diameter and RPA diameter were related to the risk of 5-year all-cause mortality in patients with CTD-PAH. In Cox multivariate proportional hazard analysis, MPA diameter and gender were predictors of all-cause mortality in CTD-PAH patients. An all-cause mortality risk prediction model revealed that baseline MPA diameter has the ability to predict 5-year all-cause mortality in CTD-PAH patients. Kaplan-Meier analysis showed that the 5-year survival rate was significantly lower in patients with MPA ≥37.70 mm (P ≤ 0.00012) compared with MPA ≤ 37.70 mm. MPA diameter ≥37.70 mm measured by chest multi-slice CT was a potential independent risk factor of the poor long-term prognosis in Chinese CTD-PAH patients.

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension.

BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

Pulmonary Hypertension Parameters Assessment by Electrocardiographically Gated Computed Tomography: Normal Limits by Age, Sex, and Body Surface Area in a Chinese Population.

Pulmonary hypertension (PH) parameters such as pulmonary artery or right ventricular size can be measured easily on computed tomography (CT). However, there are limited data on electrocardiographically (ECG) gated CT. We sought to determine age-specific and sex-specific normal reference values for PH parameters normalized by body surface area (BSA) using ECG-gated cardiac CT in a Chinese population. In total, we enrolled 519 non-PH patients undergoing ECG-gated CT coronary angiography and measured PH parameters, including main pulmonary artery (MPA) and right pulmonary artery (RPA) diameters and distension, the ratio of MPA to ascending aorta (AAO) diameter (MPA/AAO), and the ratio of right ventricular to left ventricular diameter (RV/LV). Maximum MPA and RPA diameters were also normalized to BSA (nMPA, nRPA). Age, sex, BSA, and body mass index (BMI) were variably associated with PH parameters. Age was an independent predictor of all PH parameters. The maximum MPA diameter (26.5±2.7 mm), maximum RPA diameter (20.9±3.0 mm), nMPA (15.8±2.0 mm/m), nRPA (12.4±2.0 mm/m), and RV/LV (0.85±0.11) increased with age. MPA/AAO (0.80±0.10), MPA, and RPA distension (25.4%±7.1%; 23.3%±6.7%) correlated negatively with age. Although absolute MPA and RPA diameters were slightly larger in men, women had significantly larger nMPA and nRPA values. MPA and RPA sizes and RV/LV were correlated positively with BSA and BMI. Using ECG-gated cardiac CT, we determined the normal reference values of PH parameters for non-PH adult Chinese patients, and these values were variably influenced by age, sex, BSA, and BMI.

Measurement of right pulmonary artery diameter in normal chest radiographs

Introduction: Many pathological condition and hypertension can be diagnosed by the measurement of the pulmonary artery. Our main objective was to measure the diameter of right pulmonary artery in normal chest radiographs.&#x0D; Methods: A cross-sectional study was performed in which, a total of 113 cases of chest radiographs were selected from July to October 2014, performed by qualified radiographer and reported by the radiologist. Right pulmonary artery is measured in Computed Radiography (CR) computer console. Obtained data were analyzed using in SPSS software version 20.&#x0D; Results: Among 113 cases, 52.2 % were male and 47.8 % were female. The mean diameter of the right pulmonary artery was found to be 11.96±2.04 mm, where in male, it was found to be 12.41 ± 2.0 mm and in female, it was found to be 11.46 ± 1.9 mm. The diameter of pulmonary artery was not correlated with height, weight, and BMI at 5% level of significance.&#x0D; Conclusion: This showed that female have narrower right pulmonary artery diameter than male. There was no significant relationship between pulmonary artery diameter and the height, weight and BMI. There was also no variation of measurement between male and female patients.

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt

BackgroundTetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF. MethodsFifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively. ResultsStenting group were significantly younger (1.62±0.34 vs 2.80±0.52, p=0.001), had lower body weight (3.28±0.48 vs 5.03±0.67, p=0.001) and lesser body surface area (0.20±0.01 vs 0.26±0.20, p=0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9±0.54mm (z-score -3.08±0.97) and increased at surgery to 4.6±0.49mm (z-score –0.79±0.66) (p=0.001). The mean left pulmonary artery (LPA) diameter was 2.5±0.42mm (z-score -3.3±0.86), which increased to 3.3±0.40mm (z-score -2.2±0.74) at surgery (p=0.005). The mean RPA diameter in mBTS group at palliation was 3.2±0.32mm (z-score –2.9±0.70) and increased at surgery to 4.3±0.55mm (z-score –1.1±0.94) (p=0.001). The mean LPA diameter was 2.8±0.26mm (z-score -3.3±0.62), which increased to 3.2±0.24mm (z-score –2.4±0.52) at surgery (p=0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p=0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications. ConclusionRVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies.

Assessment of the correlation between the severity of interstitial lung disease and clinical parameters by cardiopulmonary ultrasound performance

Objective To evaluate the application value of cardiopulmonary ultrasound(CPUS) in patients with interstitial lung diseases(ILD). Methods Ninety patients with clinically diagnosed interstitial lung diseases and 30 healthy subjects were included in this study. The conventional echocardiographic parameters and right ventricular free wall longitudinal strain (RVLS_FW) were measured in all patients and healthy subjects. The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored using a semi-quantitative scoring method. Patients′ pulmonary function parameters and clinical outcome score (GAP score) were recorded. Fourteen patients belong to other types of ILD and 19 patients with incomplete clinical data were unable to perform GAP scoring, finally 57 patients′ clinical and ultrasonographic parameters were measured. On the basis of the pulmonary arterial systolic pressure (PASP) obtained by Doppler echocardiography, 90 patients were divided into two groups: ILD patients with pulmonary hypertension(ILDPH, PASP ≥36 mmHg, 1 mmHg=0.133 kPa) and ILD patients without PH (ILDNPH, PASP<36 mmHg). Comparsion between ILDPH, ILDNPH and healthy subjects were then evaluated. According to the GAP score, all cases were divided into three groups: low risk, moderate risk and high risk. Statistical analysis was performed to examine the relationship between CPUS parameters and clinical parameters. Results ①Compared with ILDNPH patients, ILDPH patients had significantly lower right ventricular function, wider basal right ventricular diameter (RVD), proximal right ventricular outflow diameter (DRVOT1) and right pulmonary artery diameter (DRPA). Compared with healthy subjects, ILDNPH patients had mildly lower right ventricular function and wider left pulmonary artery diameter (DLPA ) and right ventricular outflow tract dimensions at the distal or pulmonic valve (DRVOT2). ②A good correlation was found between lung ultrasound (LUS) scores and pulmonary function parameters, especially diffusion capacity for carbon monoxide of the lung(DLco)(r=-0.68, P<0.001). ③With the increased risk of patients, the right ventricular function was gradually decreased, DRVOT2, DRPA, DLPA were gradually widened, and the lung ultrasound score was gradually increased. A weak correlation was found between GAP scores with RVLS_FW, LUS scores, DRPA(r=0.44, 0.34, 0.31, P<0.05). Conclusions CPUS parameters are useful in the assessment of interstitial lung disease and could reflect the prognosis of ILD patients to some extent. Therefore, on the basis of GAP scores, addition of RVLS_FW and LUS score will be more helpful to evaluate the prognosis of ILD patients. Key words: Cardiopulmonary ultrasound; Lung diseases, interstitial; GAP score; Pulmonary function test

Reasearch on correlation between lung ultrasound findings of interstitial lung diseases and cardiac involvement

Objective To assess the relationship between lung ultrasonography and cardiac involvement (pulmonary artery systolic pressure, right ventricular function) in patients with interstitial lung diseases(ILD) by integrative cardiopulmonary ultrasound (also called thoracic ultrasound, TUS). Methods Seventy two patients with clinically diagnosed ILD were investigated at the Department of Respiratory Medicine in our hospital. The tranditional echocardiographic parameter included pulmonary arterial systolic pressure(PASP), tricuspid regurgitation area(ATR), main pulmonary artery diameter(DMPA), left pulmonary artery diameter (DLPA), right pulmonary artery diameter(DRPA), right ventricular outflow tract dimensions at the proximal or subvalvular level(DRVOT1), right ventricular outflow tract dimensions at the distal or pulmonic valve(DRVOT2), right ventricular basal diameter(RVTD), mid-right-ventricular diameter(RVDm), tricuspid annular plane systolic excursion(TAPSE), left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd). Tissue Doppler parameters includpeak velocity of tricuspid annulus (S′, e′, a′) and myocardial performance index(MPI); Two-dimensional speckle tracking imaging(2D-STI) parameter was right ventricular global strain(RVGLS). The number of B lines and the performance of pleural line were evaluated by lung ultrasound.Statistical analysis was performed on the above TUS indexes. Results ①With the use of PASP higher than 36mmHg as the criterion for pulmonary hypertension(PH), all patients were divided into group ILDPH and group ILDNPH, comparison of TUS parameters in two groups, several parameters had statistical difference including ATR, RVD, RVDm, RPA, RVGLS, MPI, FAC, the number of B lines and the grade of pleural line. ②According to the degree of pleural involvement, all patients were divided into severe group and mild-moderate group, in the comparison of echocardiographic parameters, only ATR, RPA and RVGLS had statistic difference. ③A positive correlation was found between the number of B lines and PASP(r=0.547), a weak correlation was found between the grade of pleural line and PASP or RVGLS. ④A cut off more than 35 B lines had 95.8% sensitivity, 37.5% specificity in predicting elevated PASP(>36 mmHg), and the area under the ROC curve was 0.707. Conclusions TUS can effectively assess ILDs. With the disease progresess, the structure or function of right ventricular will gradually damaged.Lung ultrasound can not only evaluate the changes of lung in ILD, but also indirectly reflect PASP and the function of right ventricle, and it combined with echocardiography can provide more useful information for clinical diagnosis and management of ILDs. Key words: Integrative cardiopulmonary ultrasound; Interstitial lung diseases; Pulmonary hypertension; Ventricular function, right

Canine pulmonary vein-to-pulmonary artery ratio: echocardiographic technique and reference intervals

ObjectivesThe size of the pulmonary veins (PVs) and pulmonary arteries (PAs) changes in response to hemodynamic alterations caused by physiological events and disease. We sought to create standardized echocardiographic methods for imaging the right ostium of the pulmonary veins (RPVs) and the right pulmonary artery (RPA) using specific landmarks and timing to quantify vessel diameters and phasic changes during the cardiac cycle. AnimalsFifty client-owned healthy dogs prospectively recruited. MethodsM-mode and 2-dimensional images were obtained from modified right parasternal long and short axis views. Right ostium of the pulmonary veins and RPA measurements were timed with electrical [peak of the QRS complex (RPVQRS and RPAQRS) and end of T wave (RPVT and RPAT)] or mechanical events [RPV and RPA vessels at their respective maximal (RPVMAX; RPAMAX) and minimal (RPVMIN; RPAMIN) diameters]. Right ostium of the pulmonary veins and RPA measurements were also indexed to the aorta. ResultsIn normal dogs regardless of the echocardiographic view or time in the cardiac cycle, the RPV/RPA ratio approximated 1.0. Mechanically timed fractional changes (distensibility indices) in RPV and RPA diameters did not differ (p=0.99; 36.9% and 36.8%, respectively). ECG-timed fractional changes (distensibility indices) in RPV and RPA diameter were at least 50% smaller than mechanically timed changes (p<0.05). RPV:Ao and RPA:Ao ranged between 0.3 and 0.6, with lower values obtained in diastole and larger values in systole (p<0.0001). Multiple positive and negative deflections were identified on the RPV and RPA M-mode tracings. ConclusionThis study provides detailed methodology and 2D and M-mode reference intervals for the RPV and RPA dimensions and the phasic changes during the cardiac cycle of the dog using echocardiography.

CT measurement of central pulmonary arteries to diagnose pulmonary hypertension (PHTN): more reliable than valid?

The association between main pulmonary artery (MPA) size and pulmonary arterial hypertension (PAHTN) is well established; however, the clinical utility of routine measurement of MPA is uncertain due to considerable overlap between normal patients and those with pulmonary hypertension. The lack of diagnostic accuracy could be further degraded by variability among the radiologists. It is unknown whether the addition of right and left pulmonary artery measurements would improve accuracy or further impair it.The purposes of this study are to verify the accuracy of a proposed cutoff value for the size of MPA in the diagnosis PAHTN, to determine the interrater agreement for this measurement, and to determine whether addition of right pulmonary artery (RPA) and left pulmonary artery (LPA) measurement or simple assessment of patient comorbidities can improve the accuracy. Materials and methodsPatients undergoing both cardiac catheterization and chest computed tomography (CT) within 3 months of each other at a large university hospital between January 2010 and December 2012 were identified. Patients with prior cardiac surgery or congenital heart disease and critically ill patients were excluded from the study population. Patients with pericardial disease or severe lung disease documented on CT examinations were also excluded. From the remaining patients, 45 patients with normal pulmonary artery pressure and 50 patients with proven pulmonary hypertension were selected. Demographic data and clinical information was collected from medical records of these patients.Three radiologists with different years of experience in cardiothoracic imaging measured the MPA, RPA, and LPA diameters on axial images using an electronic ruler on 3D work stations independently and were masked to the patient clinical symptoms, diagnosis, and each other's measurement to prevent bias. Association between MPA diameter (MPAD) and patient characteristics assessed by one-way analysis of variance for scalar measures. Each reader's measurements were used to construct a separate receiver operating curve (ROC) to assess optimal MPA threshold. The ability of an MPA measurement threshold to correctly identify PAHTN was assessed using chi-squared. Chi-squared was also used to assess the effect of categorical comorbidities on false positive diagnosis. ResultsNone of the demographic data or patients' factors (age, gender, height, weight, body surface area, and body mass index) were related to the size of MPAD.The distribution of the MPAD was normal in both groups. Based on prior literature, MPAD (≥3.15cm) was selected as the cutoff value to diagnose PAHTN. Review of ROCs did not suggest a superior cutoff value for any reader. Using this threshold per case interrater agreement was good, kappa values >0.65.Based on an average measurement for all three readers, MPAD was 82% sensitive and 62% specific for PAHTN. Limiting positive diagnosis to those subjects with both MPAD ≥3.15 and either enlarged RPA diameter (RPAD) or LPAD diminished sensitivity but did not improve specificity. Defining positive study as the presence of any dilated artery (MPAD, RPAD, or LPAD) increased sensitivity to 94% but decreased specificity to 27%.Comorbidities that might cause fluctuating mean pulmonary artery pressures could not be shown to account for false positive studies. The 29 true negative patients and 16 false positive patients did not differ in the prevalence of obstructive sleep apnea/home oxygen use or documented congestive heart failure/low ejection fraction. ConclusionPreviously proposed threshold of MPAD ≥3.15cm is likely optimal but is not specific for identifying patient with PAHTN. Interobserver differences in MPAD measurement do not account this inaccuracy.Incorporation or RPA and LPA measurement does not improve diagnostic accuracy of PAHTN, and assessment of comorbidities does not easily identify likely false positive cases. Diagnosis of PAHTN based solely on CT examinations of the chest may not be sufficiently accurate for clinical use.

Diagnostic value of CT pulmonary artery imaging for idiopathic pulmonary artery hypertension

To evaluate the diagnostic value of CT pulmonary artery (CTPA) imaging with idiopathic pulmonary artery hypertension (IPAH). A total of 20 patients with right heart catheterization (RHC) proven IPAH were retrospectively analyzed between January 2012 and November 2015.The imaging was analyzed including pulmonary parenchyma, pulmonary interstitial, mediastinal lymph nodes, pericardium and pleural cavity on the CTPA examination.Cardiovascular parameters were measured in CTPA including right ventricle biggest short axis diameter (RVD), left ventricle biggest short axis diameter (LVD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD), right low pulmonary artery diameter (RLPAD), ascending aorta diameter (AAD) and descending aorta diameter (DAD), and parameters were calculated including the ratio of the main pulmonary and ascending aorta diameter (rPA), the ratio of the ascending and descending aorta diameter (rAD), the ratio of the right ventricular and left ventricular short axis diameter (RV/LV). The relationship between sex, pulmonary, lymph nodes, pericardium, pleural and pulmonary arrery pressure (PAP) was analyzed by Spearman rank correlation analysis.All the parameters between mild-moderate (4 cases) and severe (16 cases) PAH were analyzed by independent sample t test.PAP of different age (<50 years and≥50 years) groups was analyzed by Pearson correlation analysis. Of 20 cases, 7 cases showed patch exudative change, 5 cases showed"mosaic pattern"inhomogeneous perfusion, 3 cases displayed ill-defined centrilobular nodules, 6 cases manifested mediastinal lymphadenopathy, 10 cases had pericardial effusion including 4 cases of pleural effusion, 4 cases of dilated bronchial artery, 1 cases of secondary right pulmonary artery embolism.When comparing the presence or absence of pleural effusion, these was statistical difference of PAP (r=0.445, P=0.049). LVD, LPAD, RPAD, AAD, DAD and rPA were statistically different between mild-moderate and severe PAH (t values were 3.194, -3.393, -7.771, 10.299, 11.394 and -12.715, respectively, P<0.05). PAP was statistically different between different age groups (r=-0.481, P=0.032). CTPA is a very important examination for the diagnosis of IPAH.The changes of lung, mediastinum, percardium, pleural cavity and the cardiovascular parameters can help diognose and evaluate IPAH.

Evaluation for the clinical effect of duct occluder in treatment of intracristal ventricular septal defect

Objective To evaluate the clinical effect for transcatheter closure of intracristal ventricular septal defects (IVSD) using duct occluder. Methods Between Jun.2012 and Sep.2013, implantation of duct occluder was conducted in 27 IVSD patients, which was compared with acentric ventricular septal occluder attempted in 53 IVSD patients.The transthoracic echocardiography, electrocardiography, and clinical examination were observed at 24 hours, and after 1, 3, 6 and 12 months follows-up. Results Implantation of duct occluders were achieved in 26(96.23%) patients and implantation of acentric ventricular septal occluder in 42(79.25%) patients.The mean follow-up time was 6.78 months (1-17 months). The procedure time, fluoroscopic time and residual shunt were not statistically different between the 2 groups(all P>0.05). The size of VSD(t=-3.124, P=0.003) and occluder diameter (t=-4.285, P<0.001)were smaller and the procedure success rate was higher in the duct occluder group (χ2=9.099, P=0.011). Left ventricular end diastolic dimension, left atrial diameter, left ventricular end diastolic dimension, right ventricular end diastolic dimension and pulmonary artery diameter were decreased significantly (F=57.62, 5.002, 4.754, 2.782, P=0.000, 0.033, 0.001, 0.030)after surgical procedure compared with those before procedure, except for the right atrial diameter and left ventricular ejection fraction.No new serious aortic regurgitation or increased mitral regurgitation, tricuspid regurgitation was shown after procedure in 2 groups.Complete left bundle branch block occurred in 2 patients respectively, pericardial effusion and thromboembolism of right femoral artery occurred in 1 patient in the acentric ventricular septal occluder group. Conclusions The duct occluder for IVSD closure has presented a good result, without serious complications, which provides a new method for IVSD closure.Further studies are necessary to determine the long-term results in a larger population of patients. Key words: Congenital heart disease; Ventricular septal defect; Interventional therapy