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Sun ML, Zhu YJ, Zhou YP, Zhu XJ, Yang YJ, Cheng CY, Mei KY, Li XM, Liu C, Xu XQ, Sun K, Jing ZC. Percutaneous transluminal pulmonary angioplasty for Takayasu arteritis-associated pulmonary hypertension: A single-arm meta-analysis. Catheter Cardiovasc Interv 2023; 102:558-567. [PMID: 37522190 DOI: 10.1002/ccd.30773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/24/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The efficacy and safety of percutaneous transluminal pulmonary angioplasty (PTPA) for Takayasu arteritis-associated pulmonary hypertension (TA-PH) remain unclear. OBJECTIVES To examine the efficacy and safety of PTPA in TA-PH. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials Library were searched from inception to August 18, 2022, for articles investigating the efficacy and safety of PTPA for TA-PH. The primary efficacy outcomes were pulmonary vascular resistance (PVR) changes from baseline to re-evaluation and 6-minute walking distance (6MWD). The safety outcome was procedure-related complications. RESULTS Five articles comprising 104 patients with TA-PH who underwent PTPA were included. The scores of article quality, as assessed using the methodological index for nonrandomized studies tool, were high, ranging from 13 to 15 points. The pooled treatment effects of PVR (weighted mean difference [WMD]: -4.8 WU; 95% confidence interval [CI]: -6.0 to -3.5 WU; I2 = 0.0%), 6MWD (WMD: 101.9 m; 95% CI: 60.3-143.6 m; I2 = 70.4%) significantly improved. Procedure-related complications, which predominantly present as pulmonary artery injury and pulmonary injury, occurred in 32.0% of the included patients. Periprocedural death occurred in one patient (1.0%, 1/100). CONCLUSIONS Patients with TA-PH could benefit from PTPA in terms of hemodynamics and exercise tolerance, at the expense of procedure-related complications. PTPA should be encouraged to enhance the treatment response in TA-PH. These findings need to be confirmed by further studies, ideally, randomized controlled trials. REGISTRATION PROSPERO CRD42022354087.
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Affiliation(s)
- Ming-Li Sun
- Phase I Clinical Trial Research Center, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yong-Jian Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu-Ping Zhou
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Jie Zhu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin-Jian Yang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Yan Cheng
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke-Yi Mei
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Mei Li
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Liu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Sun
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Cheng Jing
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Balloon Pulmonary Angioplasty for Takayasu Arteritis and Peripheral Pulmonary Artery Stenosis Mimicking Chronic Thromboembolic Pulmonary Hypertension. Life (Basel) 2022; 12:life12111797. [DOI: 10.3390/life12111797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Balloon pulmonary angioplasty (BPA) has been reported to be effective and safe to an acceptable level in patients with distal-type, inoperable chronic thromboembolic pulmonary hypertension (CTEPH), resulting in improved long-term survival. However, evidenced treatment options and strategy including medical therapy of antithrombotic therapy, glucocorticoids, immunosuppressants, and pulmonary hypertension (PH)-specific therapies are scarce in patients with significant PH and right heart failure associated with Takayasu arteritis and peripheral pulmonary artery stenosis, both of which mimic CTEPH. Moreover, there has been still concern on safety and lack of established methodology in performing BPA for these conditions. In this report, we would like to review recent publications including several case reports and discuss the efficacy, safety, and suitable methods of BPA in this population.
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Huang Z, Wang M, Hu F, Liu X. Long-Term Outcomes After Percutaneous Transluminal Pulmonary Angioplasty in Patients With Takayasu Arteritis and Pulmonary Hypertension. Front Immunol 2022; 13:828863. [PMID: 35359930 PMCID: PMC8961863 DOI: 10.3389/fimmu.2022.828863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/21/2022] [Indexed: 01/20/2023] Open
Abstract
Objective To investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH). Methods Data from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up. Results The mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26–71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences (P<0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved (P=0.016, P<0.001, P<0.001, and P=0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up (P<0.001, P<0.001, and P=0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident. Conclusions Results of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.
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Маrtynuk TV, Aleevskaya AM, Gramovich VV, Danilov NM, Korobkova IZ, Matchin UG, Solodovnikova LV, Beketova TV. [Possibility of complex medicamental and endovascular treatment of pulmonary hypertension in Takayasu arteritis with predominant pulmonary arteries' lesion]. TERAPEVT ARKH 2020; 92:85-91. [PMID: 32598780 DOI: 10.26442/00403660.2020.05.000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/22/2022]
Abstract
Takayasu arteritis (TA) is a systemic vasculitis with predominatly lesions of aorta and its large branches. In some cases pulmonary arteries (PA) are involved in the pathological inflammatory process and lead to the formation of pulmonary hypertension and significantly worse the prognosis. Timely development of lesion of PA, appointment of adequate therapy and surgical treatment can prevent irreversible damage of blood vessels and improve the prognosis. Perioperative administration of interleukin-6 inhibitor inhibitor (tocilizumab) in at patients with indications for vascular surgery, including angioplasty PA, should be considered as a promising approach to control the inflammatory activity of TA, reduce the dose of glucocorticoids and the risk of postoperative complications. We present the clinical experience of significant improvement in the patients condition was achieved by using two-stage balloon angioplasty on the background of control of the disease activity with interleukin-6 tocilizumab intravenously and specific therapy with riociguat and iloprost.
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Affiliation(s)
| | | | | | - N M Danilov
- National Medical Research Center for Cardiology
| | | | - U G Matchin
- National Medical Research Center for Cardiology
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Kamada H, Ota H, Aoki T, Sugimura K, Yaoita N, Shimokawa H, Takase K. 4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis. Radiol Case Rep 2020; 15:190-194. [PMID: 31890066 PMCID: PMC6928274 DOI: 10.1016/j.radcr.2019.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/24/2019] [Indexed: 12/03/2022] Open
Abstract
A 43-year-old woman presented with dyspnea during exertion and lower leg edema. Contrast-enhanced computed tomography images demonstrated extensive proximal narrowing in the right main pulmonary artery with thickening and enhancement. Right heart catheterization revealed the presence of precapillary pulmonary hypertension with a mean pulmonary arterial pressure of 45 mm Hg. The patient was diagnosed with large-vessel vasculitis with isolated pulmonary artery involvement. Takayasu's arteritis was suspected, but histological examination was not performed. Several sessions of pulmonary arterial intervention were stratified for the right main pulmonary artery. After treatment, mean pulmonary arterial pressure had decreased to 22 mm Hg with improvement in symptoms. Thoracic 4D-flow magnetic resonance imaging was performed before and after intervention to evaluate the volume flow rates of pulmonary arteries. The rates increased at the inlet of the right pulmonary artery (before: 23 mL/s vs after: 47.5 mL/s) and the main pulmonary artery (before: 71.2 mL/s vs after: 82.5 mL/s), and decreased at the inlet of the left pulmonary artery (before: 46.2 mL/s vs after: 31.7 mL/s). The split ratio of volume flow rate between the right and left pulmonary arteries improved after treatment (before. right:left = 33.1:66.9; after, right:left = 60.0:40.0), approaching normal values. This report quantitatively describes perioperative hemodynamic changes in a patient with pulmonary hypertension using 4D-flow magnetic resonance imaging. Stent placement for stenosis in the right pulmonary artery resulted in an increase in overall pulmonary blood flow and also improved blood flow balance between the right and the left pulmonary arteries.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Tang H, Dai Z, Wang M, Guo B, Wang S, Wen J, Li T. Lumped-Parameter Circuit Platform for Simulating Typical Cases of Pulmonary Hypertensions from Point of Hemodynamics. J Cardiovasc Transl Res 2020; 13:826-852. [PMID: 31933143 PMCID: PMC7541384 DOI: 10.1007/s12265-020-09953-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
Pulmonary hypertension (PH) presents unusual hemodynamic states characterized by abnormal high blood pressure in pulmonary artery. The objective of this study is to simulate how the hemodynamics develops in typical PH cases without treatment. A lumped-parameter circuit platform of human circulation system is set up to simulate hemodynamic abnormalities of PH in different etiologies and pathogenesis. Four typical cases are considered, which are distal pulmonary artery stenosis, left ventricular diastolic dysfunction, ventricular septal defect, and mitral stenosis. The authors propose regulation laws for chambers and vessels to adapt the abnormal hemodynamic conditions for each PH case. The occurrence and development of each PH case are simulated over time using the lumped-parameter circuit platform. The blood pressure, blood flow, pressure-volume relations for chambers and vessels are numerically calculated for each case of PH progression. The model results could be a quite helpful to understand the hemodynamic mechanism of typical PHs. Graphical Abstract.
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Affiliation(s)
- Hong Tang
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China.
| | - Ziyin Dai
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Miao Wang
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Binbin Guo
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Shunyu Wang
- The Second Hospital of Dalian Medical University, Dalian City, China
| | - Jiabin Wen
- The Second Hospital of Dalian Medical University, Dalian City, China
| | - Ting Li
- School of Information and Communication EngineeringDalian Minzu University, Dalian City, China
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Alizadehasl A, Saedi S, Ganji H, Pourafkari L. Isolated peripheral pulmonary stenosis in Takayasu arteritis. Int J Rheum Dis 2019; 23:116-119. [DOI: 10.1111/1756-185x.13742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Azin Alizadehasl
- Echocardiography Research Center Rajaei Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran
| | - Sedigheh Saedi
- Adult Congenital Heart Disease Department Rajaei Cardiovascular, Medical and Research Center Iran University of Medical Sciences Tehran Iran
| | - Hanifeh Ganji
- Department of Cardiology Shahrkord University of Medical Sciences Shahrkord Iran
| | - Leili Pourafkari
- Cardiovascular Research Center Tabriz University of Medical Sciences Tabriz Iran
- Anesthesiology Department University of Buffalo Buffalo NY USA
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He Y, Lv N, Dang A, Cheng N. Pulmonary Artery Involvement in Patients with Takayasu Arteritis. J Rheumatol 2019; 47:264-272. [PMID: 31092716 DOI: 10.3899/jrheum.190045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI). METHODS The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed. RESULTS Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20-27) vs 10 (6-15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21-58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007). CONCLUSION Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.
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Affiliation(s)
- Yanru He
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
| | - Naqiang Lv
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
| | - Aimin Dang
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China. .,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College.
| | - Nan Cheng
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
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Weinstock BS, Haim YD. Pulmonary artery stenting in a patient with Takayasu's arteritis using a novel balloon-expandable covered stent. SAGE Open Med Case Rep 2019; 7:2050313X19841955. [PMID: 31007921 PMCID: PMC6457077 DOI: 10.1177/2050313x19841955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/14/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with Takayasu’s arteritis have pulmonary artery involvement more
commonly than previously appreciated. The majority of these lesions are in
segmental or sub-segmental arteries, but there are some patients who have severe
stenosis of the main pulmonary arteries. Interventional treatment of these
patients is technically feasible, but there are only limited case reports
describing such intervention. Balloon angioplasty and stenting in these lesions
often require high pressure inflations to achieve adequate results and thus has
increased risk due to the possibility of pulmonary artery rupture. The recently
approved Viabahn BX balloon-expandable covered stent may be an optimal device
for main pulmonary artery stenosis as it is relatively low profile, can be
over-expanded to large vessel diameter without compromise or disruption of the
polytetrafluoroethylene covering and virtually eliminates the risk of
catastrophic pulmonary artery rupture. We report here the first known use of
this novel stent for treatment of severe pulmonary artery stenosis.
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Affiliation(s)
- Barry S Weinstock
- AdventHealth Orlando, Orlando, FL, USA.,Orlando Heart & Vascular Institute, Altamonte Springs, FL, USA
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Surgical intervention and its role in Takayasu arteritis. Best Pract Res Clin Rheumatol 2018; 32:112-124. [PMID: 30526891 DOI: 10.1016/j.berh.2018.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
Abstract
Vascular surgery remains an important option in the management of Takayasu arteritis (TA). Its use is predominantly confined to the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases, this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Open surgery, although more invasive, offers enhanced duration of arterial patency, whereas for endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures. Although there is increasing interest in the role of stent grafts and tailor-made endovascular stents, long-term outcomes remain to be reported. Interventional outcomes are improved and complications reduced by therapeutic control of disease activity before and after surgery. The wider use of combined immunosuppression and the introduction of biologic therapy for refractory TA may reduce future requirements for surgical intervention.
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Ramalho AR, Costa S, Silva Marques J. Looking for the Right Side in Large Vessel Vasculitis: A Multimodality Imaging-Guided Success. Circulation 2017; 136:234-238. [PMID: 28696270 DOI: 10.1161/circulationaha.116.026892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Rita Ramalho
- From Coimbra Hospital and University Centre, University Hospitals, Cardiology A Unit, Avenida Bissaya Barreto, Coimbra, Portugal.
| | - Susana Costa
- From Coimbra Hospital and University Centre, University Hospitals, Cardiology A Unit, Avenida Bissaya Barreto, Coimbra, Portugal
| | - João Silva Marques
- From Coimbra Hospital and University Centre, University Hospitals, Cardiology A Unit, Avenida Bissaya Barreto, Coimbra, Portugal
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Dong H, Jiang X, Peng M, Zou Y, Guan T, Zhang H, Song L, Wu H, Yang Y, Gao R. Percutaneous Transluminal Angioplasty for Symptomatic Pulmonary Stenosis in Takayasu Arteritis. J Rheumatol 2014; 41:1856-62. [DOI: 10.3899/jrheum.131007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective.The aim of this study was to evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) for symptomatic pulmonary stenosis in Takayasu arteritis (TA).Methods.From January 2009 to December 2012, clinical data of 14 patients [mean age 33.9 ± 9.3 yrs; 11 patients female (78.6%)] with symptomatic pulmonary stenosis in TA underwent PTA and were analyzed prospectively.Results.PTA was successfully performed in 22 lesions of 14 patients. Among those lesions, 18 were treated by PTA alone while the others were treated with stent implantation. Three patients (21.4%) had reperfusion pulmonary injury; 2 patients recovered completely while the other died of respiratory failure 3 days after the procedure. Mean pulmonary arterial pressure (PAP) decreased from 53.4 ± 15.8 mmHg to 38.4 ± 12.7 mmHg immediately after intervention (p < 0.001). After an average of 29 months of followup, the New York Heart Association functional class and 6-min walking distances improved while mean PAP measured by echocardiography decreased significantly (compared with baseline, all p < 0.01). One patient died of severe pulmonary infection and cardiac shock at 28 months after the procedure.Conclusion.The study showed that PTA improved subjective symptoms and objective variables of the patients with symptomatic pulmonary stenosis in TA, with an acceptable mortality. PTA may be a promising therapeutic strategy for symptomatic pulmonary stenosis in TA.
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Fujita K, Nakashima K, Kanai H, Kumakura H, Minami K. A successful surgical repair of pulmonary stenosis caused by isolated pulmonary Takayasu's arteritis. Heart Vessels 2012; 28:264-7. [PMID: 22706962 DOI: 10.1007/s00380-012-0262-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 05/11/2012] [Indexed: 11/28/2022]
Abstract
A 48-year-old man underwent surgery to treat pulmonary stenoses of unknown origin. The right main pulmonary artery was severely stenotic, and the orifice of the left pulmonary artery was focally constricted. The patient was nearly asymptomatic, despite marked pulmonary hypertension and right heart strain. The pressure gradients beyond the stenotic regions were 88 mmHg bilaterally. The cause of the stenoses could not be established before operation. The right main pulmonary artery and ascending aorta were successfully replaced. It was suspected that the ascending aorta was involved because it was markedly thickened and adhered tightly to the right pulmonary artery. It was therefore also replaced. However, only the transected right pulmonary artery showed histological evidence consistent with a diagnosis of Takayasu's arteritis. The postoperative course was uneventful. The patient was completely free of symptoms six months after the operation. To our knowledge, this is the thirteenth surgically treated case of isolated pulmonary Takayasu's arteritis to be reported.
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Affiliation(s)
- Kishu Fujita
- Department of Cardiovascular Surgery, Kitakanto Jyunkanki Hospital, 740 Shimohakoda, Hokkitsumachi, Shibukawa, Gunma, 377-0061, Japan.
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Ravindranath KS, Rangan K, Bhat PSS, Jagadeesh AM, Manjunath CN. Intraoperative pulmonary artery stenting in aortoarteritis: a hybrid procedure. Cardiovasc Interv Ther 2011; 26:162-5. [PMID: 24122540 DOI: 10.1007/s12928-011-0050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/17/2010] [Indexed: 11/26/2022]
Abstract
A 40-year old male presented with history of dyspnea and recurrent syncope. Preliminary evaluation revealed findings suggestive of severe pulmonary hypertension. His echocardiogram revealed severe stenosis of the right pulmonary artery (RPA) with severe pulmonary hypertension, which was confirmed on 64-slice MSCT. On cardiac catheterization, the stenotic segment could not be crossed. Hence he underwent surgical reconstruction of the RPA. Post-operatively, he developed arterial desaturation and hypotension due to compression of the reconstructed segment by the ascending aorta. Subsequently, intraoperative direct stenting of the RPA was performed on a beating heart. Post-procedure there was a significant drop in right heart pressures which was sustained on 3-month follow up. The patient also had occlusion of the Coeliac and Superior Mesenteric arteries which was demonstrated on MSCT and angiography, suggesting Aortoarteritis as the etiology. This case illustrates an unusual presentation of Aortoarteritis and the role of hybrid procedures in situations where percutaneous intervention may not be technically feasible.
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Affiliation(s)
- Khandenahally Shankarappa Ravindranath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jaya Nagar 9th Block, BG Road, Bangalore, 560069, Karnataka, India,
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Endovascular stent implantation for isolated pulmonary arterial stenosis caused by Takayasu’s arteritis. Clin Res Cardiol 2010; 99:573-5. [DOI: 10.1007/s00392-010-0161-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Garcia-Olivé I, Prats Bardají MS, Calvo Pascual S, Sánchez Berenguer D, Valverde Forcada E, Ruiz-Manzano J. [Severe pulmonary hypertension and Takayasu arteritis]. Arch Bronconeumol 2008; 44:170-2. [PMID: 18361889 DOI: 10.1016/s1579-2129(08)60032-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Takayasu arteritis is an inflammatory disease that affects large vessels, especially the aorta and its branches. The clinical features of the disease depend on which arteries are affected. Although pulmonary artery involvement is common, only rarely is this the main clinical manifestation. We describe the case of a young woman with dyspnea who had severe pulmonary hypertension secondary to Takayasu arteritis of the pulmonary artery. She was administered corticosteroid (methylprednisolone) and immunosuppressant (azathioprine) therapy and a stent was implanted in the left pulmonary artery. Both hemodynamic and clinical signs improved.
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Affiliation(s)
- Ignasi Garcia-Olivé
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Garcia-Olivé I, Prats Bardají MS, Calvo Pascual S, Sánchez Berenguer D, Valverde Forcada E, Ruiz-Manzano J. Hipertensión pulmonar grave y enfermedad de Takayasu. Arch Bronconeumol 2008. [DOI: 10.1157/13116605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pelage JP, El Hajjam M, Lagrange C, Chinet T, Vieillard-Baron A, Chagnon S, Lacombe P. Pulmonary Artery Interventions: An Overview. Radiographics 2005; 25:1653-67. [PMID: 16284141 DOI: 10.1148/rg.256055516] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interventional radiologists should be familiar with minimally invasive procedures used to treat various abnormalities of the pulmonary arteries. These well-established techniques, which obviate open surgery, are safe and effective when performed by an experienced interventionalist. Catheter-based thrombolysis with intrapulmonary arterial infusion of thrombolytic drugs, percutaneous thrombectomy, or embolus fragmentation can be performed in patients with life-threatening pulmonary embolism. Pulmonary artery stenoses, mainly encountered in patients with pulmonary vasculitis (as in Behçet disease or Takayasu arteritis), may be treated with balloon angioplasty and stent placement. Transcatheter embolization of pulmonary arteriovenous malformation is the standard treatment for hereditary hemorrhagic telangiectasia and is a very effective alternative to surgery to correct an aneurysm or pseudoaneurysm. In cases of hemoptysis that originates in the pulmonary artery, early diagnosis is mandatory for treatment with embolization. Percutaneous retrieval of foreign bodies from the heart or the pulmonary arteries and endovascular biopsy should also be part of the armamentarium of interventional radiologists.
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Affiliation(s)
- Jean-Pierre Pelage
- Department of Radiology, Hôpital Ambroise Paré, 9 ave Charles-de-Gaulle, 92104 Boulogne Cedex, France.
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