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Morey AGN, Karnia JJ, Wiggen KE. The utility of cardiac-gated computed tomography in diagnosing a reverse patent ductus arteriosus in a dog with a concurrent intracardiac right-to-left shunt. J Vet Cardiol 2024; 52:90-95. [PMID: 38296713 DOI: 10.1016/j.jvc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024]
Abstract
A five-month-old male intact Goldendoodle presented for evaluation for peripheral cyanosis following exercise. Transthoracic echocardiography demonstrated severe right ventricular wall thickening and right atrial dilation secondary to pulmonary hypertension. An agitated saline contrast study demonstrated an interatrial right-to-left shunt. Cardiac-gated computed tomography confirmed a reverse patent ductus arteriosus. This case report highlights the utility of cardiac-gated computed tomography in identifying multi-level intra- and extra-cardiac shunts.
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Affiliation(s)
- A G N Morey
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA
| | - J J Karnia
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA
| | - K E Wiggen
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA.
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2
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Patel N, Hyder SN, Michaud E, Moles V, Agarwal PP, Rosenfield K, Abe K, Haft J, Visovatti SH, Cascino TM, Auger WR, Mclaughlin VV, Aggarwal V. Interventional Imaging Roadmap to Successful Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100429. [PMID: 39132377 PMCID: PMC11307535 DOI: 10.1016/j.jscai.2022.100429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 08/13/2024]
Abstract
Balloon pulmonary angioplasty (BPA) is an evolving treatment modality for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. Although several imaging modalities currently exist for evaluating CTEPH, their individual use, specifically in the clinical practice of BPA, has not been well described. In this article, we provide a preprocedural, intraprocedural, and postprocedural interventional imaging roadmap for safe and effective BPA performance in routine clinical practice. Preprocedural assessment includes transthoracic echocardiography for right ventricular assessment, ventilation/perfusion scan to identify pulmonary segments with the highest degree of hypoperfusion, cross-sectional chest imaging excluding alternative causes of mismatched defects and providing anatomic and perfusion imaging concurrently, and nonselective invasive pulmonary angiography for risk stratification of individual lesion subtypes. Intraprocedural assessment includes subselective segmental angiography (SSA) for delineating segmental and subsegmental branch anatomy, lesion identification, and vessel sizing. Intravascular ultrasound and optical coherence tomography serve as adjunctive intraprocedural tools for more accurate vessel sizing and lesion characterization when SSA alone is insufficient. Postprocedural considerations include chest radiography to monitor for immediate postprocedure complications and echocardiography for the interval assessment of the right ventricle on longer-term follow-up.
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Affiliation(s)
- Nimai Patel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Syed N. Hyder
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erinleigh Michaud
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Victor Moles
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Prachi P. Agarwal
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Rosenfield
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott H. Visovatti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas M. Cascino
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - William R. Auger
- Division of Pulmonary Medicine, Department of Internal Medicine, University of California San Diego, San Diego, California
| | - Vallerie V. Mclaughlin
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Vikas Aggarwal
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan
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Gumbiene L, Kapleriene L, Jancauskaite D, Laukyte-Sleniene M, Jureviciene E, Rudiene V, Paleviciute E, Mataciunas M, Sileikiene V. Insights to correlations and discrepancies between impaired lung function and heart failure in Eisenmenger patients. Pulm Circ 2020; 10:1350650120909729. [PMID: 32166016 PMCID: PMC7052468 DOI: 10.1177/2045894019899239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Abstract
Impaired lung function and spirometric signs of airway obstruction without common
risk factors for chronic obstructive pulmonary disease could be found in
patients with Eisenmenger syndrome. This study aimed to analyse the association
between lung function parameters and disease severity (including heart failure
markers, associated congenital heart defect) as well as the possible reasons for
airflow obstruction in Eisenmenger syndrome. The data of 25 patients with
Eisenmenger syndrome were retrospectively evaluated. The patients were divided
into groups according to airflow obstruction and a type of congenital heart
defect. Airflow obstruction was found in nearly third (32%) of our cases and was
associated with older age and worse survival. No relation was found between
airway obstruction, B-type natriuretic peptide level, complexity of congenital
heart defect and bronchial compression. Most of the patients (88%) had gas
diffusion abnormalities. A weak negative correlation was noticed between gas
diffusion (diffusing capacity of the lung for carbon monoxide) and B-type
natriuretic peptide level (r = −0.437, p = 0.033). Increased residual volume was
associated with higher mortality (p = 0.047 and p = 0.021, respectively). A link
between B-type natriuretic peptide and lung diffusion, but not airway
obstruction, was found. Further research and larger multicentre studies are
needed to evaluate the importance of pulmonary function parameters and
mechanisms of airflow obstruction in Eisenmenger syndrome.
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Affiliation(s)
- Lina Gumbiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lina Kapleriene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dovile Jancauskaite
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Monika Laukyte-Sleniene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Elena Jureviciene
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Virginija Rudiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Egle Paleviciute
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Mataciunas
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Virginija Sileikiene
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
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Lee SE, Im JH, Sung JM, Cho IJ, Shim CY, Hong GR, Chung N, Jung JW, Chang HJ. Detection of mechanical complications related to the potential risk of sudden cardiac death in patients with pulmonary arterial hypertension by computed tomography. Int J Cardiol 2017; 243:460-465. [DOI: 10.1016/j.ijcard.2017.05.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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Lee SE, An HY, Im JH, Sung JM, Cho IJ, Shim CY, Hong GR, Chung N, Jung JW, Chang HJ. Screening of Mechanical Complications of Dilated Pulmonary Artery Related to the Risk for Sudden Cardiac Death in Patients with Pulmonary Arterial Hypertension by Transthoracic Echocardiography. J Am Soc Echocardiogr 2016; 29:561-6. [DOI: 10.1016/j.echo.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Indexed: 12/31/2022]
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