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Badea R, Enache R, Predescu LM, Platon P, Catana N, Deleanu D, Iosifescu AG, Radu N, Radu T, Olaru‐Lego G, Coman IM, Popescu BA. Left main coronary artery compression in precapillary pulmonary hypertension. Pulm Circ 2024; 14:e12391. [PMID: 38784819 PMCID: PMC11112051 DOI: 10.1002/pul2.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty-five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow-up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%-90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease-associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA-to-aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end-diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre-capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA-to-aorta, RV end-diastolic area and PH etiology) and long-term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.
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Affiliation(s)
- Ruxandra Badea
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
| | - Roxana Enache
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Lucian M. Predescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Pavel Platon
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Nicu Catana
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Dan Deleanu
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Andrei George Iosifescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Noela Radu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
| | - Teodora Radu
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Georgiana Olaru‐Lego
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Ioan M. Coman
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Bogdan A. Popescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
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Kubisa B, Kubisa A, Piotrowska M, Safranow K, Grodzki T, Peregud-Pogorzelska M. Right Heart Echocardiography Parameters and Other Predictors to Evaluate Mechanical Cardiac Support Necessity During Lung Transplantation. Transplant Proc 2022; 54:2307-2312. [PMID: 36180254 DOI: 10.1016/j.transproceed.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lung transplantation (LuTx) is a challenge when right heart function fails. Mechanical circulatory support (MCS) is then necessary. METHODS We aimed to investigate whether preoperative transthoracic echocardiography (TTE) can predict MCS use and help to exclude the sickest patients. Between 2011 and 2018, 52 patients at our institution received LuTx and qualified for this study: 35 bilateral, 16 single, 1 lobar [1] and 1 retransplantation procedure. Of these, 22 were operated using MCS and 30 without MCS. The patients were aged between 18 and 65 years, and 23 were women. The indications were lung fibrosis for 18 patients, chronic obstructive lung disease for 16, cystic fibrosis for 15, primary pulmonary hypertension for 2 and bronchiectasis for 1. TTE was performed up to 30 days before treatment and 1 to 7 days after. RESULTS Patients undergoing MCS versus patients not undergoing MCS: preoperative right ventricular systolic pressure 56.5 (30) vs 37.8 (11.5) mm Hg (P = .03); tricuspid regurgitation pressure gradient 48.7 (27) vs 30.2 (10.8) mm Hg (P = .015); tricuspid annular plane systolic excursion 17.8 (4.3) vs 19.9 (2.8) mm Hg (P = .04); pulmonary artery diameter 27.5 (5.2) vs 23.9 (4.1) mm (P = .004); age 41.9 (14.1) vs 54.3 (11.8) years (P = .001). Patients who were Dead versus patients who were alive pulmonary valve acceleration time of 82.8 (24.1) vs 104.9 (27.2) ms (hazard ratio [HR] = 0.959, 95% confidence interval [CI] = 0.923-0.996 per ms, P = .02) and pulmonary artery diameter of 28.9 (5.8) vs 24.4 (4.1) mm HR = 1.225, 95% CI = 1.028-1.460 per 1 mm, P = .016 were predictors of death. CONCLUSIONS Preoperative TTE parameters: right ventricular systolic pressure, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion, and pulmonary artery diameter predicted MCS use during LuTx. Certain values of valve acceleration time and pulmonary artery diameter could help discern LuTx qualification.
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Affiliation(s)
- Bartosz Kubisa
- Thoracic Surgery and Transplantation Department, Pomeranian Medical University of Szczecin, Szczecin, Poland.
| | - Anna Kubisa
- Internal Medicine Ward, SPWSZ Hospital Szczecin-Zdunowo, Szczecin, Poland
| | - Maria Piotrowska
- Thoracic Surgery and Transplantation Department, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Tomasz Grodzki
- Thoracic Surgery and Transplantation Department, Pomeranian Medical University of Szczecin, Szczecin, Poland
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Badea R, Dorobantu DM, Sharabiani MTA, Predescu LM, Coman IM, Ginghina C. Left main coronary artery compression by dilated pulmonary artery in pulmonary arterial hypertension: a systematic review and meta-analysis. Clin Res Cardiol 2022; 111:816-826. [PMID: 35290496 DOI: 10.1007/s00392-022-01999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A meta-analysis of LMCo cases could fill the knowledge gaps in this topic. METHODS Electronic databases were searched for all LMCo/PAH studies, abstracts and case reports including pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis was used to evaluate LMCo-associated factors. Specificity, sensitivity and accuracy of PA size thresholds for diagnosis of LMCo were calculated. Treatment options and outcomes were summarized. RESULTS A total of five case-control cohorts and 64 case reports/series (196 LMCo and 438 controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46 [1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA pressure or vascular resistance. A 40 mm cut-off for the PA diameter had balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after non-conservative treatment (n = 150, predominantly stenting) was 2.7% at up to 22 months of mean follow-up, with 83% survivors having no angina at follow-up. CONCLUSION PA diameter, PA/aorta ratio and CHD are associated with LMCo, while hemodynamic parameters are not. Data from this study support that a PA diameter cut-off between 40 and 44 mm can offer optimal accuracy for LMCo screening. Preferred treatment was coronary stenting, associated with low mid-term mortality and symptom relief. Diagnosis and management of left main coronary artery compression (LMCo) in patients with pulmonary arterial hypertension (PAH).
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Affiliation(s)
- Ruxandra Badea
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest, Romania.
| | - Dan M Dorobantu
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK.,School of Population Health Sciences, University of Bristol, Bristol, UK
| | - Mansour T A Sharabiani
- Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, UK
| | - Lucian M Predescu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest, Romania.,Cardiology Department, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Ioan M Coman
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest, Romania.,Cardiology Department, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Carmen Ginghina
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest, Romania.,Cardiology Department, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
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Labin JE, Saggar R, Yang EH, Lluri G, Sayah D, Channick R, Ardehali A, Aksoy O, Parikh RV. Left main coronary artery compression in pulmonary hypertension. Catheter Cardiovasc Interv 2020; 97:E956-E966. [PMID: 33241630 DOI: 10.1002/ccd.29401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 11/07/2022]
Abstract
Extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) in the setting of pulmonary arterial hypertension (PAH) is an increasingly recognized disease entity. LMCA compression has been associated with angina, arrhythmia, heart failure, and sudden cardiac death in patients with PAH. Recent studies suggest that at least 6% of patients with PAH have significant LMCA compression. Screening for LMCA compression can be achieved with computed coronary tomography angiography, with a particular emphasis on assessment of PA size and any associated downward displacement and reduced takeoff angle of the LMCA. Indeed, evidence of a dilated PA (>40 mm), a reduced LMCA takeoff angle (<60°), and/or LMCA stenosis on CCTA imaging should prompt further diagnostic evaluation. Coronary angiography in conjunction with intravascular imaging has proven effective in diagnosing LMCA compression and guiding subsequent treatment. While optimal medical therapy and surgical correction remain in the clinician's arsenal, percutaneous coronary intervention has emerged as an effective treatment for LMCA compression. Given the prevalence of LMCA compression, its associated morbidity, and mortality, and the wide array of successful treatment strategies, maintaining a high degree of suspicion for this condition, and understanding the potential treatment strategies is critical.
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Affiliation(s)
- Jonathan E Labin
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rajan Saggar
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Eric H Yang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Gentian Lluri
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David Sayah
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Richard Channick
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Olcay Aksoy
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
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Akbal OY, Kaymaz C, Tanboga IH, Hakgor A, Yilmaz F, Turkday S, Dogan C, Tanyeri S, Demir D, Bayram Z, Cicek MB, Acar RD, Ozdemir N. Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its correlates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging 2019; 19:1302-1308. [PMID: 29237020 DOI: 10.1093/ehjci/jex303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Although left main coronary artery (LMCA) compression (Co) by pulmonary artery (PA) aneurysm (A) has been reported in some pulmonary hypertension (PH) series, clinical importance and management of this complication remain to be determined. In this single-centre prospective study, we evaluated correlates, clinical impact, and management strategies of LMCA-Co in patients with PH. Methods and results Our study group comprised 269 (female 166, age 52.9 ± 17.3 years) out of 498 patients with confirmed PH who underwent coronary angiography (CA) because of the PAA on echocardiography, angina or incidentally detected LMCA-Co during diagnostic evaluation with multidetector computed tomography. The LMCA-Co ≥ 50% was documented in 22 patients (8.2%) who underwent CA, and stenosis were between 70% and 90% in 14 of these. Univariate comparisons revealed that a younger age, a D-shaped septum, a higher PA systolic, diastolic, and mean pressures and pulmonary vascular resistance, a larger PA diameter, a smaller aortic diameter and pulmonary arterial hypertension associated with patent-ductus arteriosus, atrial or ventricular septal defects were significantly associated with LMCA-Co. Bare-metal stents were implanted in 12 patients and 1 patient underwent PAA and atrial septal defect surgery and another one declined LMCA stenting procedure. Conclusion Our study demonstrates that LMCA-Co is one of the most important and potentially lethal complications of severe PH, and alertness for this risk seems to be necessary in specific circumstances related with PAA. However, long-term benefit from stenting in this setting remains as a controversy.
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Affiliation(s)
- Ozgur Yasar Akbal
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Cihangir Kaymaz
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- Hisar Intercontinental Hospital, Department of Cardiology, Site Yolu Street, No. 7, Umraniye, Istanbul, Turkey
| | - Aykun Hakgor
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Fatih Yilmaz
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Sevim Turkday
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Cem Dogan
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Seda Tanyeri
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Durmus Demir
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Zubeyde Bayram
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Mahmut Bugrahan Cicek
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Rezzan Deniz Acar
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Nihal Ozdemir
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
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Alfonso F, Rivero F. Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension. J Am Coll Cardiol 2019; 69:2818-2820. [PMID: 28595697 DOI: 10.1016/j.jacc.2017.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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8
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Simakova MA, Marukyan NV, Gukov KD, Zverev DA, Moiseeva OM. Left main coronary artery compression by pulmonary artery aneurism in patients with long standing pulmonary arterial hypertension. ACTA ACUST UNITED AC 2018; 58:22-32. [PMID: 30625087 DOI: 10.18087/cardio.2580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
This review focuses on a rare complication of pulmonary arterial hypertension (PAH), extravasation compression of the left coronary artery (LCA) dilated by the pulmonary artery. The review described clinical manifestations and methods for diagnostics of LCA compression, and advantages of the endovascular correction of this complication in patients with pulmonary hypertension. Selection of a device to be implanted during the endovascular intervention in these patients was discussed with due account for concomitant treatment with oral anticoagulants. As an illustration of the issue under discussion, a clinical case of acute coronary syndrome in a female patient from the PAH Registry of the V. A. Almazov National Medical Research Center was provided.
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Prevalence and prognostic significance of pulmonary artery aneurysms in adults with congenital heart disease. Int J Cardiol 2018; 270:120-125. [PMID: 29891239 DOI: 10.1016/j.ijcard.2018.05.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/02/2018] [Accepted: 05/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prevalence and prognostic significance of pulmonary artery (PA) dilatation in congenital heart disease (CHD) have never been studied systematically. METHODS Chest X-rays of 1192 consecutive adults with CHD were reviewed. Major diameter of the PA was determined by imaging techniques in those with PA dilatation. A value >29 mm was considered abnormal. Data on anatomy, hemodynamics, residual lesions and outcomes were retrospectively collected. RESULTS Overall prevalence of PA dilatation was 18%. A minority of patients (5.5%) reached 40 mm (aneurysm; PAA) and 1.8% exceeded 50 mm. The most common PAA underlying malformations were pulmonary stenosis (21%), and shunts (55%). Significantly larger diameters were observed in hypertensive shunts (40 mm; IQR 36.7-45 mm vs. 34 mm; IQR 32-36 mm) (p < 0.0001). However, the largest diameters were found in cono-truncal anomalies. There was no significant correlation between PA dimensions and systolic pulmonary pressure (r = -0.196), trans-pulmonary gradient (r = -0.203), pulmonary regurgitation (PR) (r = 0.071) or magnitude of shunt (r = 0.137) (p > 0.05 for all). Over follow-up, 1 sudden death (SD) occurred in one Eisenmenger patient. Complications included coronary (3), recurrent laryngeal nerve (1) and airway (1) compressions, progressive PR (1), and PA thrombosis (1). Coronary compression and SD were strongly associated (univariate analysis) with pulmonary hypertension (120 vs. 55 mm Hg; p = 0.002) but not with extreme PA dilatation (range: 40-65 mm). CONCLUSIONS PA dilatation in CHD is common but only a small percentage of patients have PAA. Clinical impact on outcomes is low. Complications occurred almost exclusively in patients with pulmonary hypertension whereas PA diameter alone was not associated with adverse outcomes.
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10
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Cardiac dysfunction of pulmonary artery aneurysm in patients with pulmonary arterial hypertension. Int J Cardiol 2016; 228:1035-1040. [PMID: 27931011 DOI: 10.1016/j.ijcard.2016.10.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH). We evaluated the characteristics of cardiac dysfunction in patients with PAH complicated by PAA. METHODS Echocardiography and right-heart catheterization were performed in 130 PAH patients to measure the maximum dimensions of the main pulmonary artery (MPA) trunk and evaluate right ventricular (RV) and left ventricular (LV) function. RESULTS A diameter of >40mm was defined as PAA in the MPA trunk. The maximum MPA diameter was >40mm in 32 of 130 PAH patients (24.6%: Group PAA). Systolic pulmonary artery pressure (68.0±18.5 vs. 58.9±21.6mm Hg, P=0.0354) and pulmonary capillary wedge pressure (10.8±3.9 vs. 7.7±2.6mm Hg, P<0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index (19.6±6.8 vs. 14.9±5.1 cm²/m², P<0.0001), and RV fractional area change (32.3±7.8 vs. 37.3±8.8%, P=0.0048) and RV longitudinal strain (-15.4±5.1 vs. -20.4±6.1, P=0.0012) were significantly lower, and E/e' was significantly higher (8.1±2.2 vs. 6.7±1.4, P=0.0002) in Group PAA than in Group non-PAA. CONCLUSIONS In PAH patients with PAA, RV was larger and RV dysfunction was more severe, and LV diastolic dysfunction appeared. It is important to investigate the appearance of PAA and the severity of RV and LV dysfunction in PAH patients with PAA.
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