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de Biasi AR, Wang H, Medina MG, Burton E, Ogden WD. Successful beating-heart repair of pulmonary artery dissection using a composite valve-tube graft. J Card Surg 2021; 36:2136-2139. [PMID: 33651429 DOI: 10.1111/jocs.15459] [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: 01/09/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
Pulmonary artery dissection is rare but highly lethal. Recent reports suggest that surgical repair of pulmonary artery dissection may yield good outcomes in selected patients, although postoperative right ventricular failure and death have been described. Currently, only one patient over age 60 years old has been reported to survive open surgical repair of pulmonary artery dissection. Here, we present the case of a sexagenarian with pulmonary artery hypertension complicated by a dissected pulmonary artery aneurysm which was successfully repaired using a composite valve-tube graft under a beating-heart strategy.
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Affiliation(s)
- Andreas R de Biasi
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
| | - Melissa G Medina
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
| | - Elan Burton
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.,Division of Cardiothoracic Surgery, Santa Clara Valley Medical Center, San Jose, California, USA
| | - W David Ogden
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.,Division of Cardiothoracic Surgery, Santa Clara Valley Medical Center, San Jose, California, USA
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2
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Fernando DMG, Thilakarathne SMNK, Wickramasinghe CU. Pulmonary artery dissection—A review of 150 cases. Heart Lung 2019; 48:428-435. [DOI: 10.1016/j.hrtlng.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022]
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3
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Tandon R, Gupta H, Wander G, Goyal A. Pericardial tamponade due to main pulmonary artery dissection in a young patient with eisenmenger's syndrome. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2019. [DOI: 10.4103/jiae.jiae_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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DiChiacchio L, Jones KM. Massive Main Pulmonary Artery Aneurysm Complicated by Acute Dissection. Ann Thorac Surg 2018; 107:e215. [PMID: 30612989 DOI: 10.1016/j.athoracsur.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/02/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Laura DiChiacchio
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
| | - Kevin M Jones
- Critical Care Resuscitation Unit, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
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5
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Liu C, Xia L, Pu Q, Liu L. A Full-Length Pulmonary Artery Dissection. Am J Respir Crit Care Med 2018; 197:1344-1345. [PMID: 29490154 DOI: 10.1164/rccm.201705-0966im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Chengwu Liu
- 1 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; and.,2 Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, China
| | - Liang Xia
- 1 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; and.,2 Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, China
| | - Qiang Pu
- 1 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; and.,2 Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, China
| | - Lunxu Liu
- 1 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; and.,2 Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, China
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Florczyk M, Wieteska M, Kurzyna M, Gościniak P, Pepke-Żaba J, Biederman A, Torbicki A. Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension? Pulm Circ 2017; 8:2045893217749114. [PMID: 29251549 PMCID: PMC5896856 DOI: 10.1177/2045893217749114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Right ventricular failure is a leading cause of mortality in patients with pulmonary arterial hypertension (PAH). However, up to 25% of such patients die unexpectedly, without warning signs of hemodynamical decompensation. We previously documented that pulmonary artery (PA) dilatation significantly increases the risk of those deaths. Some of them may be due to dissection of PA resulting in cardiac tamponade. However, direct confirmation of this mechanism is difficult as most of such deaths occur outside hospitals. We present 4 patients with severe PAH and PA dilatation in whom PA dissection has been confirmed. Three patients had IPAH, one had PAH associated with congenital heart disease. All patients had mean pulmonary artery pressure (PAP) > 50 mmHg at diagnosis and dissection occurred late in the course of apparently well controlled disease (6 to 14 years). Several clinical elements were common to our patients - high systolic PAP, long lasting PH, progressive dilatation of PA to more than 50 mm with chest pain prior to dissection. However, clinical course followed three different patterns: sudden death due to cardiac tamponade, hemopericarditis caused by blood leaking from dissected aneurysm with imminent but not immediate cardiac tamponade, or chronic asymptomatic PA dissection. Indeed, two of our patients are alive and on lung transplantation waiting list for more than 2 years now. Further research is needed to suggest optimal management strategies for patients with stable PAH but significantly dilated proximal pulmonary arteries or confirmed PA dissection depending on the clinical presentation and expected outcome.
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Affiliation(s)
- Michał Florczyk
- 1 Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Wieteska
- 1 Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Kurzyna
- 1 Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Gościniak
- 2 Clinical and Invasive Cardiology Department, Maria Curie Skłodowska Province Hospital, Szczecin, Poland
| | - Joanna Pepke-Żaba
- 3 Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK
| | | | - Adam Torbicki
- 1 Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
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7
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Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension. Case Rep Med 2016; 2016:4739803. [PMID: 27974894 PMCID: PMC5126397 DOI: 10.1155/2016/4739803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/16/2016] [Accepted: 10/23/2016] [Indexed: 11/17/2022] Open
Abstract
Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.
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Pulmonary artery dissection in a patient with undiagnosed pulmonary hypertension – A case report and review of literature. Heart Lung 2015; 44:453-7. [DOI: 10.1016/j.hrtlng.2015.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 11/23/2022]
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Spahr JE, West SC. Heart-lung transplantation: pediatric indications and outcomes. J Thorac Dis 2014; 6:1129-37. [PMID: 25132980 DOI: 10.3978/j.issn.2072-1439.2014.07.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/23/2014] [Indexed: 11/14/2022]
Abstract
As indications for heart-lung transplant (HLT) have changed to some degree in the past 30 years, this treatment is being used less frequently in children due to more advanced care of severe heart and lung disease. This is fortunate as the outcomes for HLT are poor compared to other solid organ transplants and this is mainly due to the poorer outcome of the lung graft.
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Affiliation(s)
- Jonathan E Spahr
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Shawn C West
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
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Hostiuc S, Dermengiu D, Ceauşu M, Capatina CO, Luca L, Hostiuc M. Sudden death due to dissection of the thoracic aorta associated with dissection and rupture of the pulmonary artery: Report of two cases. Forensic Sci Int 2014; 236:e9-13. [DOI: 10.1016/j.forsciint.2013.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
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Zanotti G, Hartwig MG, Duane Davis R. A simplified technique for pulmonary artery aneurysm repair in a lung transplant recipient with right ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 2013; 145:295-6. [DOI: 10.1016/j.jtcvs.2012.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/31/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
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Żyłkowska J, Kurzyna M, Florczyk M, Burakowska B, Grzegorczyk F, Burakowski J, Wieteska M, Oniszh K, Biederman A, Wawrzyńska L, Szturmowicz M, Fijałkowska A, Torbicki A. Pulmonary Artery Dilatation Correlates With the Risk of Unexpected Death in Chronic Arterial or Thromboembolic Pulmonary Hypertension. Chest 2012; 142:1406-1416. [DOI: 10.1378/chest.11-2794] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Affiliation(s)
- Amikar Sehdev
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois 60612, USA.
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Idiopathic pulmonary artery dissection: a case report. J Med Case Rep 2009; 3:7426. [PMID: 19830206 PMCID: PMC2737775 DOI: 10.4076/1752-1947-3-7426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 01/27/2009] [Indexed: 11/08/2022] Open
Abstract
Introduction The occurrence of pulmonary artery dissection is extremely rare in patients without pulmonary hypertension, congenital cardiac abnormalities or cardiac intervention. A diagnosis of pulmonary artery dissection is rarely made during life because it generally leads to cardiogenic shock and sudden death. The progression or natural course of pulmonary artery dissection is not known and the optimum management is not defined because of the paucity of cases in the literature. Case presentation We report a rare case of a 51-year-old female patient, without pulmonary hypertension or other cardiac abnormalities, who presented with acute chest pain and was found to have a pulmonary artery dissection.. The diagnosis of pulmonary artery dissection was confirmed by computed tomography scan of the chest and cardiac magnetic resonance imaging. The patient declined surgical intervention and was followed up closely with medical therapy. At almost a year after her initial presentation, the patient is stable with no complications. Conclusions To our knowledge, there are no similar cases reported in the literature of people with pulmonary artery dissection who have been followed up and who have not had surgical intervention. We review the etiology, pathophysiology, clinical associations, diagnosis and management of patients with pulmonary artery dissection.
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Abstract
Most mediastinal masses seen on thoracic imaging are of solid tumor origin. As such, vascular lesions of the mediastinum can be mistaken for, or misinterpreted as, one of these more common mediastinal masses. This article stresses the importance of considering vascular entities in the differential diagnosis of mediastinal masses.
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