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Bax M, Romanov V, Junday K, Giannoulatou E, Martinac B, Kovacic JC, Liu R, Iismaa SE, Graham RM. Arterial dissections: Common features and new perspectives. Front Cardiovasc Med 2022; 9:1055862. [PMID: 36561772 PMCID: PMC9763901 DOI: 10.3389/fcvm.2022.1055862] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations - such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Valentin Romanov
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Boris Martinac
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY, United States
| | - Renjing Liu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
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Spontaneous idiopathic pulmonary artery dissection with ST segment elevation in Leads aVR and V1. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:125-128. [PMID: 35444853 PMCID: PMC8990139 DOI: 10.5606/tgkdc.dergisi.2022.20799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
Pulmonary artery dissection is a rare condition that often occurs on the basis of pulmonary arterial hypertension and causes complications such as cardiogenic shock and sudden death. Additionally, this condition can be idiopathic. A 59-year-old male patient with no previous history of disease presented to our clinic with chest pain and shortness of breath. Coronary arteries were normal on coronary angiography in the patient who had a positive troponin test result and ST segment elevation in leads V1, V2, V3 and aVR. Pulmonary embolism was suspected in the patient whose condition worsened. Pulmonary artery dissection was diagnosed via the contrast-enhanced computed tomography and sudden cardiac death occurred. In conclusion, pulmonary artery dissection may cause aVR segment elevation on electrocardiography.
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Regalado L, Vitellas C, Wright L, Ganapathi A, Whitson BA, Amadi CC. Pulmonary artery dissection in long standing idiopathic pulmonary arterial hypertension: A case report. Radiol Case Rep 2021; 17:227-231. [PMID: 34824656 PMCID: PMC8605200 DOI: 10.1016/j.radcr.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/16/2021] [Indexed: 12/02/2022] Open
Abstract
Pulmonary arterial dissection (PAD) is a rare and often lethal complication of chronic pulmonary arterial hypertension (PAH), which may occurs in patients with idiopathic pulmonary arterial hypertension (IPAH) and potentially in those with connective tissue disorders. While rare, sudden death often occurs secondary to acute cardiac tamponade, as the pulmonary artery dissects into the pericardium; this diagnosis is often made postmortem. Nevertheless, with the proliferation of multidetector computed tomography (MDCT) as a diagnostic test, patients may be identified very early after symptom onset, prompting rapid intervention with decreased morbidity and mortality. We report a case of IPAH complicated by pulmonary artery aneurysm (PAA) and PAD, diagnosed by CT pulmonary angiogram (CTPA), and treated with bilateral lung transplantation, pulmonic valve replacement, and re-anastomosis of the donor main PA to a pulmonary valve conduit.
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Affiliation(s)
- Luis Regalado
- The Ohio State University, College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Carol Vitellas
- The Ohio State University, College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Lindsay Wright
- Department of Radiology, The Ohio State University, Wexner Medical Center, 395 W 12th Ave, Columbus, OH 43210, USA
| | - Asvin Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W. 10th Ave, Columbus OH 43210, USA
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W. 10th Ave, Columbus OH 43210, USA
| | - Chiemezie Chianotu Amadi
- Department of Radiology, The Ohio State University, Wexner Medical Center, 395 W 12th Ave, Columbus, OH 43210, USA
- Corresponding author.
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Shibata J, Ismail K, Liu YT. Woman with dyspnea and acute respiratory distress. J Am Coll Emerg Physicians Open 2021; 2:e12416. [PMID: 33842924 PMCID: PMC8019335 DOI: 10.1002/emp2.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jacqueline Shibata
- Department of Emergency Medicine, David Geffen School of Medicine at UCLAOlive View‐UCLA Medical CenterLos AngelesUSA
| | - Khadija Ismail
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCAUSA
| | - Yiju Teresa Liu
- Department of Emergency Medicine, David Geffen School of Medicine at UCLAHarbor‐UCLA Medical CenterTorranceCAUSA
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Revels JW, Wang SS, Febbo J, Murali S, Luft K. Simultaneous pulmonary artery and Stanford type B aortic dissections via the ductus arteriosus. Radiol Case Rep 2020; 15:2382-2384. [PMID: 32994846 PMCID: PMC7515976 DOI: 10.1016/j.radcr.2020.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jonathan W. Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, Albuquerque, NM 87131, USA
- Corresponding author.
| | - Sherry S. Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, MSC 10 5530, Albuquerque, NM 87131, USA
| | - Sowmiya Murali
- Department of Radiology, University of New Mexico, MSC 10 5530, Albuquerque, NM 87131, USA
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Yoshizawa H, Kobayashi K, Kataoka M, Kameda I, Maeda H, Sakurai K, Ohta-Ogo K, Hatakeyama K, Yoshida KI. Sudden death of a middle-aged woman with congenital heart disease presented macroscopic and microscopic pulmonary artery aneurysm and dissection with thrombosis: A case report. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Quesada D, Morsky LA, Jones A, Capote AL. Pulmonary Artery Dissection Post-blunt Thoracoabdominal Trauma. Clin Pract Cases Emerg Med 2020; 4:466-467. [PMID: 32926715 PMCID: PMC7434233 DOI: 10.5811/cpcem.2019.12.44649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Pulmonary artery dissection is a rare condition that is usually diagnosed in patients exhibiting chronic pulmonary arterial hypertension, congenital heart abnormalities or secondary to iatrogenic injury. Diagnosis is often made at autopsy as many patients experience sudden death when the pulmonary artery dissection progresses rapidly and ruptures into the pericardium, resulting in acute cardiac tamponade. Case Presentation We report a case of pulmonary artery dissection, which resulted from blunt thoracic trauma diagnosed in the emergency department.
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Affiliation(s)
- Daniel Quesada
- Kern Medical, Department of Emergency Medicine, Bakersfield, California.,LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Larissa A Morsky
- Kern Medical, Department of Emergency Medicine, Bakersfield, California
| | - Amber Jones
- Kern Medical, Department of Surgery, Bakersfield, California
| | - Allan L Capote
- Kern Medical, Department of Surgery, Bakersfield, California
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Fallot Tetralogy with Dissected Pulmonary Artery Aneurysm: A Rare Case Report. Ann Vasc Surg 2020; 68:568.e7-568.e10. [PMID: 32278868 DOI: 10.1016/j.avsg.2020.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022]
Abstract
Pulmonary artery dissection is a rare and extremely dangerous disease with high mortality rates. It is one of the most serious complications of chronic pulmonary hypertension. It may be related to chronic pulmonary hypertension and pulmonary artery dilatation. Early diagnosis of pulmonary dissection is particularly important because of its high mortality. Once the symptoms worsen or severe deterioration of the disease occurs, imaging examination should be performed promptly for early diagnosis and timely treatment.
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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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Recognition of Ultrasound Artifact Mimicking Pulmonary Artery Dissection in Patients with Heart Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4919416. [PMID: 31321237 PMCID: PMC6607705 DOI: 10.1155/2019/4919416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022]
Abstract
Purpose Imaging artifacts are frequently encountered when performing clinical echocardiography. Based on our review of the literature, two-dimensional linear artifacts are mainly reported in the ascending aorta in patients with suspected aortic dissections. However, pulmonary artery artifacts that mimic pulmonary artery dissection have not been discussed. We herein report our experience with children and adults with preexisting heart conditions and pulmonary artery imaging artifacts. Methods The study population comprised 10 patients with heart disease who were treated at our hospital from March 2015 to September 2017. Nine patients were children with congenital heart disease, mainly patent ductus arteriosus (n = 8), and one patient was an adult with pulmonary artery hypertension. Transthoracic echocardiography was performed in all patients. Results We confirmed the diagnosis in six patients during a surgical operation for other indications and in four patients by computed tomographic pulmonary angiography. The most common pulmonary imaging artifact was observed from the left high parasternal view (9/10, 90%). Most of the artifacts were diagonally oriented (8/10, 80%), and a few were horizontally oriented. Half of the artifacts were located in the main pulmonary arteries with mild pulmonary artery dilatation. Pulmonary hypertension was seen only in the adult patient. The thymus gland was clearly seen in young patients. Conclusion Pulmonary artery imaging artifacts in patients with preexisting heart disease during echocardiographic examination can mimic pulmonary artery dissection. Understanding the types and origins of these ultrasound artifacts is important to avoid a false-positive diagnosis.
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Nuche J, Montero Cabezas JM, Jiménez López-Guarch C, Velázquez Martín M, Alonso Charterina S, Revilla Ostolaza Y, Arribas Ynsaurriaga F, Escribano Subías P. Frequency, Predictors, and Prognostic Impact of Pulmonary Artery Aneurysms in Patients With Pulmonary Arterial Hypertension. Am J Cardiol 2019; 123:474-481. [PMID: 30477804 DOI: 10.1016/j.amjcard.2018.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
Detection of pulmonary artery aneurysms (PAA) in pulmonary arterial hypertension (PAH) is increasing. We sought to determine the frequency of PAA in a PAH cohort, variables related to its development and its prognostic impact. We conducted a retrospective analysis of PAH patients who underwent a computed tomography or magnetic resonance. PAA was defined as a pulmonary artery >40 mm. Baseline, echocardiographic, and hemodynamic findings at PAH diagnosis were compared. Freedom from death or lung transplant was estimated by Kaplan-Meier method and compared by log-rank test. Predictors of PAA development were analyzed with multivariate models. Two-hundred patients underwent a computed tomography and/or magnetic resonance. In 77 (38%), a PAA (48.3 ± 7.2 mm) was detected. Time-course (months) of PAH was an independent risk factor for PAA (hazard ratio 1.01; 95% confidence interval 1.002 to 1.019; p = 0.016) whilst connective tissue disease was associated with a lower risk (hazard ratio 0.236; 95% confidence interval 0.060 to 0.920; p = 0.037). PAA patients showed lower rates of death and lung transplant from PAH diagnosis (p = 0.005), but no differences appeared when survival analysis was performed from first imaging test (p = 0.269). PAA patients presented a nonsignificant higher rate of sudden death (5% PAA vs 1% no-PAA; p = 0.073). In conclusion, the frequency of PAA was 38%. PAH time-course was an independent risk factor for PAA development whereas connective tissue disease -related PAH patients showed a lower risk. PAA patients showed lower rates of death or lung transplant from PAH diagnosis but no differences were found from imaging test. PAA patients had a nonsignificant higher rate of sudden death.
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Affiliation(s)
- Jorge Nuche
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Carmen Jiménez López-Guarch
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Spain
| | | | | | | | - Fernando Arribas Ynsaurriaga
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Spain
| | - Pilar Escribano Subías
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Spain.
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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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Zhang L, Li Y, Lv Q, Yuan L. Pulmonary artery aneurysm secondary to patent arterial duct and infection: A case report and review. Echocardiography 2018; 35:1878-1881. [PMID: 30267632 DOI: 10.1111/echo.14138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/01/2022] Open
Abstract
Pulmonary artery aneurysms (PAAs) are very rare condition. In this paper, we report a case of a twenty-year-old female patient with the aneurysm of the pulmonary trunk secondary to the patent arterial duct (PDA) and infection. Diagnosis of PAA was confirmed by echocardiography. The pulmonary artery computed tomographic angiography also revealed the aneurysm and drawn a similar conclusion as echo did. The patient underwent surgery of ligation of PDA and PAA aneurysmectomy repairing with pericardium graft.
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Affiliation(s)
- Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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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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Zhong W, Meredith G. A rare case of right pulmonary segmental artery dissection following pacemaker insertion. BMJ Case Rep 2018; 2018:bcr-2017-223541. [PMID: 29477997 DOI: 10.1136/bcr-2017-223541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Wenjie Zhong
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Graham Meredith
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, New South Wales, Australia
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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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A Rare Case of Hemopericardium From a Ruptured Dissecting Pulmonary Artery Aneurysm: Postmortem Computed Tomography Scan and Autopsy Findings. Am J Forensic Med Pathol 2017; 39:50-53. [PMID: 29120872 DOI: 10.1097/paf.0000000000000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nontraumatic hemopericardium is a potentially fatal pathology that is most commonly caused by myocardial wall rupture, ruptured aortic dissection, aortic aneurysm rupture, or a neoplastic process. A rare potential cause of hemopericardium is pulmonary artery dissection, with less than 100 reported cases in the literature. Pulmonary artery dissection is associated with pulmonary artery aneurysm, pulmonary artery hypertension, and congenital heart disease. We report a fatal case of nontraumatic hemopericardium caused by a ruptured dissecting pulmonary artery aneurysm in a 16-year-old girl with patent ductus arteriosus. The unenhanced postmortem computed tomography performed before autopsy was able to identify a large hemopericardium with a pulmonary artery aneurysm and lifting of mural calcification suggestive of a dissecting aneurysm. This enabled the pathologist to locate the exact rupture site that caused the hemopericardium.
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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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Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection. Case Rep Med 2017; 2017:2760535. [PMID: 28154579 PMCID: PMC5244010 DOI: 10.1155/2017/2760535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.
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Biasato I, Tursi M, Zanet S, Longato E, Capucchio M. Pulmonary artery dissection causing haemothorax in a cat: potential role of Dirofilaria immitis infection and literature review. J Vet Cardiol 2017; 19:82-87. [DOI: 10.1016/j.jvc.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/15/2016] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
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21
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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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Grint KA, Kellihan HB. Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis. J Vet Cardiol 2016; 19:182-189. [PMID: 27913078 DOI: 10.1016/j.jvc.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
Abstract
A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs.
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Affiliation(s)
- K A Grint
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Dr. Madison, WI 53706, USA
| | - H B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Dr. Madison, WI 53706, USA.
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23
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Lin CT, Raman SP, Fishman EK. An algorithmic approach to CT of pulmonary arterial disorders. Clin Imaging 2016; 40:1226-1236. [DOI: 10.1016/j.clinimag.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/10/2023]
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24
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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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Abstract
Pulmonary hypertension is the commonest condition leading to dilated pulmonary artery. We describe three different types of compression of adjacent anatomical structures by dilated pulmonary arteries. We included involvement of the left main coronary artery, left recurrent laryngeal nerve and tracheobronchial tree. Compression of these structures can cause major complications such as myocardial ischemia, hoarseness and major airway stenosis. We present a case for each scenario and review the literature for each of these complications, focusing on patients' characteristics and contemporary management.
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Affiliation(s)
- Wael Dakkak
- a Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute , Cleveland Clinic , Cleveland , OH , USA
| | - Adriano R Tonelli
- a Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute , Cleveland Clinic , Cleveland , OH , USA
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26
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Birgy C, Bresson D, Duculescu E, Carpentier M, Philit F, Jacquemin L, Levy J. Rare and life-threatening cardiovascular complication of chronic thromboembolic pulmonary hypertension diagnosed by trans-thoracic echocardiography. Int J Cardiol 2016; 203:450-2. [DOI: 10.1016/j.ijcard.2015.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/04/2015] [Indexed: 11/24/2022]
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27
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Jung LY. Is pulmonary artery dissection predictable? Heart Lung 2015; 45:79-80. [PMID: 26578382 DOI: 10.1016/j.hrtlng.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Lae-Young Jung
- Division of Cardiology, Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk 561-712, South Korea.
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28
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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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29
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Surgical repair of pulmonary artery dissection in a patient with 10-year history of Takayasu’s arteritis. Gen Thorac Cardiovasc Surg 2015; 64:745-748. [DOI: 10.1007/s11748-015-0566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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30
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Platzmann AM, Schmiady M, Rudiger A, Huebler M, Greutmann M, Bettex DA. First description of successful weaning from ECMO in a patient with Eisenmenger syndrome after repair of pulmonary artery dissection. Int J Cardiol 2015; 187:144-5. [DOI: 10.1016/j.ijcard.2015.03.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
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31
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Affiliation(s)
- Sossio Perrotta
- Department of Cardiothoracic Surgery; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Salvatore Lentini
- Cardiovascular Department; Città di Lecce Hospital GVM Care & Research; Lecce Italy
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32
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Yaman M, Arslan U, Ateş AH, Aksakal A. Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature. World J Cardiol 2015; 7:101-103. [PMID: 25717357 PMCID: PMC4325299 DOI: 10.4330/wjc.v7.i2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/18/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.
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33
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Scansen BA, Simpson EM, López-Alvarez J, Thomas WP, Bright JM, Eason BD, Rush JE, Dukes-McEwan J, Green HW, Cunningham SM, Visser LC, Kent AM, Schober KE. Pulmonary artery dissection in eight dogs with patent ductus arteriosus. J Vet Cardiol 2015; 17:107-19. [PMID: 25596918 DOI: 10.1016/j.jvc.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/04/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA). ANIMALS Eight dogs. METHODS Retrospective case series. RESULTS Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5-4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure. CONCLUSIONS Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome.
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Affiliation(s)
- Brian A Scansen
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA.
| | - Elaine M Simpson
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Jordi López-Alvarez
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire, UK; Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - William P Thomas
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Janice M Bright
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Bryan D Eason
- Department of Veterinary Clinical Sciences and the Veterinary Teaching Hospital, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Joanna Dukes-McEwan
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire, UK
| | - Henry W Green
- Department of Veterinary Clinical Sciences and the Veterinary Teaching Hospital, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Suzanne M Cunningham
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Lance C Visser
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Agnieszka M Kent
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Karsten E Schober
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
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Bezgin T, Demircan HC, Kaymaz C. Giant pulmonary artery aneurysm secondary to patent ductus arteriosus: a case report. Curr Cardiol Rev 2014; 11:163-6. [PMID: 25545802 PMCID: PMC4356724 DOI: 10.2174/1573403x1102141224145247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 11/23/2022] Open
Abstract
Aneurysms involving the main pulmonary artery and its branches are rare. Clinical experience is limited, and their management is not well established. We present the case of a 35-year-old male patient with dyspnea and hemoptysis in whom subsequent imaging studies revealed a giant pulmonary artery aneurysm associated with an uncorrected patent ductus arteriosus and Eisenmenger’s syndrome. We chose to treat the patient conservatively with medical management due to the development of Eisenmenger’s physiology while waiting for heart-lung transplantation.
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Affiliation(s)
| | | | - Cihangir Kaymaz
- Kartal Kouyolu Heart Research Hospital, Denizer Cad. 34846 Cevizli Kartal-stanbul, Turkey.
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35
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Sheikhzadeh S, De Backer J, Gorgan NR, Rybczynski M, Hillebrand M, Schüler H, Bernhardt AM, Koschyk D, Bannas P, Keyser B, Mortensen K, Radke RM, Mir TS, Kölbel T, Robinson PN, Schmidtke J, Berger J, Blankenberg S, von Kodolitsch Y. The main pulmonary artery in adults: a controlled multicenter study with assessment of echocardiographic reference values, and the frequency of dilatation and aneurysm in Marfan syndrome. Orphanet J Rare Dis 2014; 9:203. [PMID: 25491897 PMCID: PMC4272795 DOI: 10.1186/s13023-014-0203-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiographic upper normal limits of both main pulmonary artery (MPA) diameters (MPA-d) and ratio of MPA to aortic root diameter (MPA-r) are not defined in healthy adults. Accordingly, frequency of MPA dilatation based on echocardiography remains to be assessed in adults with Marfan syndrome (MFS). METHODS We enrolled 123 normal adults (72 men, 52 women aged 42 ± 14 years) and 98 patients with MFS (42 men, 56 women aged 39 ± 14 years) in a retrospective cross-sectional observational controlled study in four tertiary care centers. We defined outcome measures including upper normal limits of MPA-d and MPA-r as 95 quantile of normal persons, MPA dilatation as diameters > upper normal limits, MPA aneurysm as diameters >4 cm, and indication for surgery as MPA diameters >6 cm. RESULTS MPA diameters revealed normal distribution without correlation to age, sex, body weight, body height, body mass index and body surface area. The upper normal limit was 2.6 cm (95% confidence interval (CI) =2.44-2.76 cm) for MPA-d, and 1.05 (95% CI = .86-1.24) for MPA-r. MPA dilatation presented in 6 normal persons (4.9%) and in 68 MFS patients (69.4%; P < .001), MPA aneurysm presented only in MFS (15 patients; 15.3%; P < .001), and no patient required surgery. Mean MPA-r were increased in MFS (P < .001), but ratios >1.05 were equally frequent in 7 normal persons (5%) and in 8 MFS patients (10.5%; P = .161). MPA-r related to aortic root diameters (P = .042), reduced left ventricular ejection fraction (P = .006), and increased pulmonary artery systolic pressures (P = .040). No clinical manifestations of MFS and no FBN1 mutation characteristics related to MPA diameters. CONCLUSIONS We established 2.6 cm for MPA-d and 1.05 for MPA-r as upper normal limits. MFS exhibits a high prevalence of MPA dilatation and aneurysm. However, patients may require MPA surgery only in scarce circumstances, most likely because formation of marked MPA aneurysm may require LV dysfunction and increased PASP.
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Affiliation(s)
- Sara Sheikhzadeh
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Julie De Backer
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium.
| | - Neda Rahimian Gorgan
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Meike Rybczynski
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Mathias Hillebrand
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Helke Schüler
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Alexander M Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dietmar Koschyk
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Britta Keyser
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Kai Mortensen
- Medizinische Klinik II / Kardiologie, Angiologie, am Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany.
| | - Robert M Radke
- Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Germany.
| | - Thomas S Mir
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter N Robinson
- Institute of Medical Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Jörg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Jürgen Berger
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Stefan Blankenberg
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Nikparvar M, Parsaee M, Maleki M, Alizadehasl A, Azarfarin R. Silent Pulmonary Artery Dissection in a patient with old Pulmonary Balloon Valvuloplasty. IRANIAN JOURNAL OF MEDICAL SCIENCES 2014; 39:484-6. [PMID: 25242850 PMCID: PMC4164899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/26/2013] [Accepted: 07/14/2013] [Indexed: 12/03/2022]
Abstract
Percutaneous pulmonary balloon valvuloplasty (PBV) remains the treatment of choice for pulmonary stenosis (PS). This procedure is effective, safe and gives excellent results. Pulmonary artery (PA) dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study.
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Affiliation(s)
- Marzieh Nikparvar
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran;
| | - Mozhgan Parsaee
- Shaheed Rajaie Cardiovascular Medical and Research Center, Department of Echocardiography, Tehran, Iran;
| | - Majid Maleki
- Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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37
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Theodoropoulos P, Ziganshin BA, Tranquilli M, Elefteriades JA. Pulmonary artery aneurysms: four case reports and literature review. Int J Angiol 2014; 22:143-8. [PMID: 24436601 DOI: 10.1055/s-0033-1347907] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aneurysms of the pulmonary artery are proven to be a very rare entity. Association with structural cardiac anomalies, structural vascular anomalies, pulmonary hypertension, vasculitis, and infection has been noted. Surgical intervention of symptomatic aneurysms is recommended. A more detailed study of the natural history of these aneurysms is needed. Here, we report four cases of pulmonary artery aneurysms as well as a brief review of the literature existing on this subject. The first case is of a 41-year-old woman with the aneurysm located 1 cm distal to the pulmonary valve extending to the bifurcation of the main pulmonary artery. The second case is of a 76-year-old woman with a large aneurysm of the main pulmonary artery and the left pulmonary artery. The third case is of a 61-year-old woman with an aneurysm of the common pulmonary artery and right pulmonary artery. The fourth case is of a 28-year-old woman with a 5-cm symptomatic aneurysm extending from the valve up to the pulmonary bifurcation. Surgical excision and reconstruction was ordered for cases 1, 2, and 4.
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Affiliation(s)
- Panagiotis Theodoropoulos
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut ; Department of Surgical Diseases No. 2, Kazan State Medical University, Kazan, Russia
| | - Maryann Tranquilli
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - John A Elefteriades
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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38
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Patel V, Mehta HJ, Sadikot RT. Pulmonary artery dissection and rupture in a patient with idiopathic pulmonary artery hypertension. Am J Respir Crit Care Med 2014; 189:e10-1. [PMID: 24628324 DOI: 10.1164/rccm.201304-0693im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vipul Patel
- 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida; and
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39
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Anzouan-Kacou JB, Séka R, N'guetta R, Kramoh E, Konin C. [Giant pulmonary artery aneurysm: etiology and an exceptional 17 years natural course]. Ann Cardiol Angeiol (Paris) 2014; 64:116-20. [PMID: 24841424 DOI: 10.1016/j.ancard.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 04/08/2014] [Indexed: 11/27/2022]
Abstract
True pulmonary artery aneurysm (AAP) is rare and represent less than 1% of intra-thoracic aneurysms. We report a case of a AAP in a patient with a likely cor triatrium sinister, with an obstructive membrane responsible for pulmonary hypertension, explaining AAP. The long-term evolution of 17 years is made to an uncomplicated myocardial infarction. The patient died eight months later suddenly probably due to the rupture of the PAA.
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Affiliation(s)
- J-B Anzouan-Kacou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire.
| | - R Séka
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - R N'guetta
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - E Kramoh
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - C Konin
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
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40
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Cook R, Duarte AG, Boor P, Daniel C. Chronic pulmonary artery dissection associated with pulmonary arterial hypertension. Pulm Circ 2014; 3:692-5. [PMID: 24618553 DOI: 10.1086/674560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract Pulmonary artery dissection is a complication associated with pulmonary arterial hypertension. This complication is described as acute in onset and is frequently fatal without intervention. We describe a patient with idiopathic pulmonary arterial hypertension and chest pain found to have an unsuspected chronic pulmonary artery dissection on postmortem examination. Chronic pulmonary artery dissection should be considered in patients with chest pain and worsening dyspnea, as the frequency this condition may be underestimated.
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Affiliation(s)
- Rhonda Cook
- 1 Department of Pathology, University of Texas Medical Branch, Galveston, Texas, 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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Adams RF, Argilla M, Srichai MB. Iatrogenic Aortopulmonary Window and Pulmonary Artery Dissection Secondary to Aortic Cannulation. Circulation 2013; 128:e180-1. [DOI: 10.1161/circulationaha.112.001364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert F. Adams
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
| | - Michael Argilla
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
| | - Monvadi B. Srichai
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
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Pulmonary artery aneurysm in an octogenarian with operated secundum atrial septal defect. Herz 2013; 39:657-60. [PMID: 23989764 DOI: 10.1007/s00059-013-3887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/05/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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Ay Y, Ay NK, Aydin C, Kara I, Zeybek R. A rare complication of pre-Eisenmenger patent ductus arteriosus: Pulmonary artery dissection. Int J Surg Case Rep 2013; 4:483-5. [PMID: 23562897 DOI: 10.1016/j.ijscr.2013.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/04/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Pulmonary artery dissection associated with patent ductus arteriosus is usually seen in patients with pulmonary hypertension and Eisenmenger's syndrome. This paper presents a case with pre-Eisenmenger patent ductus arteriosus complicated by pulmonary artery dissection, and explains how she was surgically treated. PRESENTATION OF CASE The transthoracic echocardiography of a 21-year-old woman complaining of effort dyspnea revealed patent ductus arteriosus. Contrast-enhanced thoracic computed tomography scan showed patent ductus arteriosus and dissection in the main pulmonary artery extending from the edge of the patent ductus arteriosus orifice to the pulmonary valve. The patent ductus arteriosus was divided with pledgeted prolene suture and the dissected aneurysmal portion of the pulmonary artery was resected by surgery. Dacron graft interposition was applied to the main pulmonary artery. DISCUSSION Because rupture causes cardiogenic shock and sudden death, diagnosis is rare in the living subject and pulmonary artery dissection is frequently detected in autopsy. A case with pulmonary artery dissection as a result of patent ductus arteriosus has been reported in the literature, but the patient died in the preoperative period. In our study, the patient was not diagnosed to have Eisenmenger's syndrome, but had pulmonary artery dissection, a complication arising from patent ductus arteriosus. The patient underwent curative surgery that included pulmonary artery dissection repair and closure of the patent ductus arteriosus. CONCLUSION In addition to pulmonary artery aneurysm, pulmonary artery dissection must also be considered as a complication in cases of patent ductus arteriosus with high pulmonary artery pressure diagnosed in adulthood.
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Affiliation(s)
- Yasin Ay
- Department of Cardiovascular Surgery, Bezmialem Vakif University, 34093 Fatih, Istanbul, Turkey.
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Fortuny E, Vilacosta I, Viana-Tejedor A, Subhi-Issa I. Pulmonary artery intramural haematoma: an unusual cause of sudden death in patients with chronic pulmonary hypertension. HEART ASIA 2013; 5:94-5. [PMID: 27326093 DOI: 10.1136/heartasia-2013-010332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Elena Fortuny
- Cardiology Department , Cardiovascular Institute, Hospital Clínico San Carlos , Madrid , Spain
| | - Isidre Vilacosta
- Cardiology Department , Cardiovascular Institute, Hospital Clínico San Carlos , Madrid , Spain
| | - Ana Viana-Tejedor
- Cardiology Department , Cardiovascular Institute, Hospital Clínico San Carlos , Madrid , Spain
| | - Issa Subhi-Issa
- Pathology Department , Hospital Clínico San Carlos , Madrid , Spain
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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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Matsumoto A, Kawasaki T, Takeoka M, Yamano M, Sakai C, Harimoto K, Miki S, Kamitani T. Silent pulmonary artery dissection in a centenarian. J Cardiol Cases 2011; 5:e36-e38. [PMID: 30532898 DOI: 10.1016/j.jccase.2011.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022] Open
Abstract
Pulmonary artery dissection is an extremely rare and fatal disease that is difficult to diagnose. We report a case of a 97-year-old woman with heart failure, who was diagnosed as having silent pulmonary artery dissection by chance during transthoracic echocardiography. Surgical treatment for pulmonary artery dissection was not performed, but the patient has been doing well in a sanatorium for more than 2 years, being a centenarian.
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Affiliation(s)
- Asumi Matsumoto
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Tatsuya Kawasaki
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Mayumi Takeoka
- Department of Clinical Physiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Michiyo Yamano
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Chieko Sakai
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Kuniyasu Harimoto
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Shigeyuki Miki
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Tadaaki Kamitani
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
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Matsumura Y, Ogino H, Sasaki H, Nakanishi N. Pulmonary artery dissection associated with multiple coronary–pulmonary artery fistulae. Interact Cardiovasc Thorac Surg 2010; 11:207-8. [DOI: 10.1510/icvts.2010.233841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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A rare case of right and left pulmonary artery dissections on 64-slice multidetector computed tomography. J Thorac Imaging 2010; 25:W136-7. [PMID: 20531230 DOI: 10.1097/rti.0b013e3181c65af5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary artery dissection is a rare but life-threatening disease, which has mainly been diagnosed at postmortem examination rather than in living patients. Herein we report an unusual case of pulmonary artery dissection involving the right and left pulmonary arteries with Eisenmenger syndrome confirmed by multidetector computed tomography (CT) and echocardiography in a living patient. The CT findings of our case are presented, and the utility of multidetector CT in the evaluation of pulmonary artery dissection is discussed.
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Islam S, Cevik C, Islam EA, Singhatiraj E, Jones J, Rodriguez S, Nugent K. Pulmonary valve stenosis causing massive pulmonary artery aneurysm: a conservative approach. J Cardiovasc Med (Hagerstown) 2010; 13:593-6. [PMID: 20442668 DOI: 10.2459/jcm.0b013e328337d83e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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