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Marrocchio C, Humphries SM, Lynch DA. Chest Computed Tomography Findings in Unilateral Pulmonary Fibrosis Secondary to Chronic Hypoperfusion. J Thorac Imaging 2024; 39:269-274. [PMID: 38095281 PMCID: PMC11338022 DOI: 10.1097/rti.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE Unilateral lung fibrosis is uncommon and few cases secondary to parenchymal hypoperfusion have been reported, requiring further understanding of this entity. This study aims to report the chest computed tomography (CT) findings of patients with unilateral lung fibrosis related to parenchymal hypoperfusion observed in our institution. PATIENTS AND METHODS Patients with a chest CT between 2004 and 2022 showing a condition causing hypoperfusion of either lung and ipsilateral unilateral lung fibrosis were retrospectively identified. Clinical and scintigraphic data were collected. Pattern and distribution of fibrosis were recorded, and its progression was evaluated when follow-up was available. In adequate CTs, fibrosis was quantified using data-driven textural analysis (DTA). Affected and contralateral lungs and baseline and follow-up data were compared using the Wilcoxon signed-rank test. RESULTS Thirteen patients (male: 7, female: 6, median age: 61 y) were included; 5 with congenital unilateral absence of a pulmonary artery and 8 with fibrosing mediastinitis. The mean scintigraphic perfusion of affected lungs was 3.3% ± 1.1 compared with 96.7% ± 1.1 contralaterally (n = 7, P = 0.017). Fibrosis had a UIP pattern in one case, indeterminate in the others, and was most commonly diffuse craniocaudally and peripheral or central axially. DTA in 12 patients showed a mean fibrotic score of 32% ± 24.6 compared with 0.5% ± 0.4 in the contralateral lungs ( P = 0.002). Median follow-up was 4.5 years (minimum to maximum: 1 to 13 y). Of 10 patients, fibrosis was progressive in 60%. DTA of 5 follow-up CTs showed increased reticulations ( P = 0.043). CONCLUSION In patients with lung hypoperfusion, the possible complication of lung fibrosis should be considered.
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Affiliation(s)
- Cristina Marrocchio
- Department of Medicine and Surgery, Unit of Radiological Sciences, University of Parma, Parma, Italy
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CHOI M, LEE N. Isolated left hypoplasia of the pulmonary artery accompanied by lung hypoplasia and chronic bronchial disease in a cat. J Vet Med Sci 2024; 86:892-896. [PMID: 38880613 PMCID: PMC11300138 DOI: 10.1292/jvms.23-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/03/2024] [Indexed: 06/18/2024] Open
Abstract
A 2-year-old castrated Russian Blue cat presented with inappetence, depression, and labored respirations. Radiography findings suggested left lung atelectasis; however, the ultrasonography findings did not indicate lung atelectasis. The left pulmonary artery (PA) was abnormally small on echocardiography; further, there were no other cardiac anomalies. Computed tomography revealed an abnormally small left PA and left lung. Furthermore, bronchiectasis and tree-in-bud patterns were observed in the lung lobes. Based on these findings, the cat was diagnosed with isolated left PA hypoplasia, presumed left lung hypoplasia, and feline chronic bronchial disease. Early diagnosis of this disease is important because it can cause serious complications, including recurrent respiratory infection, bronchiectasis, massive hemoptysis, and pulmonary hypertension.
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Affiliation(s)
- Mihyun CHOI
- BON Animal Medical Center, Suwon, Republic of Korea
| | - Namsoon LEE
- Section of Medical Imaging, Veterinary Medical Center,
Chungbuk National University, Cheongju, Republic of Korea
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Parsaee M, Saedi S, Behrooj S, Emami E, Salehi P, Mohammadzadeh A. A rare association of the absence of left pulmonary artery with ventricular septal defect, pulmonary hypertension, and more interestingly, patent ductus arteriosus in an adult patient: Case report and literature review. Clin Case Rep 2024; 12:e9138. [PMID: 38988892 PMCID: PMC11233255 DOI: 10.1002/ccr3.9138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024] Open
Abstract
Key Clinical Message In this study, we introduced one of the rarest concomitants of the absence of left pulmonary artery (LPA), which was seen in our patient along with patent ductus arteriosus (PDA) and ventricular septal defect (VSD). Abstract Unilateral absence of pulmonary artery (UAPA) is a congenital heart disease in association with other abnormalities such as tetralogy of Fallot and septal defects or isolated in 30% of cases and occurs in the right lung in two thirds of cases. Our case is a 33-year-old man who was hospitalized with symptoms of cough, shortness of breath, and hemoptysis. The echocardiography revealed a large ventricular septal defect, absent left pulmonary artery, and severe pulmonary hypertension (PH) along with patent ductus arteriosus. These findings were confirmed by CT angiography. This association has rarely been found in past studies. Due to PH and pulmonary infection, the patient was treated with intravenous prostaglandin and antibiotics. However, in cases of timely diagnosis and treatment of UAPA, fatal complications such as pulmonary hypertension, morbidity, and mortality are reduced. This case emphasizes the importance of awareness of this abnormality and its associated anomalies to enable early diagnosis and treatment.
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Affiliation(s)
- Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Sedigheh Saedi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Soudabeh Behrooj
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Elaheh Emami
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Pegah Salehi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ali Mohammadzadeh
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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Raja Shariff RE, Yusoff MR, Ibrahim KS, Kasim S. Delayed Diagnosis of Unilateral Absence of Pulmonary Artery Presenting with Recurrent Bronchopneumonia. CASE (PHILADELPHIA, PA.) 2024; 8:103-108. [PMID: 38524981 PMCID: PMC10954568 DOI: 10.1016/j.case.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Unilateral absence of the pulmonary artery (UAPA) is a rare congenital condition. •Patients with UAPA may present initially following recurrent bouts of pneumonia. •Echocardiography remains a useful tool for diagnosis in resource-limited settings.
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Affiliation(s)
- Raja Ezman Raja Shariff
- Cardiology Department, Universiti Teknologi Mara (UiTM) Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Mohd Rahal Yusoff
- Cardiology Department, Universiti Teknologi Mara (UiTM) Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Khairul Shafiq Ibrahim
- Cardiology Department, Universiti Teknologi Mara (UiTM) Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Sazzli Kasim
- Cardiology Department, Universiti Teknologi Mara (UiTM) Sungai Buloh, Sungai Buloh, Selangor, Malaysia
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5
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Yamane T, Urata T, Okamoto T. Three-dimensional Computed Tomography of Asymmetrical Interstitial Lung Disease. Intern Med 2024; 63:755-756. [PMID: 37468241 PMCID: PMC10982016 DOI: 10.2169/internalmedicine.2168-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Takashi Yamane
- Department of Respiratory Medicine, Kochi Health Sciences Center, Japan
| | - Tomoyuki Urata
- Department of Respiratory Medicine, Kochi Health Sciences Center, Japan
| | - Taku Okamoto
- Department of Respiratory Surgery, Kochi Health Sciences Center, Japan
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Mattioni G, Nosotti M, Rosso L, Palleschi A, Tosi D, Mendogni P. Pneumonectomy for Unilateral Proximal Interruption of Pulmonary Artery: A Case Series from the Literature. Life (Basel) 2023; 13:2328. [PMID: 38137929 PMCID: PMC10744847 DOI: 10.3390/life13122328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Unilateral proximal interruption of the pulmonary artery (UPIPA) is a rare congenital disease, and its optimal management remains undefined in the existing literature. The occasional necessity for pneumonectomy is still supported by limited evidence. METHODS A systematic review of the literature was conducted using the PubMed search engine, focusing on UPIPA cases that received pneumonectomy. Thirty-one pertinent articles were selected and included in the analysis. A case reported from our institution was included in the analysis. RESULTS We found 25 adults and seven children affected by UPIPA who received an indication for pneumonectomy, plus an additional case that was reported by our institution. Among adult patients, the predominant indication was hemoptysis (57%), followed by suspected or confirmed lung cancer (23%). Approximately 46% of surgical procedures were classified as urgent or emergent. Postoperative complications were observed in 36% of cases, with no recorded mortality. In pediatric cases, pneumonectomy was primarily a life-saving intervention, performed urgently or emergently in 75% of instances. A possible late complication in pediatric patients involves a mediastinal shift leading to respiratory distress, which may be mitigated using an inflatable prosthesis. CONCLUSIONS Pneumonectomy achieves complete resolution of UPIPA symptoms. In the adult population, its primary indication is hemoptysis, with procedures conducted in both elective and urgent/emergent settings. Despite a mortality rate of zero, a notable proportion of patients may experience postoperative complications. In pediatric cases, the clinical presentation varies more extensively, and pneumonectomy is typically reserved for life-threatening situations, emphasizing the need for careful patient selection.
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Affiliation(s)
- Giovanni Mattioni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
- School of Thoracic Surgery, University of Milan, 20122 Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.N.); (L.R.); (A.P.); (D.T.); (P.M.)
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7
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Malani SK, Kashyap P, Nalawade D. A rare case of unilateral agenesis of left pulmonary artery presenting as severe pulmonary arterial hypertension. Glob Cardiol Sci Pract 2023; 2023:e202315. [PMID: 37575286 PMCID: PMC10422877 DOI: 10.21542/gcsp.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 08/15/2023] Open
Abstract
A 26-year-old young male patient presented with progressive dyspnea over the previous 2 years. The patient also had pulmonary hypertension. Computed tomography (CT) pulmonary angiography showed absence of the left pulmonary artery, and conventional pulmonary and aortic root angiograms showed ipsilateral lung receiving collaterals from the left internal mammary artery and thyrocervical trunk.
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Maini A, Cousins S, Holliday T, Memoli JW, Vasu TS, Khaitan PG. Hemoptysis: unilateral pulmonary artery atresia? a case report. J Cardiothorac Surg 2023; 18:199. [PMID: 37386643 DOI: 10.1186/s13019-023-02255-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/03/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Asymptomatic, isolated cases of unilateral pulmonary artery atresia may present in adulthood with symptoms such as recurrent respiratory infections, dyspnea, hemoptysis, and pulmonary hypertension. Unlike previously reported patients that underwent surgical management for this pathology, the patient in this report had no chronic history of recurrent respiratory infections, dyspnea, or pulmonary hypertension, making a diagnosis prior to extensive imaging difficult. CASE PRESENTATION A 55-year-old male presented to our emergency department (ED) with a 3-day history of recurrent cough with 2-3 tablespoons of hemoptysis per episode, chills, and occasional wheezing. A computed tomography angiography (CTA) was performed, which identified a congenital absence of the left pulmonary artery and a right-sided aortic arch. Hypertrophied left intercostal and bronchial arteries were noted to be perfusing the left lung. V/Q scan confirmed a heterogeneous distribution of gas throughout both lung fields with 97% perfusion to the right lung, but no visualization of the left lung on the perfusion images. Given extensive collateral blood supply to the left lung, interventional radiology performed a GELFOAM® embolization of the hypertrophied left bronchial artery and two parasitized arteries from the left subclavian artery to minimize intra-operative blood loss. This was immediately followed by a left thoracotomy, pneumonectomy, intercostal muscle flap placement, and bronchoscopy. The procedure was 360 min long with a total of 1500 cc blood loss that was salvaged and re-infused. No additional blood products were administered. The patient remained intubated post-operatively and was transferred to the surgical intensive care unit. His postoperative course was complicated by troponin leak, rhabdomyolysis, delirium, and ileus, all of which resolved over time. He was discharged home on postoperative day seven and continues to do well one-year later. CONCLUSIONS The patient in this report presented with several episodes of isolated hemoptysis but unlike previously reported cases of unilateral pulmonary artery atresia, he had no history of recurrent respiratory infections, dyspnea, or pulmonary hypertension. Although unilateral pulmonary artery atresia is a rare diagnosis, in patients with unexplained, isolated hemoptysis, further examination of the vasculature may be warranted, and surgical management may be beneficial in appropriate, symptomatic patients.
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Affiliation(s)
- Aneel Maini
- Department of General Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Sebastian Cousins
- Department of Pulmonology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Tyler Holliday
- Department of General Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jessica Wang Memoli
- Department of Pulmonology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Tajender Singh Vasu
- Department of Pulmonary and Sleep Medicine, Virginia Heart, Falls Church, VA, USA
| | - Puja Gaur Khaitan
- Department of General Surgery, Division of Thoracic Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington, DC, 20010, USA.
- Department of Surgery, Division of Thoracic Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, PO Box 11001, Abu Dhabi, UAE.
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Khaladkar SM, Kumar D, Kapoor R. Isolated unilateral absence of pulmonary artery- an unusual cause of hemoptysis: a case report. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-023-00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Isolated unilateral absence of one pulmonary artery (IUAPA) is a rare malformation and a rare cause of hemoptysis. It occurs due to malformation of the sixth aortic arch during embryogenesis. This condition has variable presentations like dyspnoea, reduced exercise tolerance, chest pain, pleural effusion, recurrent bronchopneumonia, pulmonary hypertension, and haemoptysis can be asymptomatic.
Case Presentation
We describe a case of a 34-year-old female presenting with recent onset hemoptysis associated with mild dyspnoea and cough. Chest Radiograph revealed unilateral hyperlucent lung field which was later diagnosed as Isolated unilateral absence of pulmonary artery on high resolution computed tomography of chest with angiography.
Conclusion
Absent pulmonary artery should be considered as an important differential in cases presenting with hemoptysis. This case emphasises the significance of combining computed tomography with pulmonary angiography to accurately evaluate and define congenital lung abnormalities.
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Saccomanno J, Pappe E, Dulce M, Madlung E, Gabriel F, Doehn JM, Schürmann D, Witzenrath M, Hübner RH. Unilateral Endobronchial Vascular Hypertrophy in a Young Patient with Hemoptysis. Am J Respir Crit Care Med 2023; 207:e1-e3. [PMID: 36174190 DOI: 10.1164/rccm.202205-1018im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Eva Pappe
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Miriam Dulce
- Department of Radiology, Charité-Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany
| | - Elena Madlung
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Frieder Gabriel
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Jan-Moritz Doehn
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Dirk Schürmann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin, Berlin, Germany; and
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Zheng J, Zhang DF. Pulmonary vein wedge angiography in a child with unilateral absence of pulmonary artery. Pediatr Neonatol 2023; 64:87-90. [PMID: 36115822 DOI: 10.1016/j.pedneo.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/30/2022] [Accepted: 05/28/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jun Zheng
- Department of Pediatrics, Hainan Women and Children's Medical Center, 17, Changbin Road, Xiuying Dist., Haikou City 570000, Hainan, China
| | - Du-Fei Zhang
- Department of Pediatrics, Hainan Women and Children's Medical Center, 17, Changbin Road, Xiuying Dist., Haikou City 570000, Hainan, China.
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Yi D, Xia J, Zhou X, Liu C, Liu L, Yan H, Ma X. Case report: A rare case of anomalous origin of the left coronary artery from the pulmonary artery accompanied with unilateral absence of pulmonary artery in an adult patient. Front Cardiovasc Med 2023; 10:1160893. [PMID: 37153465 PMCID: PMC10157036 DOI: 10.3389/fcvm.2023.1160893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Both the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and unilateral absence of the pulmonary artery (UAPA) are rare congenital malformations, ALCAPA accompanied with UAPA is extremely rare. Here, we reported a middle-aged man admitted to our department for evaluation of chest pain during exercise. Physical examination and lab tests did not unveil obvious abnormality; however, transthoracic echocardiogram (TTE) revealed multivessel myocardial collateral blood flow signals in the left ventricular wall and ventricular septum, a shunting flow from the left coronary artery into the pulmonary artery and dilated right coronary artery (RCA), which supported but did not confirm the diagnosis of ALCAPA. Coronary angiography (CAG) showed an absent left coronary ostium and a dilated RCA, with extensive collaterals supplying the left coronary system. Multidetector computed tomography angiography (MDCTA) was then performed and revealed the anomalous origin of the left main coronary artery (LMCA) arising from the pulmonary artery, and it incidentally unveiled another rare congenital malformation of UAPA. The patient underwent surgical correction of ALCAPA by reimplantation of the LMCA to the aorta, without surgical treatment of UAPA. The patient had been in good clinical condition and remained angina free with good exercise tolerance during follow-up (∼6 months so far). In this case, we discussed the diagnostic value of TTE, CAG, and MDCTA on rare abnormalities as ALCAPA and UAPA. We highlighted the role of multiple non-invasive imaging modalities in diagnosing rare causes of angina in adult patients, and the importance of careful examination in avoiding misdiagnosis. To our best knowledge, this is the first report of ALCAPA accompanied with UAPA in an adult patient.
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Affiliation(s)
- Dong Yi
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Juan Xia
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
| | - Xiang Zhou
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Chengwei Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Li Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hua Yan
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
- Correspondence: Hua Yan Xiaojing Ma
| | - Xiaojing Ma
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
- Correspondence: Hua Yan Xiaojing Ma
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Lim CP, Lim KE. Proximal Interruption of the Pulmonary Artery: Case Reports. ACTA CARDIOLOGICA SINICA 2023; 39:185-188. [PMID: 36685150 PMCID: PMC9829837 DOI: 10.6515/acs.202301_39(1).20220720a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/20/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Chean-Ping Lim
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Kun-Eng Lim
- Department of Medical Imaging, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Wong YS, Abidin ZZ, Musa AN, Kadir RFA, Johari B. Unilateral pulmonary artery agenesis: An unusual cause of hemoptysis. Respir Med Case Rep 2023; 43:101834. [PMID: 36950023 PMCID: PMC10025273 DOI: 10.1016/j.rmcr.2023.101834] [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: 02/18/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Unilateral pulmonary artery agenesis (UPAA) is a rare congenital malformation of the pulmonary artery due to agenesis of the sixth aortic arch during embryogenesis. Diagnosis can be challenging due to variable clinical presentations. Case A 29-year-old female at third trimester of twin pregnancy presented with massive hemoptysis. Computed tomography angiogram (CTA) showed unilateral absence of the right pulmonary artery with multiple dilated tortuous bronchial arteries supplying the right lung. Selective embolization of the bronchial artery was performed post-partum. Conclusion Clinicians should have a high clinical suspicion of collateral artery bleeding in patients who present with unexplained hemoptysis and typical UPAA radiographic findings.
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Affiliation(s)
- Yen Shen Wong
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Corresponding author.
| | | | | | | | - Bushra Johari
- Department of Radiology, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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15
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Loo YJ, Thomas R, Yagnik L. Isolated unilateral absence of pulmonary artery ( IUAPA) in adults: A case series and review of literature. Respirol Case Rep 2022; 11:e01073. [PMCID: PMC9745554 DOI: 10.1002/rcr2.1073] [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: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Unilateral Absence of Pulmonary Artery (UAPA) is a rare congenital malformation that is usually associated with cardiac anomalies. When there is no congenital cardiac abnormality it is rarer still and is termed isolated unilateral absence of pulmonary artery (IUAPA) (4). IUAPA may remain undetected until adulthood and frequently found incidentally on imaging for other indications. Symptoms are usually secondary to complications which include pulmonary hypertension, recurrent respiratory tract infections, bronchiectasis and haemoptysis. We report two cases with widely contrasting presentation and trajectories, leading to individualized management strategies.
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Affiliation(s)
- Yi Jia Loo
- Department of Respiratory MedicineFiona Stanley HospitalPerthWestern AustraliaAustralia
| | - Rajesh Thomas
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWestern AustraliaAustralia,School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Lokesh Yagnik
- Department of Respiratory MedicineFiona Stanley HospitalPerthWestern AustraliaAustralia,Department of Respiratory MedicineMount HospitalPerthWestern AustraliaAustralia
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Yan X, Cen J, Luo X, Chen J, Wen S, Wu J, Zhuang J. Surgical repair of unilateral absence of pulmonary artery in children with pulmonary hypertension: a single-center retrospective study. Transl Pediatr 2022; 11:1813-1822. [PMID: 36506767 PMCID: PMC9732598 DOI: 10.21037/tp-22-491] [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: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The early diagnosis of unilateral absence of pulmonary artery (UAPA) in children offers an opportunity for effective intervention. Due to the lack of clinical evidence, a consensus regarding surgical treatment has yet to be reported. The aim of this study is to evaluate the effectiveness and safety of pulmonary artery (PA) reconstruction with a "two-segment" technique to repair UAPA in patients with pulmonary hypertension. METHODS Intraoperatively, the ligamentum arteriosum connecting the innominate artery and distal PA was dissected and occluded. A conduit created by fresh autologous pericardium formed the first "segment" of the neo-PA. The second "segment" was a Gore vascular graft with integrated rings anastomosed between the proximal end of the pericardial conduit and the main pulmonary artery (MPA). RESULTS A total of five consecutive patients were included, and the absent PA was successfully reconstructed using the "two-segment" technique in all patients. Following revascularization, the direct measurement of the pressure in MPA during the operation showed that the average mean pulmonary artery pressure (mPAP) decreased from 31.3±16.0 to 16.8±4.2 mmHg (P=0.047). The average mPAP/radial mean arterial pressure (rMAP) ratio decreased from 0.59±0.27 preoperatively to 0.30±0.10 postoperatively (P=0.028). The mean follow-up period was 18.85±4.67 months. The median diameter of the reconstructed PA (pericardial segment) measured by transthoracic echocardiography (TTE) was 6.1 mm. One patient safely underwent a redo operation to repair relative stenosis in the neo-PA. CONCLUSIONS Early PA reconstruction may effectively alleviate pulmonary hypertension in children with UAPA. The "two-segment" technique is safe and can facilitate potential redo pulmonary arterioplasty. Anticoagulation and antiplatelet therapy, as well as frequent follow-up, is required after the operation.
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Affiliation(s)
- Xinjian Yan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaokang Luo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinlin Wu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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17
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Yamamoto K, Nakano Y, Otsuka F. Isolated unilateral absence of adult pulmonary artery. Clin Case Rep 2022; 10:e6652. [PMCID: PMC9701867 DOI: 10.1002/ccr3.6652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Koichiro Yamamoto
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Yasuhiro Nakano
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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18
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Demir M, Akdağ S, Deniz MA, Şimşek H. An isolated congenital absence of right pulmonary artery associated with pulmonary hypertension with coronary collaterals: A case report. Echocardiography 2022; 39:1367-1369. [DOI: 10.1111/echo.15450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Muhammed Demir
- Department of Cardiology Dicle University School of Medicine Diyarbakir Turkey
| | - Serkan Akdağ
- Department of Cardiology Memorial Hospital Diyarbakir Turkey
| | - Mehmet Akif Deniz
- Department of Radiology Dicle University School of Medicine Diyarbakir Turkey
| | - Hakkı Şimşek
- Department of Cardiology Dicle University School of Medicine Diyarbakir Turkey
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19
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Mastromoro G, Calcagni G, Vignaroli W, Anaclerio S, Pugnaloni F, Rinelli G, Secinaro A, Bordonaro V, Putotto C, Unolt M, Digilio MC, Marino B, Versacci P. Crossed pulmonary arteries: An underestimated cardiovascular variant with a strong association with genetic syndromes-A report of 74 cases with systematic review of the literature. Am J Med Genet A 2022; 188:2351-2359. [PMID: 35491976 DOI: 10.1002/ajmg.a.62763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/08/2022]
Abstract
Crossed pulmonary arteries (CPAs) represent an uncommon anatomic variant, usually associated with some specific syndromes and conotruncal defects. This finding has been described in 22q11.2 Deletion Syndrome (22q11.2DS). We evaluated the correlation between CPAs and genetic diseases, in order to better define the characteristics of this variant, considered a rare anatomic pattern. An in-depth analysis of CPAs genotype-phenotype correlations was performed via a literature review. We detected 74 CPAs patients through echocardiography. Of these 74 patients, 35.1% of patients showed additional intracardiac malformations, while 29.7% showed extracardiac vascular anomalies, of which 16.2% were associated with intracardiac defects and 13.5% were not. In all, 62.2% of patients were diagnosed with genetic diseases and 52.2% of them were 22q11.2DS patients. In conclusions, CPAs represent a cardiovascular variant, which is detectable in nonsyndromic individuals, but especially in various genetic syndromes and in particular in 22q11.2DS patients. Data on the real prevalence of this morphology is lacking in literature. Knowledge of this anatomic variant is useful to interpret the unusual course of the pulmonary branches and is helpful information before cardiovascular surgical correction. Moreover, due to the strong association of CPAs with some genetic syndromes, the identification of this anatomic pattern can indicate the utility of a genetic assessment of these patients.
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Affiliation(s)
- Gioia Mastromoro
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Walter Vignaroli
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Anaclerio
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Flaminia Pugnaloni
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Gabriele Rinelli
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Veronica Bordonaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Marta Unolt
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Maria Cristina Digilio
- Rare Diseases and Medical Genetics, Department of Pediatrics, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
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20
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Ono Y, Niimi K, Horio Y, Takihara T, Takahashi G, Harada K, Takiguchi H, Tomomatsu K, Hayama N, Oguma T, Aoki T, Urano T, Sekiguchi T, Koizumi J, Asano K. Trans-arterial Embolization in a Patient with Unilateral Absence of Pulmonary Artery: Treatment Success and the Four-year Prognosis. Intern Med 2022; 61:2343-2346. [PMID: 35022349 PMCID: PMC9424082 DOI: 10.2169/internalmedicine.8667-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Unilateral absence of the pulmonary artery (UAPA) with or without other anomalies in the heart is a rare congenital malformation. A 55-year-old Filipino woman without a remarkable medical history was admitted to our hospital for hemoptysis. Contrast-enhanced chest computed tomography revealed the absence of the left pulmonary artery. Echocardiography and right heart catheterization showed no cardiac malformations or pulmonary hypertension. We diagnosed her with isolated left-sided UAPA and performed transarterial embolization of the left inferior phrenic artery. This resolved the hemoptysis, and there was no recurrence during the four-year follow-up period.
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Affiliation(s)
- Yoshitaka Ono
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Kyoko Niimi
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Yukihiro Horio
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | | | - Genki Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Kazuki Harada
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | | | | | - Naoki Hayama
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Takuya Aoki
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tetsuya Urano
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tatsuya Sekiguchi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Japan
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21
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Cui H, Yang Y, Qiu H, Cen J, Wen S, Zhuang J, Chen J. Pulmonary artery reconstruction and correction of tetralogy of Fallot combined with the absence of the mediastinal left pulmonary artery. J Card Surg 2022; 37:2285-2291. [PMID: 35526149 DOI: 10.1111/jocs.16588] [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: 02/10/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tetralogy of Fallot (TOF) is the most common deformity combined with the unilateral absence of the mediastinal pulmonary artery (UAMPA), and its treatment strategy remains controversial. In this study, we analyzed the effect of bilateral pulmonary reconstruction in patients with TOF combined with UAMPA. METHODS This was a single-center, retrospective review of 1713 patients with TOF between January 2009 and November 2021. Overall, eight patients were diagnosed with TOF combined with UAMPA. Among them, seven underwent surgery: three underwent one-stage TOF correction with bilateral pulmonary artery reconstruction; three patients underwent bilateral pulmonary artery reconstruction, followed by two-stage TOF correction after several months; and one patient underwent two procedures of left pulmonary artery reconstruction, and the ventral septal defect remained open. The left pulmonary arteries were reconstructed with a Goretex conduit in three cases, direct anastomosis in two cases, and the modified autologous tissue extension technique in two cases. RESULTS All seven patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation of >97%. During follow-up echocardiography, we noted that the left pulmonary arteries reconstructed with a Goretex conduit or direct anastomosis had thrombosis or stenosis. However, those reconstructed using the modified autologous tissue extension technique was unobstructed. CONCLUSIONS In patients with TOF and UAMPA, if there is a pulmonary artery confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of the pulmonary artery extension technique and autologous tissue for bilateral pulmonary reconstruction could reduce the incidence of anastomotic stenosis.
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Affiliation(s)
- Hujun Cui
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongchao Yang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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22
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Ghazarian A, King M, Premyodhin N, Gradus-Pizlo I. Pulmonary hypertension in an adult with unilateral absence of left pulmonary artery. SAGE Open Med Case Rep 2022; 10:2050313X221127667. [PMID: 36199807 PMCID: PMC9527981 DOI: 10.1177/2050313x221127667] [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: 06/24/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Unilateral absence of pulmonary artery is a rare congenital abnormality that occurs due to malformation of the sixth aortic arch during embryonic development. The clinical presentation of unilateral absence of pulmonary artery can vary based on age of diagnosis; however, in the adult population, it can present with a variety of manifestations including hemoptysis, recurrent pneumonia, and pulmonary hypertension or as an incidental finding. Diagnosis and management of unilateral absence of pulmonary artery remain a challenge. Here, we describe a case of a 37-year-old female with no known past medical history who presented with progressively worsening dyspnea and fatigue. She was incidentally found to have unilateral absence of pulmonary artery on computerized tomography angiography of the chest. Her imaging and physical exam demonstrated signs of volume overload and severe pulmonary hypertension. She received diuretics with good response and was discharged with referral to pulmonary hypertension clinic and eventual follow-up with right heart catheterization. In summary, we describe a rare congenital condition and highlight its diagnostic and therapeutic challenges.
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Affiliation(s)
- Armen Ghazarian
- Department of Medicine, School of Medicine, University of California, Irvine, Orange, CI, USA
| | - Matthew King
- Department of Medicine, School of Medicine, University of California, Irvine, Orange, CI, USA
| | - Ned Premyodhin
- Department of Medicine, School of Medicine, University of California, Irvine, Orange, CI, USA
- Division of Cardiology, School of Medicine, University of California, Irvine, Orange, CI, USA
| | - Irmina Gradus-Pizlo
- Department of Medicine, School of Medicine, University of California, Irvine, Orange, CI, USA
- Division of Cardiology, School of Medicine, University of California, Irvine, Orange, CI, USA
- Irmina Gradus-Pizlo, Division of Cardiology, School of Medicine, University of California, Irvine, UCI Medical Center, 101 The City Drive South, City Tower, Ste 400, Orange, CA 92868, USA.
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23
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Mingjun T, Minjuan Z. Analysis of Ultrasonic Features Based on Absence of Pulmonary Artery. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
According to clinical features and ultrasonic imaging features of patients with absence of pulmonary artery, it is necessary to analyze ultrasonic imaging features of absence of pulmonary artery to provide clinical basis for improving the diagnostic value and prognosis. The data and
color Doppler echocardiography of 45 patients with absence of pulmonary artery are collected, who are confirmed by cardiac catheterization, CTA and operation, and the clinical features and ultrasonic imaging features are studied. The research results show that 57% of the patients have left
absence of pulmonary artery and 91% of them have other cardiovascular malformations, where ASD/PFO is the most common, PDA and VSD are the second. Patients with UAPA have changes of pulmonary artery, the incidence of pulmonary artery abnormalities in multiple malformations, changes of ASD/PFO,
PDA and VSD are mainly pulmonary hypertension. The ejection fraction of patients with UAPA is normal. The main manifestation of pulmonary hypertension is the increase of right cardiac volume load, and the main manifestation of pulmonary stenosis is the increase of collateral circulation. Pulmonary
hypertension and its associated cardiovascular malformations may be related to the prognosis of patients. Ultrasound doctors should understand such diseases to improve the diagnosis rate and the prognosis.
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Affiliation(s)
- Tian Mingjun
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Zheng Minjuan
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
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24
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Liang M, Yao J, Wang Z, Wu Z. Endarterectomy for Pulmonary Embolism in a Woman with Unilateral Absence of Pulmonary Artery. Ann Thorac Surg 2021; 113:e171-e173. [PMID: 34048756 DOI: 10.1016/j.athoracsur.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
Unilateral absence of pulmonary artery (UAPA) is a very rare congenital cardiovascular malformation. To the best of our knowledge, chronic thromboembolic pulmonary hypertension has never been reported in adults with UAPA. In this report, we present the case of a 31-year-old woman with UAPA who developed chronic thromboembolic pulmonary hypertension following multiple episodes of pulmonary embolism due to thrombophilia. Pulmonary thromboendarterectomy was performed, and the short-term outcome was satisfactory.
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Affiliation(s)
- Mengya Liang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianping Yao
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiping Wang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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25
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Kashyap JR, Kumar S, Reddy S, Rao K R, Sehrawat O, Kashyap R, Kansal M, Reddy H, Kadiyala V, Uppal L. Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India. Cureus 2021; 13:e14399. [PMID: 33981512 PMCID: PMC8108404 DOI: 10.7759/cureus.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography. Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography. Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels. Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.
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Affiliation(s)
- Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Suraj Kumar
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Sreenivas Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Raghavendra Rao K
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Ojasav Sehrawat
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Rashmi Kashyap
- Community Medicine, Dr Yashwant Singh Parmar Government Medical College, Nahan, IND
| | - Maninder Kansal
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Hithesh Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Vikas Kadiyala
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Lipi Uppal
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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26
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Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
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Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
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27
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Goel N, Goyal N, Kumar R. Exertional dyspnea and hemoptysis in an adolescent: is it tuberculosis only? Monaldi Arch Chest Dis 2021; 91. [PMID: 33550793 DOI: 10.4081/monaldi.2021.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
Unilateral pulmonary artery atresia (UPAA), commonly detected in childhood, can occasionally present in adulthood with typical symptoms of recurrent pulmonary infections, dyspnoea on exertion and hemoptysis. An 18-year-old girl presented with complaints of cough, dyspnea on exertion and hemoptysis. Chest radiograph revealed dilated pulmonary trunk, signs of left sided volume loss and cavitating lesion in left lower zone. Pulmonary CT angiography found left pulmonary artery atresia. Endobronchial lung biopsy revealed granulomatous inflammation. Diagnosis of left sided UPAA with pulmonary tuberculosis was established. She responded well to the anti-tubercular therapy. This case highlights the importance of awareness about UPAA as a possible differential for exertional dyspnea, recurrent chest infections, hemoptysis and pulmonary hypertension in adults.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Nitesh Goyal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
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28
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Congenital isolated unilateral agenesis of pulmonary arteries in adults: case series and review. Indian J Thorac Cardiovasc Surg 2020; 37:144-154. [PMID: 33584030 DOI: 10.1007/s12055-020-01032-w] [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: 04/21/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
Congenital, isolated unilateral agenesis of pulmonary arteries (UAPA) has a bimodal clinical presentation. It is either diagnosed in early infancy or during adulthood. Early diagnosis and timely surgical correction at infancy prevent the development of irreversible pulmonary hypertension and enable prolonged survival. Though surgical intervention is a conclusive method of treatment, its outcome depends upon the reversibility of pulmonary hypertension and the adequacy of the pulmonary artery dimension. Adults with UAPA can be asymptomatic (diagnosed incidentally) or symptomatic. They may present clinically with myriads of symptoms like exertional dyspnea, recurrent lung infection, hemoptysis, and atypical chest pain. For cases where definitive surgical treatment is not feasible, interventional and medical management should be carried out as part of palliative therapy. A retrospective analysis of 22 cases of UAPA in adults published in the literature from the years 2017-2020 are presented here, along with our institutional case.
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Commentary: Isolated unilateral absence of pulmonary artery, a rare disease with diverse presentations. JTCVS Tech 2020; 3:348-349. [PMID: 34317926 PMCID: PMC8305742 DOI: 10.1016/j.xjtc.2020.07.015] [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: 07/10/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
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Marshall MB, White A. Commentary: Unilateral pulmonary artery agenesis and lung cancer: Sharks on one side, bears on the other. JTCVS Tech 2020; 3:346-347. [PMID: 34317925 PMCID: PMC8303057 DOI: 10.1016/j.xjtc.2020.06.031] [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: 06/11/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- M Blair Marshall
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Bista B, Ferris J, Na N, Krishnam M, Urgun D. Unilateral absence of pulmonary artery and azygous continuation of interrupted inferior vena cava. Radiol Case Rep 2020; 15:688-690. [PMID: 32382363 PMCID: PMC7198913 DOI: 10.1016/j.radcr.2020.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022] Open
Abstract
Unilateral absence of pulmonary artery is a rare developmental anomaly. Infrahepatic inferior vena cava interruption is a well-recognized but uncommon developmental anomaly. Presence of both these anomalies in a single individual is extremely rare. A 58-year-old man with a history of recurrent lower extremity deep vein thrombosis and venous insufficiency presented to our emergency department with bilateral calf pain and swelling. Ultrasound demonstrated extensive deep vein thrombosis throughout bilateral lower extremities. Computed tomography angiography showed smooth tapering of the right pulmonary artery with absent distal most segment. To our knowledge, there is only 1 case report in the literature so far with both the abnormalities present in a single individual.
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Jankovic J, Vesovic R, Djurdjevic N, Mitic J. Hemoptysis. Is it caused by Pasteurella multocida infection or congenital pulmonary artery anomalies? Germs 2020; 9:193-197. [PMID: 32042726 DOI: 10.18683/germs.2019.1177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022]
Abstract
Introduction Pasteurella multocida colonizes the oropharynx of various domestic and wild animals. In humans, respiratory tract P. multocida infection is the second most frequent localization and usually manifests as pneumonia. Unilateral absence of pulmonary artery (UAPA) is a very rare congenital anomaly. Adult patients with UAPA are usually asymptomatic or their symptoms are nonspecific. Case report We report a female patient with hemoptysis admitted to our clinic where we isolated P. multocida in sputum. The organism was also isolated from nasopharyngeal swab of her dog. During hospitalization, she was also diagnosed with UAPA and chronic obstructive pulmonary disease (COPD). Discussion Respiratory P. multocida infection develops more commonly through contact with animal secretions. It occurs most often in immunocompromised patients and in individuals with comorbidities. Hemoptysis very rarely follows P. multocida infection while it is common in cases of UAPA due to existing developed collateral circulation especially in older patients. Conclusions Ceased hemoptysis after adequate treatment and no recurrence of it over six years of following up the patient led us to conclude that the cause of hemoptysis was P. multocida infection and not UAPA which was more likely to be the case.
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Affiliation(s)
- Jelena Jankovic
- MD, MSc, Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia
| | - Radomir Vesovic
- MD, MSc, Clinic for Thoracic Surgery, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia
| | - Natasa Djurdjevic
- MD, MSc, Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia
| | - Javorka Mitic
- MD, PhD, Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia
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Wang J, Lu X, Ding X, Cao DB. Left lung cancer in a patient with congenital unilateral absence of the left pulmonary artery: a case report and literature review. World J Surg Oncol 2020; 18:32. [PMID: 32028965 PMCID: PMC7006177 DOI: 10.1186/s12957-020-1810-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Unilateral absence of pulmonary artery (UAPA) is a rare congenital disease of pulmonary circulation, which is often accompanied by other cardiovascular anomalies. Infrequently, it may remain undiagnosed until adulthood. More rarely, it is to be found with lung cancer in the ipsilateral or contralateral lung simultaneously. Case presentation A 56-year-old man with complaints of intermittent left chest pain for 2 months was referred to our hospital. Chest computed tomography(CT) revealed a cavitary lesion measuring 5.5 cm × 5.7 cm in the superior segment of the left lower lobe. Absence of left pulmonary artery and right-sided aortic arch were found on chest computed tomography angiography (CTA). The tumor was successfully removed via left pneumonectomy, and postoperative histopathology showed that the tumor was a squamous cell carcinoma (T2bN1). At a postoperative 24-month follow-up, the patient was free of disease and no evidence of recurrence or metastasis. Based on literature review, this is the ninth case of lung cancer in UAPA patients. Conclusions Lung cancer and UAPA occurred ipsilaterally in 66.7% of these cases (6/9), including the present case. For those patients who occurred contralaterally, surgical treatment may be more challenging. CT and CTA could provide an accurate diagnosis for this disease entity. Identification and recognition of this rare and special disease entity may facilitate timely diagnosis and appropriate treatment.
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Affiliation(s)
- Jing Wang
- Department of Radiology, The First Hospital of Jilin University, No.71 XinMin Street, Changchun, 130021, China
| | - Xiaoqian Lu
- Department of Radiology, The First Hospital of Jilin University, No.71 XinMin Street, Changchun, 130021, China
| | - Xiaobo Ding
- Department of Radiology, The First Hospital of Jilin University, No.71 XinMin Street, Changchun, 130021, China
| | - Dian-Bo Cao
- Department of Radiology, The First Hospital of Jilin University, No.71 XinMin Street, Changchun, 130021, China.
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Li J, Wang H, Liu Z. The stress model of abutment tooth and periodontal tissues with unilateral mandibular dissociation and loss by precision extracoronal attachment. Saudi J Biol Sci 2020; 26:2118-2121. [PMID: 31889805 PMCID: PMC6923453 DOI: 10.1016/j.sjbs.2019.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
In order to explore the application of the precision extracoronal attachment based on three-dimensional finite element stress model in the repair of unilateral mandibular dissociation and loss, the stress distribution of the butment and periodontal tissues when the precision extracoronal attachment was used in unilateral mandibular dissociation and loss was analyzed, so as to provide reference for the application of materials in clinical repair. In this study, the biomechanics of oral cavity and its attachment were analyzed to provide theoretical basis for model construction. Because the degree of periodontal tissue absorption and the number of abutment teeth affected the restoration effect of the coronal precision attachment, the models were established from these two perspectives. The results showed that when the periodontal tissue absorption of both abutment teeth exceeded 1/3, the method of double abutment restoration was not recommended. When three abutments were used, there was a significant decrease compared with the absorption of the periodontal tissue of the double abutment. In clinic, the stress distribution of the distal abutment teeth and its periodontal tissues can be improved by increasing the number of abutment tooth. However, since increasing the number of abutments required an increase in the amount of healthy tooth tissue, it couldn’t be blindly selected in the clinic. After comprehensive consideration, it is appropriate to choose two abutment teeth for restoration.
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Affiliation(s)
- Juan Li
- Department of Periodontology, Affiliated Stomatological Hospital of Xuzhou Medical University, China
| | - Huijie Wang
- Department of Hospital Nursing, Affiliated Stomatological Hospital of Xuzhou Medical University, China
| | - Zongxiang Liu
- Department of Periodontology, Affiliated Stomatological Hospital of Xuzhou Medical University, China
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Sumdani H, Shahbuddin Z, Farhataziz N, Barkley JM. Unilateral Pulmonary Fibrosis Due to Absence of Right Pulmonary Artery. Cureus 2019; 11:e5161. [PMID: 31528513 PMCID: PMC6743663 DOI: 10.7759/cureus.5161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pulmonary fibrosis is typically a bilateral, progressive interstitial lung disease that is often idiopathic but can be associated with risk factors such as advanced age, environmental exposure, and drug toxicity. The pathophysiology is incompletely understood but involves transforming growth factor. The treatment choices for idiopathic disease include medical therapy that manipulates epigenetic pathways and lung transplantation. Here we present a 30-year-old female with no identifiable risk factors who developed unilateral pulmonary fibrosis. Clinical investigation eventually revealed a congenitally absent right pulmonary artery which was presumed to cause her unilateral disease. In contrast to idiopathic pulmonary fibrosis, treatment options for pulmonary fibrosis due to unilateral absence of a pulmonary artery include ipsilateral pulmonary vasculature embolization and/or pneumonectomy if disease is unmanageable without therapy.
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Affiliation(s)
- Hasan Sumdani
- Neurosurgery, Texas A&M College of Medicine, Round Rock, USA
| | - Zanab Shahbuddin
- Emergency Medicine, University of North Texas Health Science Center, Fort Worth, USA
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Yang T, Sun J, Xu H, Yan J, Li S, Wang Q, Zhang J. Surgical Management of Tetralogy of Fallot with Unilateral Absence of the Pulmonary Artery. Pediatr Cardiol 2019; 40:1026-1034. [PMID: 31049646 DOI: 10.1007/s00246-019-02109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
Tetralogy of Fallot with unilateral absence of the pulmonary artery (UAPA) is a rare congenital heart disease. The aim of the present study was to examine the surgical strategy for Tetralogy of Fallot with UAPA by summarizing our experience of its treatment. We retrospectively evaluated 17 patients admitted to our hospital for treatment between 2006 and 2017. All patients were diagnosed with absence of the left pulmonary artery. The Nakata Index (NI), NI Z score, and McGoon ratio of the existing pulmonary artery were calculated. All patients were divided into one-stage complete repair (group A) or palliative procedure (group B) groups according to these criteria and surgical treatments. There were nine treated patients in group A, with a mean NI of 595.6 ± 690.32 mm2/m2 (169.3-2433 mm2/m2) and a mean NI Z score of - 1.57 ± 3.02 (- 4.60 to 5.27). There were eight treated patients in group B, with a mean NI of 107.61 ± 49.49 mm2/m2 (53.15-216.39 mm2/m2) and a mean NI Z score of - 6.27 ± 1.56 (- 8.22 to - 3.54). The mean follow-up time in group A was 5.58 ± 3.42 years (1-11.7 years), while that in group B was 5.4 ± 3.42 years (0.6-12.1 years). No hospital deaths occurred and the follow-up results were good in both groups. In conclusion, development of a single existing pulmonary artery can be evaluated using the NI and the NI Z score. These evaluations can be used to select complete repair or palliative procedures for patients and achieve good results.
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Affiliation(s)
- Tengjiao Yang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jing Sun
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Haitao Xu
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jun Yan
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Qiang Wang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jing Zhang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China.
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Smith NE, Fabian T, Nabagiez J. Unilateral pulmonary artery atresia in an adult: A case report. Respir Med Case Rep 2018; 26:105-107. [PMID: 30581727 PMCID: PMC6297891 DOI: 10.1016/j.rmcr.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/18/2018] [Indexed: 11/23/2022] Open
Abstract
Intro Unilateral pulmonary artery atresia (UPAA), while encountered frequently in the congenital cardiac anomaly cohort, is occasionally diagnosed in adulthood after typical symptoms of hemoptysis, pulmonary infection, or as an incidental finding on contrast CT scan. Due to its rarity, a brief discussion of UPAA and its treatment is warranted. Case report A 35 year old male presented with three days of hemoptysis. After diagnosis of right UPAA, he underwent angioembolization of 6 large systemic collaterals supplying his right lung, followed by right pneumonectomy. He was discharged on post-operative day 3, and at follow up 6 weeks later was doing well with minimal residual incisional pain and excellent pulmonary reserve. Conclusions UPAA presents classically with hemoptysis, but also with pneumonia, pulmonary hypertension, or incidentally. Management includes selective collateral embolization, pneumonectomy, or medical management directed towards decreasing pulmonary hypertension in patients unable to tolerate pneumonectomy due to comorbidities. Pneumonectomy in these patients is characterized by dense and hypervascular adhesions, with large volume blood loss expected during adhesiolysis, which can be decreased with pre-operative embolization. Outcomes are typically excellent in otherwise healthy patients.
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Affiliation(s)
- Nathan E Smith
- Albany Medical Center, Department of Cardiothoracic Surgery, 50 New Scotland Ave, Albany, NY, 12208, United States
| | - Thomas Fabian
- Albany Medical Center, Department of Cardiothoracic Surgery, 50 New Scotland Ave, Albany, NY, 12208, United States
| | - John Nabagiez
- Albany Medical Center, Department of Cardiothoracic Surgery, 50 New Scotland Ave, Albany, NY, 12208, United States
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Abstract
Proximal interruption of the pulmonary artery (PIPA) is an uncommon developmental anomaly resulting in underdevelopment of the proximal portion of the pulmonary artery with preservation of the intrapulmonary segments. Clinical presentation ranges between an asymptomatic incidental finding to massive hemoptysis. When findings suggestive of PIPA are present radiographically, the diagnosis of PIPA can be definitively diagnosed with computed tomography or magnetic resonance pulmonary angiography. Other imaging modalities, such as nuclear perfusion scan and catheter angiography can help in the diagnosis.
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