Home About us Contact
|
Home About us Contact | ||
|
|
||
Pulmonary Artery (pulmonary + artery)
Kinds of Pulmonary Artery Terms modified by Pulmonary Artery Selected AbstractsTranspulmonary Stenting of Both Pulmonary Arteries with a Surgical Access through Redo SternotomyJOURNAL OF CARDIAC SURGERY, Issue 4 2009Yacine Aggoun M.D. He developed 21 months later stenosis at the origin of both pulmonary arteries. The conventional interventional catheterization approaches were not available due to femoral vein thrombosis and severe transient complete atrioventricular block due to the manipulations to catheterize the left pulmonary artery. The stenoses were treated by implant of stents using a surgical access to the proximal portion of a Contegra valved conduit (Medtronic, Inc., Minneapolis, MN, USA) by sternotomy. [source] Balloon Debanding the Pulmonary Artery: In Vitro Studies and Early Clinical ExperienceCONGENITAL HEART DISEASE, Issue 4 2009Gareth J. Morgan MPhil ABSTRACT Despite increasing corrective procedures for children with congenital heart disease, there remains a place for surgical banding of the main pulmonary artery (PA). In the vast majority of cases, these bands eventually need to be removed. We examined three cases of percutaneous disruption of PA bands using balloon catheters at our institution. We also performed an in vitro study of PA band disruption mechanism and disruption pressure. Our in vitro study suggested a predictable burst pressure for PA bands over the range of diameters routinely used in pediatric practice. Of three patients who underwent interventional debanding, two patients had successful disruption of their PA bands with no reintervention at 19 months and 23 months follow up. Balloon disruption of surgical PA bands may offer a less invasive alternative to surgical band removal. In vitro analysis suggests that the burst pressure required and mechanism of disruption are predictable. [source] Anomalous Left Anterior Descending Coronary Artery from the Pulmonary Artery, Unroofed Coronary Sinus, Patent Foramen Ovale, and a Persistent Left-sided SVC in a Single Patient: A Harmonious Quartet of DefectsCONGENITAL HEART DISEASE, Issue 2 2009Andrew J. Klein MD ABSTRACT Unroofing of the coronary sinus without complex structural heart defects is a rare congenital defect often seen in conjunction with a persistent left-sided superior vena cava. Anomalous origin of the left anterior descending artery from the pulmonary artery with normal origin of the left circumflex coronary artery is an even rarer congenital cardiac defect. We report a case of a 54-year-old woman presenting with mild dyspnea on exertion who was found on invasive and noninvasive evaluations to have a unique combination of defects,unroofed coronary sinus, persistent left-sided superior vena cava, patent foramen ovale, and anomalous origin of the left anterior descending artery from the pulmonary artery without evidence of previous coronary ischemia. [source] Congenital Left Ventricular Splint in an Adult Patient with Unrepaired Anomalous Left Coronary Artery from the Pulmonary ArteryCONGENITAL HEART DISEASE, Issue 4 2007Adam M. Sabbath MD ABSTRACT A 24-year-old woman presented with a recent increase in dyspnea on exertion and development of presyncope. The patient stated that she has reproducible episodes of dizziness and near fainting when she climbs a flight of stairs and activity is limited to a slow gait. [source] Respiratory Syncytial Viral Infection in an Infant with Unrepaired Anomalous Left Coronary Artery from the Pulmonary ArteryCONGENITAL HEART DISEASE, Issue 4 2007Karen McClard MD ABSTRACT Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary anomaly in children that requires necessary and urgent repair. We report a child who was hospitalized with respiratory failure due respiratory syncytial viral (RSV) infection and was subsequently diagnosed with ALCAPA. Aggressive treatment for RSV included synagis and nebulized ribavirin prior to surgical repair. After waiting 4 weeks for the RSV infection to resolve, she underwent successful left coronary artery reimplantation on hospital day 27 and has regained normal left ventricular size and function. [source] Embolization of Atrial Septal Occluder Device into the Pulmonary Artery: A Rare Complication and Usefulness of Live/Real Time Three-Dimensional Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 6 2009Harvinder S. Dod M.D. Percutaneous closure of atrial septal defects (ASD) in adults has emerged as an alternative to surgery. We report a rare complication of an atrial septal occluder device embolization into the pulmonary artery which was detected by fluoroscopy and echocardiography. The potential usefulness of live/real time three-dimensional transthoracic echocardiography in the management of patients undergoing percutaneous ASD occlusion is described. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source] Reverse Flow in Left Coronary Artery as the Clue to Diagnosis of an Anomalous Origin of the Left Coronary into Pulmonary Artery in an Infant with Dilated CardiomyopathyECHOCARDIOGRAPHY, Issue 6 2008Rodrigo Estévez M.D. No abstract is available for this article. [source] Anterior Aortic Reimplantation of Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) Originating from the Nonfacing Sinus in an AdultJOURNAL OF CARDIAC SURGERY, Issue 2 2010Panagiotis G. Sfyridis M.D. Intraoperative findings and surgical technique are discussed.,(J Card Surg 2010;25:214-217) [source] Off-Pump Total Cavopulmonary Connection in a Patient with Hypoplastic Right Pulmonary Artery and Right Lung Secondary to KyphoscoliosisJOURNAL OF CARDIAC SURGERY, Issue 5 2008Murat Ugurlucan M.D. Pulmonary vasculature and status of the lungs are critically important for the success of the operation. In this report, we present a 10-year-old patient with single ventricle heart and severely hypoplastic unilateral pulmonary artery and respective lung due to kyphoscoliosis who underwent extracardiac Fontan procedure without cardiopulmonary bypass, successfully. [source] Giant Aneurysm of Aortocoronary Saphenous Vein Graft Compressing the Left Pulmonary ArteryJOURNAL OF CARDIAC SURGERY, Issue 4 2006Bruno Chiappini M.D. CT scan displayed a mass with an internal lumen compressing the left atrium as well as the left pulmonary artery. [source] Systemic Pulmonary Artery Shunt Using a Bovine Mesenteric Venous Graft in NewbornsJOURNAL OF CARDIAC SURGERY, Issue 4 2000Afksendiyos Kalangos M.D., F.E.T.C.S., Ph.D. Clinical and echocardiographic studies proved that all shunts were patent and functioning well after an average of 8.8 months despite no postoperative anti-coagulation or antiplatelet regimen. Histological examination of two grafts explanted at the time of bidirectional cavopulmonary anastomosis showed no dense fibrotic mural infiltration, calcification, or anastomotic hyperplasia. Bovine mesenteric venous grafts can be used for the construction of systemic pulmonary artery shunts with advantages similar to that of human vein allografts, such as the facility of implantation, good short- and mid-term patency, easy takedown, and avoidance of complications presumably specific to polytetraflu-oroethylene. [source] Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardia Originating in the Main Stem of the Pulmonary ArteryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2002CARL TIMMERMANS M.D. Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an idiopathic ventricular tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an idiopathic right ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences. [source] Percutaneous Retrieval of a Wallstent from the Pulmonary Artery Following Stent Migration from the Iliac VeinJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2002RAJIV M. ASHAR M.D. Wallstents are being used increasingly in conjunction with balloon dilatation for treatment of iliac vein stenosis. Stent misplacement or migration is a complication of the procedure, and may be symptomatic and warrant repositioning or removal. We report the case of a patient whose iliac vein stenosis was managed with two overlapping Wallstents and was complicated by embolization of one stent into the right ventricle (RV) and the other to the pulmonary artery (PA). This article illustrates percutaneous endovascular removal of a migrated stent from the PA using a jugular and femoral approach. [source] Thrombosis of the Pulmonary Artery in a Yearling Thoroughbred ColtJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009J. Bryan First page of article [source] Extraction of the Inner Coil of a Pacemaker Lead Slid into the Pulmonary ArteryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007F.E.S.C., PIER GIORGIO GOLZIO M.D. A patient required lead extraction for chronic draining sinus, due to abandoned leads. Preoperatively, the chest film showed a filament in the right pulmonary artery: it was the inner coil of an old atrial lead that, while remaining anchored to the auricle, slid outside the outer coil. By right subclavian approach, the old ventricular lead and the outer coil of the atrial lead were removed. Then, by right jugular approach, the freely floating end of theinner atrial coil was grasped by a pig-tail catheter, drawn back into the superior vena cava, exteriorized by a Lasso catheter, and finally extracted. [source] Spasmogenic action of endothelin-1 on isolated equine pulmonary artery and bronchusEQUINE VETERINARY JOURNAL, Issue 2 2003A. E. M. BENAMOU Summary Reasons for performing study: There is currently little published information about the effects of endothelin-1 (ET-1), a potent endogenous spasmogen of vascular and airway smooth muscle, on pulmonary vasculature and airways or which ET receptor subtypes mediate ET-1-induced vasoconstrictive and bronchoconstrictive action in the horse. Objectives: To investigate the effect of endothelin-1 (ET-1) on smooth muscle from isolated equine pulmonary artery and bronchus. In addition, the roles of ETA and ETB receptors in ET-1 mediated contraction in these tissues were assessed. Methods: The force generation of ring segments from pulmonary arteries or third-generation airways (obtained from horses subjected to euthanasia fororthopaedic reasons) were studied in an organ bath at 37°C in response to exogenous endothelin and selective endothelin A (BQ123) or B receptor (BQ788) antagonists. Results: ET-1 produced concentration-dependent contractions of the equine pulmonary artery and bronchus. The threshold for contraction was 10,10 and 10,9 mol/l ET-1 for pulmonary artery and bronchus, respectively. The maximal contraction induced by the highest ET-1 concentration (10,7 mol/l) was 173 and 194% of the contraction obtained with 100 mmol/l KCl in pulmonary artery and bronchus, respectively. ET-1 potency was 25 times greater in equine pulmonary artery than in equine bronchus (concentration of ET-1 producing 50% of maximal contraction [EC50] = 5.6 10,9 mol/l and 2.2 10,8 mol/l, respectively). In pulmonary artery, ET-1 induced contractions were significantly inhibited by the ETA receptor antagonist BQ123 (1 ,mol/l; dose-response curve to ET-1 was shifted to the right by 5.4-fold), but not by the ETB antagonist BQ788. In bronchus, dose-responses curves to ET-1 were shifted to the right by BQ123 (1 ,mol/l; 2.5-fold), but not by BQ788 (1 ,mol/l). In the presence of both antagonists, the dose-response curve to ET-1 was shifted to the right by 4.5-fold. Conclusions: These functional studies demonstrate that ET-1 is a potent spasmogen of equine third generation pulmonary artery and bronchus, and that contractions are mediated via ETA receptors in the former and both ETA and ETB receptors in the latter. Potential clinical relevance: Endothelin receptor antagonists may have potential for treating equine pulmonary hypertension or bronchoconstriction. [source] Primary Pulmonary Artery Sarcoma: Surgical Management and Differential Diagnosis with Pulmonary Embolism and Pulmonary Valve StenosisJOURNAL OF CARDIAC SURGERY, Issue 6 2009Xiao-Peng Hu M.D. We present six cases of primary pulmonary artery sarcomas and discuss clinical features, differential diagnosis, surgical treatment, and outcome of the tumors. Methods: Between January 1994 and July 2008, six patients were identified with the disease during operation. Three patients were initially diagnosed with pulmonary valve stenosis, and two patients had a presumptive diagnosis of chronic pulmonary embolism. Two patients had simple or partial tumor resection. Four patients had radical tumor resection and homograft reconstruction of the pulmonary arteries. Results: Histological examinations showed five malignant mesenchymomas and one fibrosarcoma. One patient died of refractory pulmonary hypertension during operation. Two patients died 4 months postoperatively because of brain metastases. Two patients were alive for 3 and 9 months, respectively after the operation with recurrent tumor. One patient is alive even 2 years after resection with no signs of recurrence or metastasis. Conclusions: Because of similar clinical features, pulmonary artery sarcomas are often confused with other pulmonary vascular obstructive diseases. Computed tomography scanning and gadolinium-enhanced magnetic resonance imaging could be useful methods for differential diagnosis. The prognosis is very poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis. Early diagnosis and radical surgical resection presents the only opportunity for a potential cure. [source] Transpulmonary Stenting of Both Pulmonary Arteries with a Surgical Access through Redo SternotomyJOURNAL OF CARDIAC SURGERY, Issue 4 2009Yacine Aggoun M.D. He developed 21 months later stenosis at the origin of both pulmonary arteries. The conventional interventional catheterization approaches were not available due to femoral vein thrombosis and severe transient complete atrioventricular block due to the manipulations to catheterize the left pulmonary artery. The stenoses were treated by implant of stents using a surgical access to the proximal portion of a Contegra valved conduit (Medtronic, Inc., Minneapolis, MN, USA) by sternotomy. [source] Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:JOURNAL OF CARDIAC SURGERY, Issue 2 2004Literature Review, Our Experience Materials and Methods: Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 ± 1.9 years. Mean gradient across the right ventricular outflow tract was 63 ± 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. Results: Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 ± 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 ± 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 ± 0.4 versus 1.7 ± 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 ± 6 mmHg, significantly lower than preoperatively (p < 0.001). Conclusions: Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice. (J Card Surg 2004;19:175-183) [source] Assessing normal pulse wave velocity in the proximal pulmonary arteries using transit time: A feasibility, repeatability, and observer reproducibility study by cardiovascular magnetic resonanceJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2007MRCP, William M. Bradlow BM Abstract Purpose To calculate pulse wave velocity (PWV) in the proximal pulmonary arteries (PAs) by cardiovascular magnetic resonance (CMR) using the transit-time method, and address respiratory variation, repeatability, and observer reproducibility. Materials and Methods A 1.9-msec interleaved phase velocity sequence was repeated three times consecutively in 10 normal subjects. Pulse wave (PW) arrival times (ATs) were determined for the main and branch PAs. The PWV was calculated by dividing the path length traveled by the difference in ATs. Respiratory variation was considered by comparing acquisitions with and without respiratory gating. Results For navigated data the mean PWVs for the left PA (LPA) and right PA (RPA) were 2.09 ± 0.64 m/second and 2.33 ± 0.44 m/second, respectively. For non-navigated data the mean PWVs for the LPA and RPA were 2.14 ± 0.41 m/second and 2.31 ± 0.49 m/second, respectively. No statistically significant difference was found between respiratory non-navigated data and navigated data. Repeated on-table measurements were consistent (LPA non-navigated P = 0.95, RPA non-navigated P = 0.91, LPA navigated P = 0.96, RPA navigated P = 0.51). The coefficients of variation (CVs) were 12.2% and 12.5% for intra- and interobserver assessments, respectively. Conclusion One can measure PWV in the proximal PAs using transit-time in a reproducible manner without respiratory gating. J. Magn. Reson. Imaging 2007;25:974,981. © 2007 Wiley-Liss, Inc. [source] In vivo MR imaging of pulmonary arteries of normal and experimental emboli in small animalsJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2006Mathieu Lederlin MD Abstract Purpose To demonstrate the feasibility of pulmonary MRA in living rodents. Materials and Methods A three-dimensional (3D) gradient echo sequence was adapted to perform a time-of-flight (TOF) angiography of rat lung. Angiogram with a spatial resolution of 195 × 228 × 228 ,m3 was acquired in around 33 minutes. The method was then applied in animals before and after pulmonary embolism (PE) induction. Section of the proximal right pulmonary artery was measured and compared between the two populations. Results Good quality images were obtained with a contrast-to-noise ratio (CNR) of 9 ± 3 in the proximal part of the pulmonary artery. Cross-section areas of the right main artery are statistically different before (3.45 ± 0.69 mm2) and after induction of PE (4.3 ± 0.86 mm2). Conclusion This noninvasive tool permits angiogram acquisition at around 200 ,m spatial resolution and objective distinction between healthy and embolized arteries. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] Proximal pulmonary artery blood flow characteristics in healthy subjects measured in an upright posture using MRI: The effects of exercise and age,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2005Christopher P. Cheng PhD Abstract Purpose To use MRI to quantify blood flow conditions in the proximal pulmonary arteries of healthy children and adults at rest and during exercise in an upright posture. Materials and Methods Cine phase-contrast MRI was used to calculate mean flow and reverse flow index (RFI) in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in healthy children and adults in an open-MRI magnet equipped with an upright MRI-compatible ergometer. Results From rest to exercise (150% resting heart rate), blood flow (liters/minute/m2) increased in the RPA (1.4 ± 0.3 vs. 2.5 ± 0.4; P < 0.001), LPA (1.1 ± 0.3 vs. 2.2 ± 0.6; P < 0.001), and MPA (2.7 ± 0.5 vs. 4.9 ± 0.5; P < 0.001). RFI decreased in the LPA (0.040 ± 0.030 vs. 0.017 ± 0.018; P < 0.02) and MPA (0.025 ± 0.024 vs. 0.008 ± 0.007; P < 0.03). Adults experienced greater retrograde flow in the MPA than the children (0.042 ± 0.029 vs. 0.014 ± 0.012; P < 0.02). Conclusion It appears that at both rest and during exercise, in children and adults alike, RPA/LPA mean blood flow distribution is predominantly determined by distal vascular resistance, while retrograde flow is affected by proximal pulmonary bifurcation geometry. J. Magn. Reson. Imaging 2005;21:752,758. © 2005 Wiley-Liss, Inc. [source] Navigator-gated three-dimensional MR angiography of the pulmonary arteries using steady-state free precession,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2005Benjamin K. Hui AB Abstract Purpose To assess the quality of a navigator-gated, free breathing, steady-state free precession (SSFP) technique in comparison to a single breathhold for pulmonary artery imaging in normal volunteers. Materials and Methods Sagittal sections of the left pulmonary arteries of 10 volunteers were obtained with a three-dimensional SSFP sequence using both a single breathhold of 30 seconds and a navigator-gated version of the same sequence. The images were compared and rated by a blinded cardiovascular radiologist for image quality, sharpness, and artifact. Results On a scale ranging from ,2 to 2, in which positive numbers denote that the navigator method was favorable compared to the single breathhold method, image quality was rated 0.7 ± 1.4, sharpness 0.6 ± 1.5, and artifact 0.1 ± 1.4. Thus, there was no statistical difference between the two methods. Conclusion The navigator-gated SSFP sequence is able to acquire images equal in quality to the breathhold sequence. This may be of clinical importance for pulmonary imaging in patients who are unable to sustain a long breathhold. J. Magn. Reson. Imaging 2005;21:831,835. © 2005 Wiley-Liss, Inc. [source] Successful medical treatment of abdominal aortic aneurysms in a patient with Behçet's disease: Imaging findingsJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2005E Yekeler Summary Arterial manifestations of Behçet's disease consist of aneurysm formation, stenosis and occlusion. Aneurysms in Behçet's disease most commonly involve the pulmonary arteries and have been shown to resolve with medical treatment. However, this regression pattern with medical therapy has not been reported for aortic aneurysms to date. We present a 43-year-old man with bilateral abdominal aortic aneurysms resulting from Behçet's disease resolving with medical therapy. [source] Comparison of relaxation responses to multiple vasodilators in TxA2 -analog and endothelin-1-precontracted pulmonary arteriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2007C. Piamsomboon Background:, Peri-operative pulmonary hypertension can lead to right ventricular dysfunction and to an increase in morbidity and mortality. Altered function of the pulmonary vascular endothelium and vasoconstriction play a crucial role in the development of elevated pulmonary vascular resistance. Because pulmonary artery vasoreactivity is dependent on many factors including the constricting agent that precipitated the event therefore the aim of the current study was to investigate the effectiveness of different classes of vasodilator agents to reverse endothelin-1 (ET-1) or thromboxane A2 (TxA2)-induced vasoconstriction in porcine pulmonary artery (PA) in vitro. Methods:, Relaxation responses to vasodilatory drugs were studied in PA precontracted with ET-1 (1 × 10,8 M) or TxA2 analog (U46619, 1 × 10,8 M). All vasodilating drugs were added in a cumulative fashion and isometric tension measurements were obtained using an organ chamber technique. Results:, In both groups relaxation responses to the vasodilators were dose dependent. When ET-1 was used as a constrictor nitroglycerin and milrinone caused nearly complete (80,100%) relaxation, whereas other agents were of limited effectiveness (40,50%). On the other hand, in the vessels constricted with U46619, olprinone, indomethacin, prostaglandin E1 (PGE1), nitroglycerin, milrinone and clevidipine induced complete (90,110%) vasodilatation but brain natriuretic peptide (BNP), l -arginine, and isoproterenol relaxed the vessels maximally by 45,60%. Conclusions:, Nitroglycerin and milrinone are very effective in reversing ET-1 and U46619-induced pulmonary vasoconstriction in vitro. The effectiveness of other drugs studied was dependent on the type of constrictor used. BNP, l -arginine and isoproterenol were shown to have minimal vasodilatory effects in porcine PA. [source] ORIGINAL ARTICLE: Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications.JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2010A systematic review, meta-analysis of the management outcome studies Summary.,Background:,Multiple-detectors computed tomographic pulmonary angiography (CTPA) has a higher sensitivity for pulmonary embolism (PE) within the subsegmental pulmonary arteries as compared with single-detector CTPA. Multiple-detectors CTPA might increase the rate of subsegmental PE diagnosis. The clinical significance of subsegmental PE is unknown. We sought to summarize the proportion of subsegmental PE diagnosed with single- and multiple-detectors CTPA and assess the safety of diagnostic strategies based on single- or multiple-detectors CTPA to exclude PE. Patients and methods:,A systematic literature search strategy was conducted using MEDLINE, EMBASE and the Cochrane Register of Controlled Trials. We selected 22 articles (20 prospective cohort studies and two randomized controlled trials) that included patients with suspected PE who underwent a CTPA and reported the rate of subsegmental PE. Two reviewers independently extracted data onto standardized forms. Results:,The rate of subsegmental PE diagnosis was 4.7% [95% confidence interval (CI): 2.5,7.6] and 9.4 (95% CI: 5.5,14.2) in patients that underwent a single- and multiple-detectors CTPA, respectively. The 3-month thromboembolic risks in patients with suspected PE and who were left untreated based on a diagnostic algorithm including a negative CTPA was 0.9% (95% CI: 0.4,1.4) and 1.1% (95% CI: 0.7,1.4) for single- and multiple-detectors CTPA, respectively. Conclusion:,Multiple-detectors CTPA seems to increase the proportion of patients diagnosed with subsegmental PE without lowering the 3-month risk of thromboembolism suggesting that subsegmental PE may not be clinically relevant. [source] Expression and function of phosphodiesterases in nitrofen-induced congenital diaphragmatic hernia in ratsPEDIATRIC PULMONOLOGY, Issue 4 2010Irene W.J.M. van der Horst MD Abstract Background Congenital diaphragmatic hernia (CDH) is an anomaly associated with pulmonary hypoplasia and pulmonary hypertension (PH). The limited efficacy of current approaches to treat PH in CDH, including inhaled nitric oxide (NO), drives the search for other therapies. Phosphodiesterases (PDEs) degrade cyclic nucleotide second messenger cAMP and cGMP downstream of NO thereby limiting the vasodilatory response to NO. Objective To identify therapeutic targets by cataloguing the expression and function of PDE isoforms in the pulmonary vasculature in nitrofen-induced CDH in fetal rats. Methods/Results Quantitative RT-PCR revealed PDE1,5 and PDE9 mRNA expression in pulmonary arteries (PAs) of control and nitrofen-induced CDH term fetal rats. In this order of potency, the PDE inhibitors Sildenafil (PDE5),>,EHNA (PDE2),>,Rolipram (PDE4),>,Cilostamide (PDE3) all dilated isolated third generation PA after pre-constriction with the thromboxane analog U46619. Hyperoxic pre-incubation of PAs significantly attenuated vasodilatation induced by the PDE5 inhibitor Sildenafil (65% vs. 33%, P,<,0.004). CDH PAs dilated significantly less to PDE2 inhibitor EHNA compared to control (51% vs. 72%, P,<,0.05). Subsequently PDE2 protein expression was higher in PAs of CDH animals. Conclusion Most PDE isoforms exist in the PAs of fetal rats and their inhibition causes pulmonary vasodilatation. PDE5 inhibition was the most potent vasodilator, however, there were no differences between groups. PDE5-induced vasodilatation was attenuated by hyperoxic pre-incubation. PDE inhibitors might be considered therapeutic targets in combination with iNO in neonates with CDH. Pediatr Pulmonol. 2010; 45:320,325. © 2010 Wiley-Liss, Inc. [source] Gene transfer of vascular endothelial growth factor reduces bleomycin-induced pulmonary hypertension in immature rabbitsPEDIATRICS INTERNATIONAL, Issue 3 2005Fangqi Gong AbstractBackground:,The purpose of the present paper was to investigate the effect of gene transfer of vascular endothelial growth factor (VEGF) on bleomycin (BLM)-induced pulmonary hypertension in immature rabbits. Methods:,Immature rabbits (1 month old) were divided into control group (intratracheal injection of normal saline), BLM group (intratracheal injection of BLM), liposome group (intratracheal injection of BLM and liposomes) and the trans-gene group (intratracheal injection of BLM and DNA,liposome complex). The pulmonary arterial pressure (PAP) were measured by microcatheter, the pathological changes and the expression of VEGFmRNA and endothelial nitric oxide synthase (eNOS) mRNA of endothelial cells in pulmonary arteries were evaluated by hematoxylin,eosin (HE) and in situ hybridization. Results:,The PAP of the BLM and liposome groups were higher than the PAP of the control and trans-gene groups. The thickness of wall increased and the cavity became narrow, and thickness index and area index increased in mid- and small-sized pulmonary arteries of the BLM and liposome groups. VEGF trans-gene was able to reduce those changes; the level of VEGFmRNA and eNOSmRNA expression in pulmonary arterial endothelial cells decreased in the BLM and liposome groups. The level of VEGFmRNA expression in the trans-gene group was higher than that in the BLM and liposome groups, but lower than that in the control group. Conclusion:,The PAP was elevated, the thickness of wall increased and the cavity became narrow in mid- and small-sized pulmonary arteries, and the level of VEGFmRNA and eNOSmRNA expression in pulmonary arterial endothelial cells decreased in immature rabbits after 2 weeks of intratracheal injection of 4 units/kg BLM. VEGF trans-gene could reduce those changes. [source] Isolated congenital spleen agenesis: A rare cause of chronic thromboembolic pulmonary hypertension in an adultRESPIROLOGY, Issue 6 2008Fumiyuki TAKAHASHI Abstract: This report describes a case of isolated congenital spleen agenesis complicated by chronic thromboembolic pulmonary hypertension (CTPH) in a 44-year-old female patient. The patient had increasing exertional dyspnoea and thrombocytosis. An echocardiogram showed severe pulmonary hypertension and right ventricular hypertrophy, and contrast-enhanced chest CT revealed multiple thromboemboli within both pulmonary arteries. A perfusion lung scan demonstrated multiple segmental defects and no spleen was detected by abdominal CT, ultrasonography or scintigraphy. Comprehensive clinical examinations disclosed no evidence of a thrombus elsewhere or of an associated malformation such as a cardiac anomaly. Anticoagulation therapy was started, and a perfusion lung scan revealed partial improvement of the hypoperfusion in the right lower lobe. However, repeat echocardiography showed the pulmonary hypertension persisting for 1 year. The multiple segmental defects in the perfusion lung scans were also persistent. Collectively, a diagnosis of CTPH with isolated congenital spleen agenesis was established. This is the first documented case of CTPH in an adult with isolated congenital asplenia. Although congenital spleen agenesis is a rare condition, this case report suggests that this possibility should be considered when a diagnosis of CTPH and thrombocytosis is made. [source] A case of pulmonary arteritis with stenosis of the main pulmonary arteries with positive myeloperoxidase-antineutrophil cytoplasmic autoantibodiesRESPIROLOGY, Issue 4 2000Hiroyuki Nakayama A 53-year-old woman was referred to our hospital with the main symptoms of productive cough, fever and exertional dyspnoea. Chest X-ray revealed enlargement of the left hilar shadow and cavitary infiltration in the right upper lobe. 99mTechnetium-macroaggregated albumin (99mTc-MAA) perfusion scintigram showed complete hypoperfusion through the entire right lung. A pulmonary angiogram revealed stenotic lesions in the right and left main pulmonary arteries. Right cardiac catheterization showed an elevated right ventricular systolic pressure. There was no evidence of systemic arterial lesions nor vasculitis. The patient was positive for myeloperoxidase (MPO)antineutrophil cytoplasmic autoantibodies (ANCA) (168 EU). The Mycobacterium avium complex sputum culture was positive. The pulmonary stenotic lesions were surgically resected. The resected pulmonary arterial lesions were pathologically diagnosed as non-specific vasculitis. The cavitary lesion disappeared 6 months after the surgery. Two years after the surgery, although the MPO-ANCA level had decreased to 12 EU, stenosis of the pulmonary arteries reappeared. It is suggested that the patient became positive for MPO-ANCA in association with the Mycobacterium avium complex infection, and that the presence of MPO-ANCA may not be related to the development of pulmonary stenosis of the main pulmonary arteries. [source] | ||||||||||||||||||||||||||||||||||||||||