scholarly journals In situ fracture of stents implanted for relief of pulmonary arterial stenosis in patients with congenitally malformed hearts

2008 ◽  
Vol 18 (4) ◽  
pp. 405-414 ◽  
Author(s):  
Doff B. McElhinney ◽  
Lisa Bergersen ◽  
Audrey C. Marshall
Keyword(s):  
Cohort Analysis ◽  
Pulmonary Arteries ◽  
Arterial Stenosis ◽  
Related Factors ◽  
Increased Risk ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
The Right ◽  
Pulmonary Arterial Stenosis

AbstractBackgroundOne of the most common uses of stents in patients with congenitally malformed hearts is treatment of pulmonary arterial stenosis. Although there are reports of fractured pulmonary arterial stents, little is known about the risk factors for, and implications of, such fractures.MethodsWe reviewed angiograms to identify fractures in stents previously inserted to relieve stenoses in pulmonary arteries from 1990 through 2001 in patients who also underwent follow-up catheterization at least 3 years after placement of the stent. We undertook matched cohort analysis, matching a ratio of 2 fractured to 1 unfractured stent.ResultsOverall, 166 stents meeting the criterions of our study had been placed in 120 patients. We identified fractures in 35 stents (21%) in 29 patients. All fractured stents were in the central pulmonary arteries, 24 (69%) in the central part of the right pulmonary artery, and all were complete axial fractures, or complex fractures along at least 2 planes. Stent-related factors associated with increased risk of fracture identified by multivariable logistic regression included placement in close apposition to the ascending aorta (p = 0.001), and a larger expanded diameter (p = 0.002). There was obstruction across 28 of 35 fractured stents, which was severe in 11. We re-stented 21 of the fractured stents, and recurrent fracture was later diagnosed in 3 of these. A fragment of the fractured stent embolized distally in 2 patients, without clinically important effects.ConclusionsIn situ fracture of pulmonary arterial stents is relatively common, and in most cases is related to compression by the aorta. There is usually recurrent obstruction across the fractured stent, but fractured stents rarely embolize, and are not associated with other significant complications.

Arteriohepatic Dysplasia: Association of Liver Disease with Pulmonary Arterial Stenosis as Well as Facial and Skeletal Abnormalities

PEDIATRICS ◽  
1980 ◽  
Vol 66 (6) ◽  
pp. 876-883
Author(s):  
Solomon E. Levin ◽  
Paniyotis Zarvos ◽  
Selwyn Milner ◽  
Arthur Schmaman
Keyword(s):  
Liver Disease ◽  
Coronary Artery ◽  
Clinical Features ◽  
Arterial Stenosis ◽  
Viral Etiology ◽  
Congenital Rubella ◽  
Arteriohepatic Dysplasia ◽  
Pulmonary Arterial ◽  
The Right ◽  
Pulmonary Arterial Stenosis

The clinical features and course of five children with the recently described syndrome of arteriohepatic dysplasia are presented. All had bilateral pulmonary arterial stenosis, proven at cardiac catheterization, as well as associated liver disease of varying severity. In one of the fatal cases, a hitherto undescribed anomaly was found—stenosis of the right coronary artery ostium. A viral etiology, eg, the congenital rubella syndrome, was considered most likely, but detailed investigations proved to be negative.

Experimental studies on the implantation of intravascular stents in puppies—potential use for aortic coarctation and pulmonary arterial stenosis

1994 ◽  
Vol 4 (4) ◽  
pp. 366-372 ◽  
Author(s):  
Toshihiro Ino ◽  
Shinjiro Shimazaki ◽  
Keijiro Yabuta ◽  
Ryozo Okada
Keyword(s):  
Aortic Coarctation ◽  
Experimental Studies ◽  
Pulmonary Arteries ◽  
Arterial Stenosis ◽  
Inferior Caval Vein ◽  
Major Disadvantage ◽  
Intravascular Stents ◽  
Pulmonary Arterial ◽  
Pulmonary Arterial Stenosis

AbstractWe have investigated angiographically and histologically the vascular response to implantation of intravascular stents in normal puppies. Eight balloon-expandable stents were placed in six mongrel puppies (weight 6.4–10.5 kg) under anesthesia. Four stents were successfully placed in the pulmonary arteries and three in the aorta. In one case, the strut of the stent was hooked by a leaflet of the tricuspid valve at the time of placement and eventually had to be implanted in the inferior caval vein. Two puppies died, one from bleeding from the femoral artery and the other from thrombotic obstruction at the superior mesenteric artery, both after successful implantation. The former was due to repeat arterial puncture and the latter wasdue to failure to use aspirin. Angiographic studies showed satisfactory opacities of the branch arteries in all but one puppy. The diameter of the arteries prior to implantation was 7.5±1.5 mm. The diameters at the middle of the stents immediately after implantation and during the period of follow-up were 6.9±1.7mm and 6.9±2.1 mm, respectively. Histologic studies revealed that neogenic endothelial layers of 30 to 40 pm in thickness had formed over the struts of the stent without formation of thrombusthree weeks after implantation. Scanning electron microscopy revealed that the endothelial cells of the neoendothelial layer had almost identical characteristics to those of normal arteries. These results indicate that clinical application of this stent is feasible but that use of anticoagulants is mandatory during and after implantation in the treatment of selected patients with aortic coarctation or pulmonary arterial stenosis. Relative progression of stenosis may occur, however, and the inability for re-expansion is a major disadvantage of this stent.

Non-confluent pulmonary arteries in a patient with pulmonary atresia and intact ventricular septum: ? a 5th aortic arch with a systemic-to-pulmonary arterial connection

2000 ◽  
Vol 10 (4) ◽  
pp. 419-422 ◽  
Author(s):  
Astolfo Serra ◽  
Francisco Chamie ◽  
R.M. Freedom
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Left Pulmonary Artery ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
The Right

AbstractMajor abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia and intact ventricular septum. Non-confluent pulmonary arteries have only rarely been described in this setting. In this case report, we describe a patient in whom the pulmonary arteries are non-confluent, with the right pulmonary artery supplied through a right-sided arterial duct, and the left pulmonary artery most likely through a fifth aortic arch, thus providing a systemic-to-pulmonary arterial connection. We discuss the various forms of non-confluent pulmonary arteries in the setting of pulmonary atresia and intact ventricular septum.

scholarly journals Pulmonary Artery Intimal Sarcoma: A Case Report

2016 ◽  
Vol 9 (1) ◽  
pp. 267-272 ◽  
Author(s):  
Joseph P. Kriz ◽  
Nabil A. Munfakh ◽  
Gregory S. King ◽  
Juan O. Carden
Keyword(s):  
Pulmonary Artery ◽  
Malignant Tumors ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Filling Defect ◽  
Intimal Sarcoma ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
Left And Right ◽  
The Right

Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung.

Early definitive repair of tetralogy of Fallot: a review of 74 cases

1997 ◽  
Vol 7 (3) ◽  
pp. 254-257 ◽  
Author(s):  
Dan Abramov ◽  
Jacob Barak ◽  
Ehud Raanani ◽  
Einat Birk ◽  
Bernardo A. Vidne
Keyword(s):  
Tetralogy Of Fallot ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arteries ◽  
Balloon Dilation ◽  
Arterial Stenosis ◽  
Definitive Repair ◽  
Pulmonary Arterial ◽  
Definitive Surgery ◽  
One Year ◽  
Pulmonary Arterial Stenosis

AbstractDefinitive repair of tetralogy of Fallot was performed on 74 patients under two years of age, including 40 under the age of one year and 13 less than 6 months of age. In six patients, there had been previous construction of a systemic-to-pulmonary arterial shunt. Patching across the ventriculo-pulmonary junction was required in 46 patients, placement of conduits in six, and procedures producing unifocaliza-tion in three. Three patients died during the 60-day postoperative period of observation. Of the 71 survivors, 64 recovered without complications. One patient had neurologic sequels, one required prolonged mechanical ventilation, two reoperation, and one balloon dilation of residual left pulmonary arterial stenosis. Morbidity and mortality were not significantly higher in those patients undergoing surgery at earlier than 6 months of age, although transjunctional patching was more common in that age group. Previous construction of a shunt was associated with a higher prevalence of distal stenosis and distortion of the pulmonary arteries, which needed surgical repair in two out of six patients (33%). Since the outcome of definitive repair is favourable in patients with tetralogy of Fallot younger than six months of age, we now advocate definitive surgery for all young symptomatic patients by the age of six months.

Transcatheter reconstruction of the right heart

2003 ◽  
Vol 13 (3) ◽  
pp. 308-311
Author(s):  
Younes Boudjemline ◽  
Tony Abdel Massih ◽  
Philipp Bonhoeffer
Keyword(s):  
Right Ventricular ◽  
Interventional Procedures ◽  
Septal Defect ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Arterial Stenosis ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
The Right ◽  
Pulmonary Arterial Stenosis

We report the interventional procedures performed on a 12-year-old child with obstruction of the right ventricular outflow tract, pulmonary valvar insufficiency, pulmonary arterial stenosis, and an atrial septal defect. A staged repair of all anomalies was performed successfully using transcatheter techniques.

Expressions of adrenomedullin mRNA and protein in rats with hypobaric hypoxia-induced pulmonary hypertension

2004 ◽  
Vol 286 (6) ◽  
pp. H2159-H2168 ◽  
Author(s):  
Kuniaki Nakanishi ◽  
Hiroshi Osada ◽  
Maki Uenoyama ◽  
Fumiko Kanazawa ◽  
Nobuhiro Ohrui ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Late Phase ◽  
Pulmonary Arteries ◽  
Hypoxic Environment ◽  
Male Wistar Rats ◽  
Pulmonary Arterial ◽  
The Right ◽  
The Brain ◽  
Altitude Level

Experimental pulmonary hypertension induced in a hypobaric hypoxic environment (HHE) is characterized by structural remodeling of the heart and pulmonary arteries. Adrenomedullin (AM) has diuretic, natriuretic, and hypotensive effects. To study the possible effects of HHE on the AM synthesis system, 150 male Wistar rats were housed in a chamber at the equivalent of a 5,500-m altitude level for 21 days. After 14 days of exposure to HHE, pulmonary arterial pressure (PAP) was significantly increased (compared with control rats). The plasma AM protein level was significantly increased on day 21 of exposure to HHE. In the right ventricle (RV), right atrium, and left atrium of the heart, the expressions of AM mRNA and protein were increased in the middle to late phase (5–21 days) of HHE, whereas in the brain and lung they were increased much earlier (0.5–5 days). In situ hybridization and immunohistochemistry showed AM mRNA and protein staining to be more intense in the RV in animals in the middle to late phase of HHE exposure than in the controls. During HHE, these changes in AM synthesis, which occurred strongly in the RV, occurred alongside the increase in PAP. Conceivably, AM may play a role in modulating pulmonary hypertension in HHE.

Sign in / Sign up

Export Citation Format

Share Document