Cardiovascular causes of tracheobronchial compression: a decade experience in a Paediatric Congenital Heart Centre

2021 ◽  
pp. 1-9
Author(s):  
Putri Yubbu ◽  
Haifa Abdul Latiff ◽  
Husna Musa ◽  
Navin Kumar Devaraj ◽  
Nurul Adha Mohd Razif ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Ct Scan ◽  
Vascular Ring ◽  
Clinical Manifestations ◽  
Vascular Compression ◽  
Pulmonary Artery Sling ◽  
Group Iii ◽  
Group I ◽  
Cardiovascular Structure ◽  
Clinical Records

Abstract Background: Vascular compression of the airway often complicates CHD management. This study evaluated the use of CT in determining cardiovascular causes, clinical manifestations, and outcome of tracheobronchial compression among children with CHD. Methods: A retrospective review of clinical records of all patients with CT scan evidence of tracheobronchial compression from January 2007 to December 2017 at National Heart Institute. Cardiovascular causes of tracheobronchial compression were divided into three groups; group I: vascular ring/pulmonary artery sling, II: abnormally enlarged or malposition cardiovascular structure due to CHD, III: post-CHD surgery. Results: Vascular tracheobronchial compression was found in 81 out of 810 (10%) patients who underwent CT scan. Group I lesions were the leading causes of vascular tracheobronchial compression (55.5%), followed by group II (34.6%) and group III (9.9%). The median age of diagnosis in groups I, II, and III were 16.8 months, 3 months, and 15.6 months, respectively. Half of group I patients are manifested with stridor and one-third with recurrent chest infections. Persistent respiratory symptoms, lung atelectasis, or prolonged respiratory support requirement were clues in groups II and III. Higher morbidity and mortality in younger infants with severe obstructive airway symptoms, associated airway abnormalities, and underlying complex cyanotic CHD. Conclusions: Vascular ring/pulmonary artery sling and abnormally enlarged or malposition cardiovascular structure were the leading causes of cardiovascular airway compression. A high index of suspicion is needed for early detection due to its non-specific presentation. The outcome often depends on the severity of airway obstruction and complexity of cardiac lesions.

Abstract 4510: Pulmonary Hypertension before Transcatheter Aortic Valve Implantation Is Reversible and Lacks Prognostic Significance

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Abdullah M Al Ali ◽  
Brad Munt ◽  
Lukas Altwegg ◽  
Karin Humphries ◽  
Ronald Carere ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Group Iii ◽  
Transcatheter Aortic Valve ◽  
Group I ◽  
Group Ii ◽  
One Year ◽  
Valve Implantation

The prognostic significance of pulmonary hypertension (PH) and the potential for reversibility in the setting of aortic stenosis (AS) have been debated. We examined the clinical correlates and prognostic significance of PH in high risk elderly patients with symptomatic severe AS undergoing transcatheter aortic valve implantation (AVI). AVI was performed in 143 patients. Adequate echocardiographic estimation of baseline pulmonary artery systolic pressure was available in 115 (80%). Patients were divided into 3 groups according to baseline pulmonary artery pressure estimated by transthoracic echocardiogram: I: <30 mmHg, II: 30 –50 mmHg and III: >50 mmHg. Clinical and echocardiographic follow-up was obtained at 1, 6 and 12 months after AVI. Group I consisted of 17 patients (15%), group II 58 patients (50%) and group III 40 patients (35%). At baseline the three groups were similar in terms of age, functional status, presence of severe pulmonary disease, aortic valve area and mean gradient. Patients with severe PH (group III) were more likely to have left ventricular dysfunction (LVEF <50%) than patients with mild to moderate PH (groups I and II) (52% vs. 21%, p=0.002) and had more severe mitral regurgitation (grade ≥ 3 in 68% vs. 41%, p =0.0002). At one month, systolic pulmonary artery pressure fell significantly in group III (11.0 ± 14.3 mmHg, p=0.0008) and this reduction was maintained at 6 months. However, the changes in group I (increase of 7.1 ± 8.7 mmHg, p=0.07) and group II (decrease of 0.9 ± 9.3 mmHg, p=0.53) were not significant. Mortality at one year following AVI was 21%, but was not related to severity of PH. Using group III as a reference, hazard ratios were 0.83 (95% CI: 0.24 –2.9) for group I and 0.88 (95% CI: 0.4 –1.9) for group II. In elderly patients with severe AS treated with transcatheter AVI, severe PH is associated with more depressed left ventricular function and more severe mitral regurgitation. Severe PH is associated with a significant and greater fall in pulmonary pressure following AVI and does not influence one year survival.

scholarly journals Double trouble: fetal diagnosis of a pulmonary artery sling and vascular ring

2016 ◽  
Vol 4 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Jesse W. Lee ◽  
Beth F. Printz ◽  
Sanjeet R. Hegde ◽  
Lisa A. Vargas ◽  
Heather Y. Sun
Keyword(s):  
Pulmonary Artery ◽  
Vascular Ring ◽  
Pulmonary Artery Sling ◽  
Fetal Diagnosis

Pulmonary Artery Sling: A New Diagnostic Tool and Clinical Review

PEDIATRICS ◽  
1982 ◽  
Vol 69 (4) ◽  
pp. 472-475
Author(s):  
Karen S. Rheuban ◽  
Nancy Ayres ◽  
J. Gordon Still ◽  
Bennett Alford
Keyword(s):  
Computed Tomography ◽  
Pulmonary Artery ◽  
Diagnostic Tool ◽  
Vascular Ring ◽  
Vascular Anomaly ◽  
Pulmonary Artery Sling ◽  
Cardiovascular Malformation ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The pulmonary artery sling is a vascular anomaly that produces severe respiratory disease in infancy. The differential diagnosis is lengthy, and the diagnostic work-up frequently includes such invasive maneuvers as bronchography, bronchoscopy, and cardiac catheterization. In this paper the use of a new noninvasive diagnostic tool, computed tomography, to aid in the diagnosis of this form of vascular ring, is discussed and a review of salient features of this cardiovascular malformation is presented.

Synovial sarcoma in children and adolescents: the St Jude Children's Research Hospital experience.

1994 ◽  
Vol 12 (11) ◽  
pp. 2360-2366 ◽  
Author(s):  
A S Pappo ◽  
J Fontanesi ◽  
X Luo ◽  
B N Rao ◽  
D M Parham ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Synovial Sarcoma ◽  
Tumor Size ◽  
Progression Free Survival ◽  
Clinical Group ◽  
Free Survival ◽  
Group Iii ◽  
Group I ◽  
Grade 3 ◽  
Clinical Records

PURPOSE AND METHODS We reviewed the clinical records and pathologic findings of 37 children and adolescents with synovial sarcoma treated at our institution over a 30-year period to evaluate the prognostic significance of tumor size, invasiveness, histology, and other features. RESULTS The 20 male and 17 female patients with synovial sarcoma had a median age of 13.7 years at diagnosis. Primary tumor sites were the extremities (n = 27), trunk (n = 8), and head and neck (n = 2). Disease stage (clinical group) was as follows: group I, n = 21; group II, n = 7; group III, n = 4; and group IV, n = 5. Nineteen patients had invasive (T2) lesions, 20 had tumors more than 5 cm in diameter, and 14 had histologic grade 3 lesions. The estimated 5-year survival rate (+/- SE) for patients with group I or II disease was 80% +/- 9%, compared with 17% +/- 15% for those with group III or IV tumors (P = .0003). An exact log-rank test, adjusted for clinical group, showed that tumor invasiveness and grade independently predicted overall and progression-free survival (P < .05); tumor size was significantly correlated with progression-free survival. A borderline significant relationship with overall survival was found for both tumor size and histologic subtype (P = .09). CONCLUSION A controlled trial of adjuvant chemotherapy is merited in children with resected synovial sarcoma (clinical group I or II) who present with unfavorable clinicopathologic features such as large, invasive, or grade 3 lesions. Children with unresected or metastatic disease fare poorly despite multimodality therapy and require novel treatment approaches.

scholarly journals Transcatheter radiofrequency pulmonary artery denervation in swine: the evaluation of lesion degree, hemodynamics and pulmonary hypertension inducibility

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalia S. Goncharova ◽  
Heber Ivan Condori Leandro ◽  
Aleksandr D. Vakhrushev ◽  
Elena G. Koshevaya ◽  
Yury A. Skorik ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
Controlled Study ◽  
Group Iii ◽  
Group I ◽  
Before And After ◽  
Pulmonary Arterial ◽  
The Mean

Abstract Background Mechanisms of positive effects of pulmonary artery (PA) denervation (PADN) remain poorly understood. The study aimed to evaluate pulmonary hemodynamic changes after PADN and their association with the extent of PA wall damage in an acute thromboxane A2 (TXA2)-induced pulmonary hypertension (PH) model in swine. Methods In this experimental sham-controlled study, 17 normotensive male white Landrace pigs (the mean weight 36.2 ± 4.5 kg) were included and randomly assigned to group I (n = 9)—PH modeling before and after PADN, group II (n = 4)—PADN only, or group III (n = 4)—PH modeling before and after a sham procedure. Radiofrequency (RF) PADN was performed in the PA trunk and at the proximal parts of the right and left PAs. PA wall lesions were characterized at the autopsy study using histological and the immunohistochemical examination. Results In groups I and II, no statistically significant changes in the mean pulmonary arterial pressure nor systemic blood pressure were found after PADN (−0.8 ± 3.4 vs 4.3 ± 8.6 mmHg, P = 0.47; and 6.0 ± 15.9 vs -8.3 ± 7.5 mmHg, P = 0.1; correspondingly). There was a trend towards a lower diastolic pulmonary arterial pressure after PADN in group I when compared with group III during repeat PH induction (34.4 ± 2.9 vs 38.0 ± 0.8; P = 0.06). Despite the presence of severe PA wall damage at the RF application sites, S100 expression was preserved in the majority of PA specimens. The presence of high-grade PA lesions was associated with HR acceleration after PADN (ρ = 0.68, p = 0.03). No significant correlation was found between the grade of PA lesion severity and PA pressure after PADN with or without PH induction. Conclusions Extended PADN does not affect PH induction using TXA2. Significant PA adventitia damage is associated with HR acceleration after PADN. Possible delayed effects of PADN on perivascular nerves and pulmonary hemodynamics require further research in chronic experiments.

scholarly journals Features of manifestations, treatment and prevention of nsaids – induced gastroduodenopathy in patients of different profile departments

2019 ◽  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clinical Manifestations ◽  
Duodenal Ulcers ◽  
Group Iii ◽  
Treatment And Prevention ◽  
Group I ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Gastroduodenal Zone

Introduction. Nonsteroidal anti-inflammatory drugs are the most commonly used medicines in medical practice. As literary sources show, they often cause unwanted side-effects. The purpose of our work was to evaluate the frequency, clinical manifestations and morphological features of lesions of the gastroduodenal zone that arise in patients of rheumatologic, neurological profiles and angiosurgery department during the course of treatment with nonsteroidal anti-inflammatory drugs of different groups, to trace the dependence of the frequency of manifestations of the pathology of the stomach and duodenum from simultaneous receiving two nonsteroidal anti-inflammatory drugs and their combination with glucocorticosteroids and anticoagulants. Material and methods. 73 patients who had used NSAIDs for a long time and had endoscopically confirmed medicated gastroduodenopathy. Patients were divided into 3 groups depending on the profile of the department: Group I included - 24 patients of the department of vascular surgery; Group II - 23 patients of the neurological department; Group III - 26 patients with rheumatological profile. Results. Asymptomatic clinical picture of NSAID-gastropathy was found, which did not coincide with the available endoscopic changes in the gastroduodenal tube: in 63% of cases, erosive changes in the mucous membrane were present, and stomach and duodenal ulcers were revealed in 11%. It was also found that in the group of patients receiving proton pump inhibitors, the incidence of gastroduodenopathy was reliably lower (34.2%) than in patients who did not receive them (53.4%). During this study, it was found that the use of selective non-steroidal anti-inflammatory drugs can significantly reduce the probability of developing the pathology of the gastroduodenal zone, compared with non-selective. Conclusions. The course of treatment with nonsteroidal anti-inflammatory drugs should be as short as possible and should be carried out with minimal but effective doses. Parallel prophylactic administration of proton pump inhibitors is appropriate in patients at high risk of developing erosions and ulcers in the background of treatment with these drugs.

Sling de Artéria Pulmonar em Recém Nato: Relato de Caso/Pulmonary Artery Sling in Newborn Baby: Case Report

1970 ◽  
Vol 5 (3) ◽  
pp. 68-79
Author(s):  
Ana Carolina Melo ◽  
Barbara Costa Barros ◽  
Helena Sant’Anna Grilo
Keyword(s):  
Case Report ◽  
Pulmonary Artery ◽  
Clinical Picture ◽  
Vascular Ring ◽  
Minas Gerais ◽  
Congenital Disease ◽  
Pulmonary Artery Sling ◽  
Vascular Sling ◽  
The Right ◽  
Hospital School

RESUMOIntrodução: Sling da artéria pulmonar, ou alça da artéria pulmonar é o nome que se dá a uma doença congênita, onde se forma um anel vascular incompleto que comprime estruturas importantes da região do mediastino. O quadro clínico pode ser desde assintomático podendo chegar ao óbito. Dos sintomáticos, mais da metade é diagnosticada logo nos primeiros meses de vida, porém nesses casos o quadro é geralmente leve e evolui de maneira lenta, porém progressiva. Estridor respiratório, tanto na inspiração quanto na expiração e cianose são sintomas comuns desses pacientes. Casuística: Esse projeto visa relatar um caso de Sling de artéria pulmonar, diagnosticado em um Hospital Escola do sul de Minas Gerais que se manifestou logo após o nascimento. Discussão: A criança em questão apresentou os sintomas clássicos da doença, porém devido sua raridade e variedade de diagnósticos diferenciais houve dificuldade em afirmar que se tratava de um Sling. Conclusão: Conclui-se que a doença foi diagnosticada e tratada a tempo e de maneira eficaz, embora fosse severa a gravidade do quadro apresentado pelo recém-nascido.Palavras-chave: Anel vascular, Sling de artéria pulmonar, Estridor respiratório. ABSTRACTIntroduction: Pulmonary artery sling or pulmonary artery handle is the name given to a congenital disease which forms an incomplete vascular ring that compresses important structures of the mediastinal region. The clinical picture may be from asymptomatic, experiencing mild cases turning to severe and even to death. More than half of symptomatic is diagnosed early in life, but in these cases the picture is generally mild and evolves slowly but progressively. Stridor, both in inspiration and in expiration and cyanosis are common symptoms of these patients. Case report: This project aims to report a case of pulmonary artery sling, diagnosed in a hospital school in southern Minas Gerais expressed just after birth. Discussion: The child presented classical symptoms of the disease, due to its rarity and another possible diagnosis was certain difficulty to be sure that it was a sling. Conclusion: The disease was diagnosed and treated on time and on the right way despite the severe gravity of the case presented by the newborn.Keywords: Vascular ring, Pulmonary artery sling, Stridor

scholarly journals NEUROPSYCHOLOGICAL STATUS OF PATIENTS WITH EPILEPSY AND CLINICAL MANIFESTATIONS OF CRANIOCEREBRAL DISPROPORATION ON THE BACKGROUND OF MODIFIED THERAPY

2018 ◽  
Vol 33 (3) ◽  
pp. 78-85
Author(s):  
V. I. Larkin ◽  
N. S. Stelmakh
Keyword(s):  
Standard Therapy ◽  
Clinical Manifestations ◽  
Epileptic Seizures ◽  
Primary Diagnosis ◽  
Long Term Memory ◽  
Group Iii ◽  
Average Value ◽  
Neuropsychological Status ◽  
Group I ◽  
Patients With Epilepsy

In the course of the study, 124 case records of patients with epileptic seizures (cryptogenic epilepsy) were analyzed. Diagnosis was established based on a typical clinical presentation, anamnesis, electroencephalogram (EEG) dynamics, and/or video EEG monitoring in the 10-hour format. Group I comprised 36 patients with normal liquor-cranial indexes ranging from 1.6 to 3.6 with an average value of 2.1±0.2; these patients received standard multicomponent therapy during the hospitalization and at the outpatient-polyclinic stage. Group II comprised 42 patients who had liquor-cranial indexes below the lower limit of normal ranging from 0.8 to 1.2 with an average value of 1.0±0.1; these patients also received therapy for primary diagnosis according to standard therapy scheme, which was identical to that in group I. Patients of group III (main group, n=46) had liquor-cranial indexes below physiological norm (from 0.8 to 1.2 with an average value of 0.9±0.1) and received modified therapy. Two-year follow up study showed that more severe cognitive deficit developed in patients with low cerebrovascular indexes receiving standard therapy compared to patients with low cerebrovascular indexes who received modified therapy. The absence of significant differences between patients of group I and III suggest that timely correction of increased intracranial pressure allowed to prevent significant aggravation of pathopsychological characteristics, loss of short-term and long-term memory, and overall cognitive function decline.

scholarly journals The analysis of efficacy of the use of inhibitor interleukin-1 in the complex therapy of secondary osteoarthritis taking into account the dynamics of clinical and functional indicators

2016 ◽  
Vol 71 (2) ◽  
pp. 141-147
Author(s):  
I. A. Starodubtseva ◽  
L. V. Vasilieva ◽  
A. V. Nikitin
Keyword(s):  
Laser Therapy ◽  
Interleukin 1 ◽  
Clinical Manifestations ◽  
Functional Condition ◽  
Underlying Disease ◽  
Complex Treatment ◽  
Secondary Osteoarthritis ◽  
Group Iii ◽  
Group I ◽  
Reduction Of Pain

Backgraund: Secondary osteoarthritis (OA) adversely affects an underlying disease and can enhance clinical manifestations of articular syndrome. Early detection of comorbid pathology and early treatment with the therapy of underlying condition is of primary importance to preserve adequate functional activity in patients.The Aims to analyze the efficacy of the use of inhibitor of interleukin -1 in the complex treatment of secondary OA in rheumatoid arthritis (RA).Materials and methods: 248 patients with secondary OA in RA were divided in 4 groups: patients of group I (n=62) took inhibitor of interleukin-1 (50mg x 2 times per day) in combination with laser therapy on the basis of methotrexate (10-20 mg per week), group II (n=60) received inhibitor of interleukin-1 in complex with methotrexate, in group III (n=62)-laser therapy with methotrexate and in group 4 – methotrexate. The analysis of treatment efficacy we estimated in 3 and 6 months according to the dynamics of pain on VAS, indexes HAQ and KOOS. Results: group 1 showed statistical significant reduction of pain on VAS on movement after 3 and 6 months on 28,53 mm (43,6%) and 31,3 мм (48%) accordingly, to values 36,87±1,56* и 33,11±1,11* (p0,05). It was noted the statistical significant advantages of HAQ dynamics in group I in comparison with groups II, III, IV (p=0,03). The most prominent statistical significant (p=0,02) significant advantages according to the dynamics of index KOOS it was noted in groups of patients who took diacerein (I and II) after 6 months complex treatment.Conclusions: the involvement of inhibitor of interleukin -1 in the complex treatment of secondary OA in patients with RA contributes to clinical improvement according to VAS (p=0,03), index KOOS, that shows functional condition of the knee and increase the quality of life by index HAQ (p=0,03) after 6 months therapy.

A New Nonstented Balloon-Expandable Graft for Straight or Bifurcated Endoluminal Bypass

1994 ◽  
Vol 1 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Geoffrey H. White ◽  
Weiyun Yu ◽  
James May ◽  
Michael S. Stephen ◽  
Richard C. Waugh
Keyword(s):  
Ct Scan ◽  
Graft Material ◽  
Duplex Scan ◽  
Graft Thrombosis ◽  
Iliac Arteries ◽  
Group Iii ◽  
Endoluminal Repair ◽  
Group I ◽  
Peripheral Aneurysms ◽  
Group Ii

Purpose: The aim of this study was to determine the feasibility of endoluminal grafting of aneurysms using a new design of nonstented endograft. Methods: Initial studies were undertaken in bench models and by implantation of endografts into animal vessels. Between May 1992 and June 1994, endoluminal repair of aneurysms was undertaken in 47 patients (44 male, 3 female). A new balloon-expandable endoluminal graft was developed and has now been studied in 25 of these 47 cases. This graft does not require adjunctive use of a vascular stent because of its unique construction, which incorporates metallic implants (graft attachment device or “GAD”) into the graft material. The design is applicable to endovascular grafting of occlusive arterial disease, as well as aneurysms. All patients were investigated by duplex scan, calibrated angiogram, and angio-CT scan and then allocated into groups that we defined according to the following criteria: group I, considered suitable for transfemoral implantation of a straight tube graft (n = 12); group II, unsuitable for transfemoral tube graft because of short neck of aneurysm, absent distal neck, or diseased iliac arteries (n = 10); and group III, peripheral aneurysms (n = 3). All patients were followed by clinical examination, duplex scan, and CT scan, with selective use of angiography. Results: Intraluminal deployment of the graft was achieved in all 25 patients; however, 3 patients from group II subsequently required conversion to open procedures because of the following complications: (1) partial graft thrombosis resulting from inadvertent omission of systemic anticoagulation during deployment (n = 1); and (2) unsuccessful deployment of the contralateral limb of a bifurcated graft in the iliac artery (n = 2). Successful endoluminal repair was achieved in 100% of patients in groups I and III, compared to 70% in group II. Conclusions: These preliminary results (in a series of high-risk patients) have demonstrated that endoluminal abdominal aortic aneurysm repair with this graft can be achieved reliably and with low morbidity in patients who fulfill the selection criteria (group I) and in peripheral aneurysms (group III), but the results were less satisfactory in aneurysms that do not have a good proximal or distal neck or in patients with diseased iliac arteries (group II). Further modification of the bifurcated version of this graft design, together with improvements in access techniques and graft materials, is required for successful endoluminal grafting in a wider range of patients.

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