scholarly journals Traumatic aorto-pulmonary artery fistula: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Ruchika Meel ◽  
Thumone Govindasamy ◽  
Ricardo Gonçalves
Keyword(s):  
Pulmonary Artery ◽  
3D Imaging ◽  
Pulmonary Valve ◽  
Stab Wound ◽  
Main Pulmonary Artery ◽  
Three Dimensional ◽  
Pulmonary Valve Replacement ◽  
The Right ◽  
Pulmonary Artery Fistula ◽  
High Index Of Suspicion

Abstract Background  Aorta-pulmonary (A-P) artery fistula following a stab wound to the chest with superimposed infective endocarditis (IE) is a rare, often unrecognized presentation. Herein, we report a case of A-P fistula due to stab chest assessed by two- and three-dimensional (3D) imaging. Case summary  A 30-year-old man presented with a history of being stabbed in the chest with a screwdriver. The chest wall laceration was sutured, an intercostal drain inserted for a haemopneumothorax, and he was subsequently discharged. He presented 3 weeks later with exertional dyspnoea, fever, rigours, and loss of weight. On examination, he had a wide pulse pressure and a harsh continuous murmur in the 2nd left intercostal space associated with a palpable thrill. Blood tests revealed raised infective markers and anaemia. All blood cultures were sterile. On echocardiography, the aortic and pulmonary valve was severely damaged, with suspicion of superimposed vegetations secondary to IE. There was severe aortic and pulmonary valve regurgitation. A fistulous connection was noted between the aorta and main pulmonary artery, just below the commissure adjoining the right and left coronary sinus of the aortic valve. On 3D imaging, the defect was quantified. The patient was subsequently referred for aortic and pulmonary valve replacement and closure of the A-P fistula. The presence of multiple vegetations was confirmed intraoperatively. He also received a 6-week course of intravenous antibiotics. Discussion  We have described a rare case of an A-P fistula due to a stab wound to the chest complicated by IE. In a patient with stab wound to the chest, a high index of suspicion of cardiac involvement must be maintained, and a careful search for intracardiac shunts must be made on echocardiography, prior to discharge. Furthermore, in addition to two-dimensional imaging, 3D imaging proved useful in providing a comprehensive assessment of the morphology of the lesion prior to surgery.

Dual-source CT in Diagnosis of Coronary Artery Fistula and its Value

2020 ◽  
Author(s):  
Cheng WANG ◽  
Yaying LI ◽  
Jiangyong LIU
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Correct Diagnosis ◽  
Main Pulmonary Artery ◽  
Image Data ◽  
Coronary Artery Fistula ◽  
Coronary Fistula ◽  
Detection And Diagnosis ◽  
The Right ◽  
Pulmonary Artery Fistula

Abstract Background: Coronary artery fistula refers to the symptom that the coronary artery trunk or branch connects with the heart cavity or the pulmonary circulation blood vessels in a congenital or an acquired manner. As early detection and diagnosis of CAF was necessary for the prevention and management of late symptoms and complications, we are supposed to master the imaging performance of CAFs so as to make a correct diagnosis. This paper seeks to investigate the imaging manifestations and application value of CT diagnosis of coronary fistula and its application value. Methods: To retrospectively analyze the clinical data and DSCT image data of 62 patients with coronary fistula, and summarize, analyze and summarize their image manifestations and types.Results: 62 CAFs originate from 58 LCA vessels, 32 RCA vessels. The distribution frequency of drainage site from high to low was as follows: 40 cases (63%) of the main pulmonary artery, 10 cases (16%) of the right atrium, 7 cases (11%) of the right ventricle, 3 cases (5%) of the left ventricle, 1 case (2%) of the left atrium, and 1 case of coronary sinus (2%), 1 case of the right lower pulmonary vein (2%). There were 39 cases (63%) of single fistula vessel, and 23 cases (37%) of multiple fistula vessel, including 21 cases of left and right coronary arteries. Coronary artery-pulmonary fistulae were the most common with a total of 40 cases. Conclusion: The popularization of CT improved the detection rate of CAFs. Coronary pulmonary-artery fistula was probably the most common seen type of CAFs. ECG-gating coronary artery CTA can accurately assess the origin of CAFs, the course of fistula vessels, and the drainage site, thereby providing important information for clinicians to treat coronary fistula.Trial registration: retrospectively registered

P885 Pulmonary artery stent implantation in an adult with chronic thromboembolic pulmonary stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E A Khalifa ◽  
S Helmy ◽  
F Elallus ◽  
S F Mohamed ◽  
M Alkuwari
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Stent Implantation ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Left Ventricular ◽  
Artery Stenosis ◽  
Pulmonary Artery Stenosis ◽  
The Right

Abstract Introduction Pulmonary artery stenosis presenting in adults is rare. Chronic thromboembolic pulmonary hypertension (CTEPH) is by far the most common cause of pulmonary artery stenosis. Stenosis in these patients are not caused by an abnormality of the arterial wall itself, but by intraluminal narrowing as a result of the only partially resolved and organized thromboembolism. In contrast to paediatric patients, in adults with pulmonary artery stenosis, pulmonary stenting is not routinely performed. Case report A 51-year male, smoker, diabetic, hypertensive, and with chronic kidney disease. He was diagnosed two years earlier with bilateral multiple pulmonary emboli and was maintained on oral anticoagulation therapy. Recently, he presented with gradually progressive shortness of breath and signs of right ventricular failure. Diagnostic imaging: 1-Transthoracic and transesophageal echocardiography showed normal global systolic left ventricular function with no regional wall motion abnormalities, dilated right ventricle (RV) with moderately impaired function, severe pulmonic valve incompetence, mild tricuspid incompetence and a severely elevated right ventricular systolic pressure (RVSP) of 82 mmHg. In addition, a small rounded mass (6 x 11 mm) was visualized attached to the posterior wall of the RV outflow tract (RVOT) about 15mm proximal to the pulmonary valve annulus, (figure A). 2- Computed tomography pulmonary angiography showed a right main pulmonary artery (RPA) with circumferential narrowing, which was highly suggestive of chronic thrombosis. There was an abrupt tapering noted in the segmental branches of the right lower lobar pulmonary artery, with non-opacification of the distal arteries. No contrast opacification was noted in the right upper lobe pulmonary arteries. The left main pulmonary artery showed thickening of its bifurcation, again suggestive of chronic thrombosis, with narrowing of its left upper lobar branch, (figures B&C). 3-Cardiac magnetic resonance (CMR) showed a non enhancing RVOT mass protruding through the incompetent pulmonary valve during systole with features suggestive of a thrombus. Management In view of the clinical history, CTEPH was considered to be the most likely aetiology of the pulmonary hypertension. The decision was to perform balloon angioplasty and stent implantation in the RPA. Immediately after the procedure, RVSP was reduced from 80 to 50 mmHg. The clinical course after this procedure was uncomplicated and the patient showed significant clinical improvement. Follow up CMR showed patent stent with improvement of RV function ( fig D) Abstract P885 Figure.

Interposition Technique for Pulmonary Valve Replacement

2021 ◽  
Vol 12 (3) ◽  
pp. 411-413
Author(s):  
Lok Sinha ◽  
Josue Chery ◽  
Richard A. Jonas ◽  
Pranava Sinha
Keyword(s):  
Pulmonary Artery ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Coronary Compression

Background: Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires accommodating 35 to 37 mm diameter sewing ring in the pulmonary position and requires anterior patch augmentation of the right ventricular outflow tract (RVOT). We present a novel “interposition” technique of PVR that allows upsizing the valve without RVOT patch augmentation. Methods: Using standard cardiopulmonary bypass, the main pulmonary artery (MPA) is dissected and transected at an appropriate level. The remnants of pulmonary valve leaflets are excised. The valve stent posts are telescoped into distal MPA, the MPA continuity is restored by end-to-end anastomosis of the proximal and distal MPA, with the interposed prosthetic valve sewing ring in the suture line between the two edges of the MPA with the bulk of the sewing ring extravascular. Result: A total of seven patients (tetralogy of Fallot, three; congenital pulmonary stenosis, four; age range: 15-33 years) underwent the procedure. No patient required RVOT patch augmentation, all patients were extubated in the operating room and were fast-tracked to recovery. Our proposed technique of PVR has the following advantages: accommodate larger size valve, eliminates risk of a paravalvar leak, coronary compression, and anterior tilting of the prosthesis. Conclusion: The valve interposition technique avoids the need for RVOT patch, allows implantation of an adequate sized prosthetic valve, maintains native geometry of the pulmonary artery without the risk of tilting of the prosthesis, and eliminates the risk of paravalvular regurgitation and left coronary compression.

A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement

2021 ◽  
Vol 12 (5) ◽  
pp. 643-648
Author(s):  
Ignacio Lugones ◽  
Jesús Damsky Barbosa ◽  
Guillermo Schvartz ◽  
Judith Ackerman ◽  
Verónica Laudani ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Landing Zone ◽  
Transcatheter Pulmonary Valve Replacement

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

Damus–Kaye–Stansel procedure 5 years after Fontan operation with ligated main pulmonary artery

2012 ◽  
Vol 23 (4) ◽  
pp. 613-616
Author(s):  
Mohsen Karimi ◽  
Carol A. Rosenberg ◽  
William Lutin
Keyword(s):  
Computed Tomography ◽  
Pulmonary Artery ◽  
Surgical Planning ◽  
Pulmonary Valve ◽  
Cardiac Computed Tomography ◽  
Fontan Operation ◽  
Main Pulmonary Artery ◽  
Three Dimensional ◽  
Subaortic Stenosis ◽  
Extracardiac Fontan

AbstractWe report a case of tricuspid atresia with transposed great arteries and rudimentary right ventricle owing to which the patient developed severe subaortic stenosis and restrictive bulboventricular foramen 5 years after her extracardiac Fontan operation. She underwent a successful modified Damus–Kaye–Stansel operation using her native pulmonary valve. Spiral cardiac computed tomography with three-dimensional reconstructions was instrumental in pre-operative surgical planning.

Repair of Anomalous Single Coronary Artery From the Pulmonary Artery (ASCAPA)

2021 ◽  
pp. 215013512110641
Author(s):  
Srujan Ganta ◽  
John Artrip ◽  
Eleanor L. Schuchardt ◽  
Wyman Lai ◽  
Justin Ryan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Preoperative Planning ◽  
Main Pulmonary Artery ◽  
Three Dimensional ◽  
Severe Heart Failure ◽  
Normal Function ◽  
Left Ventricular ◽  
Single Coronary Artery ◽  
Lv Dysfunction

We describe the management of an infant presenting with severe heart failure at 6 weeks of age found to have an anomalous single coronary artery originating from the main pulmonary artery (MPA). This patient was transferred to our hospital and ultimately had their coronary artery translocated to the ascending aorta successfully. Preoperative severe left ventricular (LV) dysfunction and moderate/severe mitral regurgitation (MR) improved to normal function and mild-to-moderate MR 6 weeks postrepair. Three-dimensional CT reconstructions proved valuable and allowed for accurate preoperative planning leading to successful coronary transfer.

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