Pulmonary Artery Stenosis: Early Interventions With Low Profile Stents Versus Delayed Interventions With Large Diameter Stents

Abstract Pulmonary artery stenosis (PAS) is a common complication of heart surgery in infancy. With recent advances in low profile-small diameter stent technology, PA stenting is now often performed in infants. While PAS stenting in older children does not impact distal PA growth and multiplication, in infants still undergoing significant PA growth, the impact of PA stent timing on long term PA development is unknown and potentially important. In a swine PAS model, the effects of early and delayed stent interventions on PA growth and cardiac function were comprehensively assessed. PA stenting had a positive impact on hemodynamics, lung perfusion, and histology, but the timing of intervention, either early or late, does not make a significant difference.

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Pulmonary artery stenosis murmurs. A new diagnostic sign of pulmonary embolism

Archives of Internal Medicine ◽

10.1001/archinte.121.1.97 ◽

1968 ◽

Vol 121 (1) ◽

pp. 97-100

Author(s):

B. S. Chertow

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Artery Stenosis ◽

Pulmonary Artery Stenosis ◽

Diagnostic Sign

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Increased Airway Pressure and Simulated Branch Pulmonary Artery Stenosis Increase Pulmonary Regurgitation After Repair of Tetralogy of Fallot

Circulation ◽

10.1161/01.cir.95.3.643 ◽

1997 ◽

Vol 95 (3) ◽

pp. 643-649 ◽

Cited By ~ 76

Author(s):

Rajiv R. Chaturvedi ◽

Philip J. Kilner ◽

Paul A. White ◽

Andrew Bishop ◽

Richard Szwarc ◽

...

Keyword(s):

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Airway Pressure ◽

Pulmonary Regurgitation ◽

Artery Stenosis ◽

Pulmonary Artery Stenosis ◽

Branch Pulmonary Artery ◽

Branch Pulmonary Artery Stenosis

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Identification and characterization of a novel ELN mutation in congenital heart disease with pulmonary artery stenosis

Scientific Reports ◽

10.1038/s41598-021-93736-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cuilan Hou ◽

Junmin Zheng ◽

Wei liu ◽

Lijian Xie ◽

Xiaomin Sun ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulmonary Artery ◽

Molecular Mechanism ◽

Protein Level ◽

Congenital Heart ◽

Artery Stenosis ◽

Pulmonary Artery Stenosis ◽

Functional Component ◽

Functional Changes

AbstractCongenital heart defects, one of the most common birth defects, affect approximately 1% of live birth globally and remain the leading cause of infant mortality in developed countries. Utilizing the pathogenicity score and inheritance mode from whole exome sequencing results, a heterozygous mutation (NM_001278939.1: c.1939G>T, p.Gly647Ter) in elastin (ELN) was identified among 6,440 variants in a female proband born with an atrial septal defect accompanied by pulmonary artery stenosis. Results of RT-PCR showed that the mutation (NM_001278939.1: c.1939G>T, p.Gly647Ter) did not affect the expression levels of ELN mRNA but increased protein level. The content of ELN truncate (functional component) was significantly lower in both the intracellular and extracellular compartments after mutation. These results indicate that the ELN mutation (NM_001278939.1: c.1939G>T, p.Gly647Ter) affected the protein truncate, which may be a functional component of ELN and play crucial roles for this pedigree. Here we report of an ELN heterozygous variant associated with congenital heart disease accompanied with pulmonary artery stenosis, which is less common. Based on our results, we speculate that this may be the main molecular mechanism underlying the mutation-led functional changes, and propose that the decrease of ELN protein level may cause this pedigree vascular abnormality, especially pulmonary artery stenosis, and reinforce the view that ELN insufficiency is the primary cause of these vascular lesions. This may be the main molecular mechanism underlying the mutation-led functional changes. Thus, systematic analysis not only enables us to better understand the etiology of this disease but also contributes to clinical and prenatal diagnosis.

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Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00709-4 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Ryan J. Pewowaruk ◽

Gregory P. Barton ◽

Cody Johnson ◽

J. Carter Ralphe ◽

Christopher J. Francois ◽

...

Keyword(s):

Ejection Fraction ◽

Pulmonary Artery ◽

Ventricular Function ◽

Intervention Group ◽

Left Ventricular ◽

Pulmonary Artery Stenosis ◽

Swine Model ◽

4D Flow ◽

4D Flow Cmr ◽

The Impact

Abstract Background Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. Methods 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. Results 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). Conclusion These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.

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Elastic Modulus and Elasticity Ratio of Malignant Breast Lesions with Shear Wave Ultrasound Elastography: Variations with Different Region of Interest and Lesion Size

Diagnostics ◽

10.3390/diagnostics11061015 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1015

Author(s):

Antonio Bulum ◽

Gordana Ivanac ◽

Eugen Divjak ◽

Iva Biondić Špoljar ◽

Martina Džoić Dominković ◽

...

Keyword(s):

Elastic Modulus ◽

Shear Wave ◽

Large Diameter ◽

Small Diameter ◽

Shear Wave Elastography ◽

Lesion Size ◽

Ultrasound Elastography ◽

Breast Lesions ◽

Malignant Breast ◽

The Impact

Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (Emin), mean (Emean), maximal (Emax) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest Emin, Emean and e-ratio values and lowest variability were observed when using the 2 mm ROI. Emax values did not differ between different ROI sizes. Larger lesions had significantly higher Emean and Emax values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the Emin, Emean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on Emax values while lesion size has no impact on e-ratio values.

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