Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

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Pulmonary Hypertension

10.1093/med/9780199764495.003.0035 ◽

2013 ◽

Author(s):

George K Istaphanous ◽

Andreas W Loepke

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Pulmonary Artery Pressure ◽

Disease Process ◽

Underlying Disease ◽

Artery Pressure ◽

Pulmonary Arterial ◽

Made In

Pediatric pulmonary arterial hypertension (PAH) is characterized by a pathologically elevated pulmonary artery pressure in children. The etiology of PAH is multifactorial, and while its prognosis is closely related to the reversibility of the underlying disease process, much progress has recently been made in its diagnosis and treatment, significantly decreasing the associated morbidity and mortality.

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Sex Differences in Pulmonary Hypertension

Frontiers in Aging ◽

10.3389/fragi.2021.727558 ◽

2021 ◽

Vol 2 ◽

Author(s):

Juan José Rodriguez-Arias ◽

Ana García-Álvarez

Keyword(s):

Pulmonary Hypertension ◽

Sex Differences ◽

Pulmonary Arterial Hypertension ◽

Animal Models ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Gender Bias ◽

Response To Treatment ◽

Experimental Animal Models ◽

Pulmonary Arterial

Pulmonary hypertension (PH) includes multiple diseases that share as common characteristic an elevated pulmonary artery pressure and right ventricular involvement. Sex differences are observed in practically all causes of PH. The most studied type is pulmonary arterial hypertension (PAH) which presents a gender bias regarding its prevalence, prognosis, and response to treatment. Although this disease is more frequent in women, once affected they present a better prognosis compared to men. Even if estrogens seem to be the key to understand these differences, animal models have shown contradictory results leading to the birth of the estrogen paradox. In this review we will summarize the evidence regarding sex differences in experimental animal models and, very specially, in patients suffering from PAH or PH from other etiologies.

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Pathophysiology and treatment of pulmonary hypertension in sickle cell disease

Blood ◽

10.1182/blood-2015-08-618561 ◽

2016 ◽

Vol 127 (7) ◽

pp. 820-828 ◽

Cited By ~ 58

Author(s):

Victor R. Gordeuk ◽

Oswaldo L. Castro ◽

Roberto F. Machado

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Sickle Cell Disease ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Sickle Cell ◽

Left Ventricular ◽

Cell Disease ◽

Pulmonary Pressure ◽

Pulmonary Arterial

Abstract Pulmonary hypertension affects ∼10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregulated hypoxic responses secondary to anemia, low O2 saturation, and microvascular obstruction. The remainder have postcapillary pulmonary hypertension secondary to left ventricular dysfunction. Although the pulmonary artery pressure in SCD patients with pulmonary hypertension is only moderately elevated, they have a markedly higher risk of death than patients without pulmonary hypertension. Guidelines for diagnosis and management of SCD-related pulmonary hypertension were published recently by the American Thoracic Society. Management of adults with sickle-related pulmonary hypertension is based on anticoagulation for those with thromboembolism; oxygen therapy for those with low oxygen saturation; treatment of left ventricular failure in those with postcapillary pulmonary hypertension; and hydroxyurea or transfusions to raise the hemoglobin concentration, reduce hemolysis, and prevent vaso-occlusive events that cause additional increases in pulmonary pressure. Randomized trials have not identified drugs to lower pulmonary pressure in SCD patients with precapillary pulmonary hypertension. Patients with hemodynamics of pulmonary arterial hypertension should be referred to specialized centers and considered for treatments known to be effective in other forms of pulmonary arterial hypertension. There have been reports that some of these treatments improve SCD-related pulmonary hypertension.

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Myocardial edema, left ventricular function, and pulmonary hypertension

Journal of Applied Physiology ◽

10.1152/jappl.1995.78.1.132 ◽

1995 ◽

Vol 78 (1) ◽

pp. 132-137 ◽

Cited By ~ 52

Author(s):

K. L. Davis ◽

U. Mehlhorn ◽

G. A. Laine ◽

S. J. Allen

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Dry Weight ◽

Left Ventricular ◽

Interstitial Edema ◽

Pulmonary Arterial

Left ventricular dysfunction has been reported in both experimentally induced and clinical pulmonary hypertension. However, the mechanism by which pulmonary hypertension causes left ventricular dysfunction is unknown. We hypothesized that acute pulmonary hypertension causes left ventricular myocardial interstitial edema and that it is this edema that causes left ventricular dysfunction. In pulmonary artery-banded or sham-operated dogs, left ventricular diameter (septal-free wall axis) and pressure were measured using sonomicrometry crystals and a micromanometer, respectively. These measurements were used to calculate preload recruitable stroke work (PRSW), an index of contractility, and the rate of active relaxation (tau) to assess systolic and diastolic left ventricular function, respectively. After 3 h of pulmonary arterial hypertension or control, the dogs were killed and the left ventricles were excised to determine wet-to-dry weight ratios. The wet-to-dry weight ratios were significantly higher in the pulmonary artery-banded dogs (3.57 +/- 0.12) than in the sham-operated dogs (3.41 +/- 0.17). PRSW decreased to 56.8 +/- 30.3% of control after 3 h of pulmonary hypertension. tau Slowed significantly from 29.8 +/- 5.8 ms at baseline to 63.6 +/- 30.4 ms after 3 h of pulmonary arterial hypertension. There were no differences in PRSW or tau in the sham-operated dogs. We conclude that pulmonary hypertension causes left ventricular myocardial interstitial edema, which results in both systolic and diastolic left ventricular dysfunction.

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Chronic Pulmonary Artery Dissection Associated with Pulmonary Arterial Hypertension

Pulmonary Circulation ◽

10.1086/674560 ◽

2013 ◽

Vol 3 (3) ◽

pp. 692-695 ◽

Cited By ~ 2

Author(s):

Rhonda Cook ◽

Alexander G. Duarte ◽

Paul Boor ◽

Cowan Daniel

Keyword(s):

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Artery Dissection ◽

Pulmonary Arterial

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The Effects of Dexmedetomidine Prescription in Paediatric Patients With Pulmonary Hypertension Under Congenital Heart Surgery

ACTA MEDICA IRANICA ◽

10.18502/acta.v58i4.3922 ◽

2020 ◽

Author(s):

Bahram Ghasemzadeh ◽

Bahador Azizi ◽

Simin Azemati ◽

Mostafa Bagherinasab

Keyword(s):

Blood Pressure ◽

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Systolic Blood Pressure ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Anesthetic Care ◽

Pulmonary Arterial

Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the postanesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P<0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P<0.001) and a lower dose of sedation (P<0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery.

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Pulmonary artery imaging

Cardiovascular Computed Tomography ◽

10.1093/med/9780198809272.003.0026 ◽

2019 ◽

pp. 455-466

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Vascular Malformations ◽

Ct Scanning ◽

Pulmonary Angiography ◽

Pulmonary Artery Hypertension ◽

Thromboembolic Disease ◽

Chronic Pulmonary Hypertension ◽

Patient Groups ◽

Pulmonary Arterial

The main indications for pulmonary artery imaging are acute pulmonary thromboembolic disease and assessment of chronic pulmonary artery hypertension. Other indications, such as investigation of haemoptysis and pulmonary arterial vascular malformations are not addressed in this chapter. Although recurrent acute thromboembolic disease may eventually lead to pulmonary hypertension, the two are essentially separate patient groups for the purpose of CT scanning. This chapter covers CT pulmonary angiography, peripheral venous imaging, and chronic pulmonary hypertension.

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Improvements in French risk stratification score were correlated with reductions in mean pulmonary artery pressure in pulmonary arterial hypertension: a subanalysis of the Japan Pulmonary Hypertension Registry (JAPHR)

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01398-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuichi Tamura ◽

◽

Hiraku Kumamaru ◽

Kohtaro Abe ◽

Toru Satoh ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Risk Stratification ◽

Arterial Hypertension ◽

Pulmonary Artery Pressure ◽

Pulmonary Arterial ◽

The Relationship ◽

Risk Stratification Score

Abstract Background Since there was no previous report, we analyzed the relationship between French Risk Stratification parameters in pulmonary arterial hypertension (PAH) and mean pulmonary arterial pressures (mPAP) using Japan PH Registry (JAPHR) national-wide cohort. Methods We enrolled 108 patients with PAH from JAPHR from previous reported cohort and analyzed the relations between French Risk Stratification scores and hemodynamic improvements. Results The ratio meeting 0 to 4 French Risk Stratification score was 21.3%, 31.5%, 32.4%, 13.0%, and 1.9% at baseline, and 6.5%, 23.2%, 33.3%, 23.2%, 13.9% at follow-up, respectively. The improvements in the number of criteria met were associated both with mPAP at follow-up (p = 0.03) and with the improvements in mPAP (p < 0.001). Conclusion The improvements in French Risk Stratification may become a marker of improved hemodynamics including mPAP.

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Acute pulmonary artery dissection with untreated pulmonary arterial hypertension

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.23.318 ◽

2016 ◽

Vol 23 (3) ◽

pp. 318-323

Author(s):

Kenji Kawade ◽

Kazuyoshi Shimizu ◽

Masao Hayashi ◽

Makiko Tani ◽

Satoshi Suzuki ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Artery Dissection ◽

Pulmonary Arterial

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Improvements in French Risk Stratification Score were Correlated with Reductions in Mean Pulmonary Artery Pressure in Pulmonary Arterial Hypertension: A Subanalysis of the Japan Pulmonary Hypertension Registry (JAPHR)

10.21203/rs.3.rs-25209/v3 ◽

2020 ◽

Author(s):

Yuichi Tamura ◽

Hiraku Kumamaru ◽

Kohtaro Abe ◽

Toru Satoh ◽

Hiroaki Miyata ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Risk Stratification ◽

Arterial Hypertension ◽

Pulmonary Artery Pressure ◽

Pulmonary Arterial ◽

The Relationship ◽

Risk Stratification Score

Abstract BackgroundSince there was no previous report, we analyzed the relationship between French Risk Stratification parameters in pulmonary arterial hypertension (PAH) and mean pulmonary arterial pressures (mPAP) using Japan PH Registry (JAPHR) national-wide cohort.MethodsWe enrolled 108 patients with PAH from JAPHR from previous reported cohort and analyzed the relations between French Risk Stratification scores and hemodynamic improvements.ResultsThe ratio meeting 0 to 4 French Risk Stratification score was 21.3%, 31.5%, 32.4%, 13.0%, and 1.9% at baseline, and 6.5%, 23.2%, 33.3%, 23.2%, 13.9% at follow-up, respectively. The improvements in the number of criteria met were associated both with mPAP at follow-up (p=0.03) and with the improvements in mPAP (p<0.001).ConclusionThe improvements in French Risk Stratification may become a marker of improved hemodynamics including mPAP.

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