Pulmonary Artery Filling Defects in COVID-19 Patients Revealed Using CT Pulmonary Angiography: A Predictable Complication?

Purpose. This study is aimed at assessing the prevalence of pulmonary artery filling defects (PAFDs) consistent with pulmonary artery embolism (PAE) in patients with SARS-CoV-2 infection and at investigating possible radiological or clinical predictors. Materials and Methods. Computed Tomography Pulmonary Angiographies (CTPAs) from 43 consecutive patients with a confirmed COVID-19 infection were retrospectively reviewed, taking into consideration the revised Geneva score and the D-dimer value for each patient. Filling defects within the pulmonary arteries were recorded along with pleural and parenchymal findings such as ground glass opacities, consolidation, crazy paving, linear consolidation, and pleural effusion. All these variables were compared between patients with and without PAFD. The predictive performance of statistically different parameters was investigated using the receiver operating characteristics (ROC). Results. Pulmonary embolism was diagnosed in 15/43 patients (35%), whereas CTPA and parenchymal changes related to pulmonary COVID-19 disease were evident in 39/43 patients (91%). The revised Geneva score and the mean D-dimer value obtained using two consecutive measurements were significantly higher in patients with PAFD. The ROC analysis demonstrated that a mean D-dimer value is the parameter with the higher predictivity (AUC 0.831) that is a cut ‐ off value > 1800 μ g / l which predicts the probability of PAFD with a sensitivity and specificity of 70% and 78%, respectively. Conclusions. This single centre retrospective report shows a high prevalence of pulmonary artery filling defects revealed using CTPA in COVID-19 patients and demonstrates that the mean value of multiple D-dimer measurements may represent a predicting factor of this complication.

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Tracheal development after left pulmonary artery reimplantation: an individual study

Scientific Reports ◽

10.1038/s41598-020-74890-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Xiaoyang Hong ◽

Ruijie Li ◽

Zhe Zhao ◽

Jiangheng Guan ◽

Hui Wang ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Arteries ◽

Left Pulmonary Artery ◽

Weaning Failure ◽

Threatening Condition ◽

Ventilation Weaning ◽

Life Threatening ◽

The Mean ◽

Tracheal Carina

Abstract Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

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Mechanical properties and dimensions of the major pulmonary arteries

Journal of Applied Physiology ◽

10.1152/jappl.1960.15.1.92 ◽

1960 ◽

Vol 15 (1) ◽

pp. 92-96 ◽

Cited By ~ 69

Author(s):

Dali J. Patel ◽

Donald P. Schilder ◽

Alexander J. Mallos

Keyword(s):

Pulmonary Artery ◽

Pulse Pressure ◽

Technical Assistance ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Cross Sectional ◽

Measurement Control ◽

The Mean ◽

The Right ◽

The Relationship

The relationship between instantaneous distending pressure and diameter of the pulmonary artery was studied in 18 living thoracotomized dogs. An electrical caliper with adequate recording characteristics was developed for instantaneous diameter measurement. Control observations were made over a range of pressures induced by rapid, right heart dextran-infusion and were compared with those obtained during norepinephrine administration. Results indicate: a) the pulse contours of the pulmonary artery pressure and diameter are essentially identical, indicating negligible inertance and viscous resistance of the vessel wall, b) the mean change in average radius during a cardiac cycle was ±7.8% ± 2.86 S.D. ± .32 S.E.M. (0.48%/cm H2O pulse pressure) under control conditions, c) the ratio of change in radius to pulse pressure, R/P, showed a significant decrease during norepinephrine administration when compared to control values within the same pressure range (P < .01) and d) the cross-sectional area of the main pulmonary artery exceeded that of the right and left combined. Note: (With the Technical Assistance of Alfred G. T. Casper) Submitted on August 25, 1959

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Impact of operative approach on pulmonary artery development following systemic-to-pulmonary shunt in patients with congenital heart disease and univentricular hemodynamics

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2014-2-10-12 ◽

2015 ◽

Vol 18 (3) ◽

pp. 10

Author(s):

N. V. Yershova ◽

O. S. Yanulevich ◽

G. V. Pavlichev ◽

A. Yu. Podoksenov ◽

V. I. Varvarenko ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulmonary Artery ◽

Congenital Heart ◽

Pulmonary Arteries ◽

Pulmonary Angiography ◽

Operative Approach ◽

Pulmonary Shunt ◽

Bidirectional Glenn Shunt ◽

Lateral Thoracotomy

The article presents the results of assessment of pulmonary arteries development depending on the operative approach in children with congenital heart disease and univentricular hemodynamics after systemic-to-pulmonary shunt. Twenty three patients were included in the study. Before a bidirectional Glenn shunt these patients underwent pulmonary angiography and assessment of indices of pulmonary artery development: the Nakata and Reddy index, the McGoon ratio. The data obtained show that sternotomy provides more adequate development of pulmonary arteries and doesn't damage the architectonics of pulmonary vessels in comparison with the patients who underwent systemic-to-pulmonary shunt through lateral thoracotomy.

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Effect of iterative reconstruction algorithm levels on noise index and figure-of-merit in CT pulmonary angiography examinations

Journal of X-Ray Science and Technology ◽

10.3233/xst-200699 ◽

2020 ◽

Vol 28 (5) ◽

pp. 893-903

Author(s):

H.H. Harun ◽

M.K.A. Karim ◽

Z. Abbas ◽

A. Sabarudin ◽

S.C. Muniandy ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Pulmonary Artery ◽

Iterative Reconstruction ◽

Figure Of Merit ◽

Pulmonary Angiography ◽

Volume Data ◽

Ct Pulmonary Angiography ◽

Increase With Increase ◽

The Mean

PURPOSE: To evaluate the influence of iterative reconstruction (IR) levels on Computed Tomography (CT) image quality and to establish Figure of Merit (FOM) value for CT Pulmonary Angiography (CTPA) examinations. METHODS: Images of 31 adult patients who underwent CTPA examinations in our institution from March to April 2019 were retrospectively collected. Other data, such as scanning parameters, radiation dose and body habitus information from the subjects were also recorded. Six different levels of IR were applied to the volume data of the subjects. Five circles of the region of interest (ROI) were drawn in five different arteries namely, pulmonary trunk, right pulmonary artery, left pulmonary artery, ascending aorta and descending aorta. The mean Signal-to-noise ratio (SNR) was obtained, and the FOM was calculated in a fraction of the SNR2 divided by volume-weighted CT dose index (CTDIvol) and SNR2 divided by the size-specific dose estimates (SSDE). RESULTS: Overall, we observed that the mean value of CTDIvol and SSDE were 13.79±7.72 mGy and 17.25±8.92 mGy, respectively. Notably, SNR values significantly increase with increase of the IR level (p < 0.05). There are also significant differences (p < 0.05) in the FOM for both SNR2/SSDE and SNR2/CTDIvol attained in different IR levels. CONCLUSION: We successfully evaluate the value of radiation dose and image quality performance and set up a figure of merit for both parameters to further verify scanning protocols by radiology personnel.

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Development of a technique for determination of pulmonary artery pulse wave velocity in horses

Journal of Applied Physiology ◽

10.1152/japplphysiol.00962.2016 ◽

2017 ◽

Vol 122 (5) ◽

pp. 1088-1094 ◽

Cited By ~ 1

Author(s):

Gonçalo Teixeira de Almeida Silva ◽

Bruce B. Guest ◽

Diego E. Gomez ◽

Martine McGregor ◽

Laurent Viel ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Pulmonary Arteries ◽

Tunica Media ◽

Potential Association ◽

The Mean ◽

Circulatory Disorders

Calcification of the tunica media of the axial pulmonary arteries (PA) has been reported in a large proportion of racehorses. In humans, medial calcification is a significant cause of arterial stiffening and is implicated in the pathogenesis of cardiac, cerebral, and renal microvascular diseases. Pulse wave velocity (PWV) provides a measure of arterial stiffness. This study aimed to develop a technique to determine PA-PWV in horses and, secondarily, to investigate a potential association between PA-PWV and arterial fibro-calcification. A dual-pressure sensor catheter (PSC) was placed in the main PA of 10 sedated horses. The pressure waves were used to determine PWV along the PA, using the statistical phase offset method. Histological analysis of the PA was performed to investigate the presence of fibro-calcified lesions. The mean (±SD) PWV was 2.3 ± 0.7 m/s in the proximal PA trunk and 1.1 ± 0.1 m/s further distal (15 cm) in a main PA branch. The mean (±SD) of mean arterial pressures in the proximal PA trunk was 30.1 ± 5.2 mmHg, and 22.0 ± 6.0 mmHg further distal (15 cm) within the main PA branch. The mean (±SD) pulse pressure in the proximal PA trunk was 15.0 ± 4.7 mmHg, and 13.5 ± 3.3 mmHg further distal (15 cm) within the main PA branch. Moderate to severe lesions of the tunica media of the PAs were observed in seven horses, but a correlation with PWV could not be established yet. Pulmonary artery PWV may be determined in standing horses. The technique described may allow further investigation of the effect of calcification of large PAs in the pathogenesis of equine pulmonary circulatory disorders. NEW & NOTEWORTHY Pulmonary artery pulse wave velocity was determined safely in standing sedated horses. The technique described may allow further investigation of the effect of calcification of large pulmonary arteries in the pathogenesis of pulmonary circulatory disorders in horses.

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Airway compression management in late-presenting absent pulmonary valve syndrome

Cardiology in the Young ◽

10.1017/s1047951113002151 ◽

2014 ◽

Vol 25 (2) ◽

pp. 295-300 ◽

Cited By ~ 3

Author(s):

Anastasia Martinez-Esteve Melnikova ◽

Tornike Sologashvili ◽

Maurice Beghetti ◽

Cécile Tissot ◽

Afksendiyos Kalangos ◽

...

Keyword(s):

Pulmonary Artery ◽

Chart Review ◽

Pulmonary Valve ◽

Pulmonary Arteries ◽

Retrospective Chart Review ◽

Absent Pulmonary Valve ◽

Airway Compression ◽

Primary Endpoints ◽

The Mean ◽

Absent Pulmonary Valve Syndrome

AbstractIntroduction: Patients with absent pulmonary valve syndrome often present early with airway compression from aneurysmal pulmonary arteries. This study reviews our experience in managing absent pulmonary valve syndrome in later presenting children, and techniques used for managing airway compression. Methods: This study is a retrospective chart review of all patients who underwent repair of absent pulmonary valve syndrome from 2000 to 2012 at our institution. The primary endpoints were post-operative bronchoscopic and clinical evidence of persistent airway compression and need for reinterventions on the pulmonary arteries. Results: A total of 19 patients were included during the study period. The mean age at repair was 4.1±3.0 years (range 10 months–11 years). In all, seven patients had pre-operative bronchoscopic evidence of airway compression, which was managed by pulmonary artery reduction plasty in four patients and Lecompte manoeuvre in three patients. There were no peri-operative deaths. In patients with pulmonary artery plasty, two had no post-operative airway compression, one patient had improved compression, and one patient had unchanged compression. In patients managed with a Lecompte manoeuvre, two patients had no or trivial airway compression and one had improved compression. There were six late reinterventions or reoperations on the pulmonary arteries – two out of four in the pulmonary artery plasty group and one out of three in the Lecompte group. Conclusions: Most late-presenting patients with absent pulmonary valve syndrome do not have airway compression. Either pulmonary artery reduction plasty or the Lecompte manoeuvre can relieve proximal airway compression, without a significantly different risk of pulmonary artery reintervention between techniques.

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THE EFFECTS OF MATERNAL HYPOXIA AND HYPEROXIA UPON THE NEONATAL PULMONARY VASCULATURE

PEDIATRICS ◽

10.1542/peds.48.4.528 ◽

1971 ◽

Vol 48 (4) ◽

pp. 528-533 ◽

Cited By ~ 2

Author(s):

Stanley J. Goldberg ◽

Richard A. Levy ◽

Bijan Siassi ◽

Joanne Betten

Keyword(s):

Pulmonary Artery ◽

Pulmonary Arteries ◽

Pulmonary Vasculature ◽

External Diameter ◽

Pulmonary Arterial ◽

The Mean ◽

Medial Hypertrophy ◽

Maternal Hypoxia ◽

Relationship Of ◽

Hypoxic Group

The fetal and newborn pulmonary artery has thickened media by comparison to that of the older infant. In this study we investigated the proposition that chronic maternal hypoxia during the latter part of gestation might induce further thickening of the neonatal pulmonary artery media. Relative medial thickness was determined by the ratio of the arterial media to external diameter. The mean ratio of small pulmonary arteries of progeny of hypoxic mothers was significantly thicker in each size group between 50 and 150 microns as compared to those born to mothers who spent their gestation in air or hyperoxic environments. Medial hypertrophy was most pronounced in the smaller arteries of the hypoxic group; no intersize variations were found between the control or hyperoxic groups. Medial thickness decreased in all arteries through 2 weeks of age; this decrease was greatest in control and hyperoxic arteries. The possible relationship of hypertrophied pulmonary arterial media and abnormally increased neonatal pulmonary vascular resistance is discussed.

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Quantitative d-dimer levels and the extent of venous thromboembolism in CT angiography and lower limb ultrasonography

VASA ◽

10.1024/0301-1526.36.4.267 ◽

2007 ◽

Vol 36 (4) ◽

pp. 267-274 ◽

Cited By ~ 20

Author(s):

Hochuli ◽

Duewell ◽

Frauchiger

Keyword(s):

Ct Angiography ◽

Lower Limb ◽

Diagnostic Yield ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Pulmonary Angiography ◽

Pulmonary Vasculature ◽

Radiographic Findings ◽

Clot Burden ◽

D Dimer

Background: We evaluated the diagnostic yield of multidetector-row CT angiography and determined the clot burden within pulmonary vasculature as a measure of pulmonary embolism (PE) severity at different d-dimer levels and pretest clinical probabilities. Patients and methods: 254 consecutive patients referred to CT pulmonary angiography for suspected PE after d-dimer testing were grouped into clinical probability classes using Wells’ score, and the frequency of PE was determined. A score representing clot burden within pulmonary vasculature was calculated from the number of obstructed segmental arteries in CT scans in a partly differing group of 96 PE positive patients. Results: The prevalence of PE increases with the d-dimer level (7% at d-dimer levels of 0.5–1 μg/ml, reaching 90% at d-dimer levels > 9 μg/ml; p < 0.001). D-dimer levels above 4 μg/ml are associated with a significantly higher clot burden in pulmonary arteries (median score 11 versus 5, and 53% versus 16% of patients in the subgroup with a score > 10 points; p < 0.001), and thrombus in a main pulmonary artery was detected more frequently (37% versus 9%, p = 0.003). Similar results were obtained for distal versus proximal deep venous thromboses, detected by ultrasonography of the lower limb in a separate group of 44 patients. Conclusions: High d-dimer levels are associated with an increased prevalence of CT radiographic findings indicating extended clinically severe PE or lower limb venous thrombosis.

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Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

10.21203/rs.3.rs-672397/v2 ◽

2021 ◽

Author(s):

Meng Yuan ◽

XinYuan Cui ◽

ChunXue Yang ◽

XinYang Zhang ◽

DeLi Zhao ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Heart Function ◽

Main Pulmonary Artery ◽

Pulmonary Angiography ◽

Trunk Diameter ◽

Right Heart Function ◽

Before And After ◽

Pulmonary Artery Obstruction ◽

D Dimer

Abstract Background To evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI),right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methods Select 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).Results MPAd, RPAd, LPAd, RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).Conclusion CTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

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Incidence and Management of Isolated Subsegmental Pulmonary Embolism.

Blood ◽

10.1182/blood.v114.22.2989.2989 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2989-2989

Author(s):

Yi-Hao Shen ◽

Phil Wells ◽

Carole Dennie ◽

Marc Carrier

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Clinical Management ◽

High Probability ◽

Conflicts Of Interest ◽

Anticoagulation Therapy ◽

Pulmonary Arteries ◽

Filling Defect ◽

Pulmonary Angiography ◽

Acute Pe

Abstract Abstract 2989 Poster Board II-965 Introduction: The use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) has improved the visualization of subsegmental pulmonary arteries. However, the clinical significance of subsegmental PE is unclear. In the PIOPED Study, PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability ventilation/perfusion (V/Q) scans. Patients with non-diagnostic (low or intermediate) V/Q scans can be safely managed without anticoagulation. The incidence and clinical management of subsegmental PE remains uncertain. Objective: To evaluate the incidence and clinical management of subsegmental PE in patients with suspected acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected acute PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. Subsegmental PE was defined as one or more pulmonary artery filling defects located in the subsegmental level, with no filling defects visualized at more proximal pulmonary artery levels. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 78 (10.4%, 95% CI: 8.4 to 12.8%) cases of subsegmental PE were identified out of 748 cases of PE diagnosed by CTPA. Forty-three (77%) of these had a single isolated subsegmental filling defect. Data could be extracted in 56 (72%) of the 78 cases. Among these 56 patients, 18 (32%) had unprovoked PE. Further investigations were performed in 50 patients (Ultrasonography (U/S) of legs (n=38), U/S and V/Q scan (n=11) or V/Q scan alone (n=1)). Deep vein thrombosis was detected in 12 patients and two patients had a high probability V/Q scan. Forty-eight (86%) patients were anticoagulated. All patients with concurrent DVT or high probability V/Q scan were started on anticoagulation therapy. Two patients experienced a major bleeding episode after anticoagulation. Out of the 8 patients left untreated, there were no recurrent VTE. Conclusion: Isolated subsegmental PE represents approximately 10% of all acute PE diagnosed by CTPA. Patients with subsegmental PE diagnosed on CTPA are more commonly receiving anticoagulation than not. Further studies are needed to establish the risk benefit ratio of anticoagulation therapy in patients with subsegmental PE diagnosed on CTPA. Disclosures: No relevant conflicts of interest to declare.

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