Pulmonary Artery
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2021 ◽  
Vol 73 ◽  
pp. S22-S23
Shashikant Singh ◽  
Tutan Das ◽  
Jaydeep Das Gupta ◽  
R.C. Barick

2021 ◽  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  

Abstract Background: Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH). But high proportion of overestimation or underestimation of sPAPECHO still remained. So we aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as reference. Methods: A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to compared the diagnostic efficacy of sPAPECHO with other TR related methods. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ±10% as the boundary. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis.Results: sPAPECHO had the greatest correlation coefficient (r=0.781, P<0.001), best diagnostic efficiency (AUC=0.98) and lowest bias (mean bias= 0.07mmHg, 95% limits of agreement: -32.08 to +32.22mmHg) compared with other TR related methods. Ordinal regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32) , respectively. Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. While TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO. Conclusions: sPAPECHO was superior to other TR-related methods in PH screening, and was often overestimated in patients with pre-capillary PH at low sPAPRHC level, even with good TR signal quality.Trial registration: This is a retrospectively registered study.

Yew Eng Tan ◽  
Kok King Chia ◽  
Noor Khairiah Abdul Karim

Abstract Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly where the left main coronary artery arises from the pulmonary artery, instead of the coronary sinus of the ascending aorta. ALCAPA is divided into infant and adult types. Life-threatening complications such as malignant arrhythmia and sudden death could ensue in adult type of ALCAPA. Imaging is the current preferred modality for ALCAPA. It is indeed a challenge to diagnose ALCAPA due to its non-specific clinical presentation and laboratory findings. We report a case of adult type ALCAPA presented with unstable angina surprisingly surviving into adulthood with no symptoms prior to presentation, which is extremely rare. Case presentation A 53-year-old lady presented with sudden onset of chest pain and worsening shortness of breath. She was initially treated as unstable angina. Physical examination revealed normal heart sound. Computed tomography coronary angiography (CTCA) showed an anomalous origin of the left coronary artery from the posterior wall of the proximal pulmonary artery, compatible with ALCAPA. The anomalous left coronary artery bifurcates into left anterior descending and left circumflex arteries. Cardiothoracic surgeon planned for occlusion of ALCAPA via the pulmonary artery, owing to the fact that unfeasible rerouting in the presence of well-established collateral supply. Conclusions ALCAPA is a rare and life-threatening condition in adults which may lead to myocardial infarction and sudden death in untreated cases. CTCA is one of the preferred modern imaging modality in ALCAPA owing to its superior ability for direct visualization of the anomaly. Hence, early identification and surgical intervention of the anomaly are paramount to reduce the morbidity and mortality.

2021 ◽  
Vol 2021 (4) ◽  
pp. 15-20
Vladislava Illarionova ◽  
Adelya Kadyrova

Objective: to determine the occurrence and clinical characteristics of different types of PS (pulmonary stenosis) in dogs Reseach tasks: to identify the breed predisposition to PS, to study the clinical, echocardiographic and electrocardiographic characteristics of various types of PS and to analyse their dependence on the severity of the heart defect. Materials and methods: a retrospective analysis of Biocontrol veterinary clinic medical records throughout six years (2014–2020). Cardiological examination of dogs presented to the primary ambulatory appointment included physical examination, echocardiography using the Philips HD15 ultrasound system, radiography and electrocardiography. Animals: 31 dogs with isolated pulmonary artery stenosis (17 males and 14 females). Breeds: French Bulldog, English Bulldog, Yorkshire Terrier, German Spitz, American Pit Bull Terrier, Staffordshire Terrier, Toy Terrier, Cane Corso, Whippet, Biewer Yorkshire Terrier, Chihuahua, Entlebucher, German Boxer, East European Shepherd, American Bully. Results and discussion: 43 dogs with a PS were examined from 1 January 2014 to 31 December 2020. Of these, 31 dogs (72 %) with isolated PS and 12 dogs (28 %) with a combination of PS with other congenital heart defects. The most common combinations were PS with aortic stenosis (25 %) and PS with ventricular septal defect (25 %). The most common form of isolated PS was type A valve stenosis (68 %). Severe stenosis prevailed (58 %). The most common breeds were French Bulldogs (22.6 %), English Bulldogs (16.1 %) and Yorkshire Terriers (9.7 %). Males were more prevalent (55 %). 61 % of animals from the group of dogs with severe PS visited clinic because of signalment, and syncope was the most frequently reported symptom (28 %). The symptoms associated with congenital heart defect were not identified in the group of animals with moderate and mild degrees of PS. ECG showed that 100 % of dogs were diagnosed with sinus rhythm. Electrical right axis deviation of the heart was detected in 45 % of dogs. Direct dependency was between the severity of the stenosis and the severity of electrical right axis deviation. According to echocardiographic studies — 100 % of animals with severe and moderate stenosis and 14% with mild stenosis were diagnosed with concentric, eccentric or mixed forms of right ventricle myocardial hypertrophy, enlargement of the right atrial. Direct dependency is founded between the severity of stenosis, the type of right ventricle hypertrophy and the size of the right atrium. The more severe stenosis, the more mixed form of hypertrophy; increase of the right atrium was recorded in dogs with mixed right ventricular hypertrophy. Post-stenotic dilatation of the trunk and branches of the pulmonary artery was determined in all dogs with single right coronary artery type R2A. Conclusions: PS is most commonly found in French Bulldogs. The most common type of PS is type A valvular stenosis in the form of an isolated defect. Severe PS is prevalent. There is direct dependency is between the severity of the defect and the severity of right ventricular myocardial hypertrophy, the large size of the right atrium and electrical right axis deviation of the heart.

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Richa Tyagi ◽  
Surya Kant ◽  
Akshyaya Pradhan ◽  
Anupam Wakhlu ◽  
Darshan Kumar Bajaj ◽  

Background. Pulmonary hypertension is a dreaded disease associated with considerable morbidity and mortality. The pulmonary hypertension developing due to chronic respiratory disease is a unique subset with symptoms often getting masqueraded by the underlying respiratory condition. The importance of early detection of this complication has been realized worldwide, and recently, the definition of pulmonary hypertension was revised to set the cutoff of mean pulmonary artery pressure (mPAP) at 20 mmHg instead of 25 mmHg at rest. In our study, we have tried to estimate the difference this new definition brings to the prevalence of pulmonary hypertension among interstitial lung disease patients at our centre. Methods. This was a cross-sectional study in which all the patients of ILDs (n = 239) attending the outdoor and indoor Department of Respiratory Medicine, King George’s Medical University, India, for the duration of one year were subjected to transthoracic echocardiography along with measurement of serum pro-B-type natriuretic peptide (BNP) and troponin T values. The data were analyzed using the different definitions, and the prevalence was compared. Result. Incidence of pulmonary hypertension among ILD patients at mPAP cutoff ≥ 25 was 28.9%, while that at value ≥20 mmHg, incidence of pulmonary hypertension increased to 46.0%. An increment of 15–20% in incidence of pulmonary hypertension was observed among different types of ILD when cutoff of mPAP was changed. Conclusion. The new definition helps in a significant increase in the detection of pulmonary hypertension, which certainly helps in earlier detection and better management of patients.

2022 ◽  
Vol 45 (1) ◽  
pp. 8-12
Jeremy C. Durack ◽  
Leon L. Chen ◽  
Saira Imran ◽  
Neil A. Halpern

2021 ◽  
pp. 1-3
Preston J. Boyer ◽  
Jeffrey D. Zampi ◽  
Arash Salavitabar

Abstract Complete thrombosis of a pulmonary artery interposition graft in an adolescent with complex repaired CHD was treated successfully with a combination of a novel mechanical thrombectomy system, stent implantation, and thrombolysis. This thrombectomy system used a flexible catheter with a built-in mechanism to attenuate blood loss, while providing effective recanalisation of a foreign graft.

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Li-Le Wang ◽  
Xiao-Li Zhu ◽  
Shu-Hua Han ◽  
Lu Xu

Background. To investigate the effect of hypoxia on pulmonary artery endothelial cells and the role of NOTCH3 in endothelial-mesenchymal transition (EnMT) and to provide a research model for pulmonary disease and explain the pathogenesis of the pulmonary disease. Methods. Pulmonary artery endothelial cells were divided into two groups and cultured in normoxic and hypoxic environments, respectively. QPCR, western blot, and immunofluorescence were used to detect endothelial cell-specific marker protein and mRNA expression in each group, and the ability of endothelial cells migration was evaluated by scratch and transwell experiment. Results. The pulmonary artery endothelial cells in the normoxic group presented a typical pebble-like arrangement, and the endothelial cells in hypoxic culture showed a long spindle appearance. Hypoxia induced high expression of NOTCH3, Jagged-1, Hes1, c-Src, and CSL. Immunofluorescence showed that endothelial cells in hypoxic culture began to express the α-SMA, and the expression of vWF increased with hypoxia. Cell viability, scratch, and transwell results showed that endothelial cells in the hypoxic group were more capable of viability and migration than those in the normoxic group. The induction of EnMT by hypoxia can be inhibited by using notch3-specific inhibitor DAPT and Jagged-1. This study also found that miR-7-5p can regulate endothelial NOTCH3, indicating that miRNA is also involved in the process of endothelial-mesenchymal transformation. Conclusion. Hypoxia promotes the transformation of endothelial cells into mesenchymal cells by opening the NOTCH3 pathway, which lays the foundation for disease progression or clinical prognosis, and is of great significance in the treatment of diseases.

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