Pulmonary Arteries
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2021 ◽  
Vol 31 (4) ◽  
pp. 537-541
T. I. Kalenchic ◽  
S. L. Kabak ◽  
N. S. Didenko ◽  
I. P. Dulub ◽  
A. Yu. Haustovich

The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.

2021 ◽  
Vol 10 (15) ◽  
pp. 3358
Maite Velázquez ◽  
Nicolás Maneiro ◽  
Ana Lareo ◽  
Agustín Albarrán ◽  
Sergio Huertas ◽  

With the advent of balloon pulmonary angioplasty (BPA) for non-surgical chronic thromboembolic pulmonary hypertension (CTEPH) patients, there is renewed interest in the pulmonary angiography technique. This technique is still the standard imaging modality to confirm CTEPH, which, in addition, helps to determine the most appropriate treatment. Furthermore, learning this technique fulfills two main purposes: to identify BPA candidates and to provide the operator with the catheter handling needed to perform BPA. Operators interested in performing BPA must learn not only the pulmonary arteries’ anatomy, but also which are the best angiographic projections and the most suitable catheters to canalize and display each segmental branch. Unfortunately, this information is scarce in the literature. With this goal, learning the diagnostic pulmonary angiography technique can be a first step on the way to perform BPA. Although there are descriptions on how to perform a pulmonary angiography with balloon-tipped catheters and the digital subtraction technique, this technique does not provide operators with the catheter knowledge and manual skill needed to cannulate each segmental branch. In contrast, learning the conventional selective segmental pulmonary angiography (SSPA) technique provides the operator with this knowledge and skills. In this review, based on the experience of the authors, we describe the pulmonary arteries’ anatomy and detail the practical aspects of the SSPA procedure, with the aim of providing operators with the anatomical and technical knowledge needed to perform BPA. We also summarize the contemporary complications of SSPA in CTEPH patients at a reference center.

2021 ◽  
Vol 12 ◽  
Yunshan Cao ◽  
Chao Geng ◽  
Yahong Li ◽  
Yan Zhang

Pulmonary thromboembolism (PTE) is the third leading cause of death in cardiovascular diseases. PTE is believed to be caused by thrombi detached from deep veins of lower extremities. The thrombi travel with systemic circulation to the lung and block pulmonary arteries, leading to sudden disruption of hemodynamics and blood gas exchange. However, this concept has recently been challenged by accumulating evidence demonstrating that de novo thrombosis may be formed in pulmonary arteries without deep venous thrombosis. On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH), a subtype of pulmonary hypertension, could have different pathogenesis than traditional PTE. Therefore, this article summarized and compared the risk factors, the common and specific pathogenic mechanisms underlying PTE, in situ pulmonary artery thrombosis, and CTEPH at molecular and cellular levels, and suggested the therapeutic strategies to these diseases, aiming to facilitate understanding of pathogenesis, differential diagnosis, and precision therapeutics of the three pulmonary artery thrombotic diseases.

2021 ◽  
Vol 21 (1) ◽  
Koichi Sugimoto ◽  
Tetsuro Yokokawa ◽  
Tomofumi Misaka ◽  
Takashi Kaneshiro ◽  
Akiomi Yoshihisa ◽  

Abstract Background It is widely recognized that metabolic disorder is associated with pulmonary hypertension (PH). It is known that hypoxia-induced elevated pulmonary artery pressure in mice returns to normal pressure during reoxygenation. However, it is still unclear how metabolic disorder affects the reverse remodeling of pulmonary arteries. In this study, we investigated the effects of high-fat diet (HFD) on the decrease in pulmonary artery pressure and reverse remodeling of pulmonary arteries in mice with hypoxia-induced PH. Methods We used female C57BL/6 mice aged 8 weeks. After being exposed to hypoxia (10% oxygen for four weeks) to induce PH, the mice were returned to normoxic conditions and randomized into a normal diet (ND) group and HFD group. Both groups were fed with their respective diets for 12 weeks. Results The Fulton index and right ventricular systolic pressure measured by a micro-manometer catheter were significantly higher in the HFD group than in the ND group at 12 weeks after reoxygenation. The medial smooth muscle area was larger in the HFD group. Caspase-3 activity in the lung tissue of the HFD group was decreased, and the apoptosis of pulmonary smooth muscle cells was suppressed after reoxygenation. Moreover, the expression levels of peroxisome proliferator-activated receptor-γ and apelin were lower in the HFD group than in the ND group. Conclusions The results suggest that metabolic disorder may suppress pulmonary artery reverse remodeling in mice with hypoxia-induced PH during reoxygenation.

2021 ◽  
Vol 17 (3) ◽  
pp. 58-63
V.Y. Tseluyko ◽  
L.M. Yakovleva ◽  
S.M. Sukhova ◽  
K.Yu. Kinoshenko ◽  
O.V. Radchenko ◽  

Background. The purpose was the analysis of the features of the course and the leading factors in the development of pulmonary embolism. Materials and methods. During the period from November 1, 2019, to December 2020, inclusive, 188 patients with acute pulmonary embolism (PE), aged 46 to 80 years old, were hospitalized at the City Clinical Hospital 8 of the Kharkiv City Council; the average age was 62.9 ± 16.7 years. In-hospital mortality was 12.2 % (23 patients). The criterion for inclusion in the study was acute PE, which was diagnosed based on the results of multislice computed tomographic angiography of the pulmonary arteries (MCT angiography of the pulmonary arteries). All patients underwent a general clinical examination, the risk and prognosis were assessed based on the generally accepted scales, standard transthoracic echocardiography (EchoCG), and Doppler ultrasound examination of the veins of the lower extremities were performed. Results. The disease was diagnosed with the same frequency in men and women; there was no difference in age. Among the most significant and important risk factors for the development of pulmonary embolism are the history of venous thrombosis/embolism and active malignant oncological disease (43 and 35 %, respectively), while the less significant ones were advanced age, varicose veins of the lower extremities and arterial hypertension 47.9, 31.4 and 52.1 %, respectively. The vast majority (57.4 %) had a combination of 2 or more risk factors. Signs of right ventricular dysfunction according to MCT angiography of the pulmonary arteries and/or echocardiography were recorded in 45.7 % of patients. A high and medium-high risk of early death associated with acute PE was found in a significant percentage (71.8 %) of patients, which required the inclusion of a thrombolytic agent in the treatment strategy.

2021 ◽  
Vol 17 (2) ◽  
pp. e28-e32
Ryan Logue ◽  
Zeenat Safdar

Chronic thromboembolic pulmonary hypertension (CTEPH) is a common long-term complication of pulmonary embolism characterized by thromboembolic obstruction of the pulmonary arteries, vascular arteriopathy, vascular remodeling, and ultimately pulmonary hypertension (PH). Although pulmonary endarterectomy (PEA) surgery is the standard of care, approximately 40% of patients in the international CTEPH registry were deemed inoperable. In addition to lifelong anticoagulation, the cornerstone of PH-specific medical management is riociguat, a soluble guanylate cyclase stimulator. Medical management should be started early in CTEPH patients and may be used as a bridge to PEA surgery or balloon pulmonary angiography. Medical management is indicated for inoperable CTEPH patients and patients who have recurrence of PH after PEA surgery.

2021 ◽  
Vol 22 (13) ◽  
pp. 6943
Ruma Pal-Ghosh ◽  
Danfeng Xue ◽  
Rod Warburton ◽  
Nicholas Hill ◽  
Peter Polgar ◽  

A key feature of pulmonary arterial hypertension (PAH) is the hyperplastic proliferation exhibited by the vascular smooth muscle cells from patients (HPASMC). The growth inducers FOXM1 and PLK1 are highly upregulated in these cells. The mechanism by which these two proteins direct aberrant growth in these cells is not clear. Herein, we identify cyclin-dependent kinase 1 (CDK1), also termed cell division cycle protein 2 (CDC2), as having a primary role in promoting progress of the cell cycle leading to proliferation in HPASMC. HPASMC obtained from PAH patients and pulmonary arteries from Sugen/hypoxia rats were investigated for their expression of CDC2. Protein levels of CDC2 were much higher in PAH than in cells from normal donors. Knocking down FOXM1 or PLK1 protein expression with siRNA or pharmacological inhibitors lowered the cellular expression of CDC2 considerably. However, knockdown of CDC2 with siRNA or inhibiting its activity with RO-3306 did not reduce the protein expression of FOXM1 or PLK1. Expression of CDC2 and FOXM1 reached its maximum at G1/S, while PLK1 reached its maximum at G2/M phase of the cell cycle. The expression of other CDKs such as CDK2, CDK4, CDK6, CDK7, and CDK9 did not change in PAH HPASMC. Moreover, inhibition via Wee1 inhibitor adavosertib or siRNAs targeting Wee1, Myt1, CDC25A, CDC25B, or CDC25C led to dramatic decreases in CDC2 protein expression. Lastly, we found CDC2 expression at the RNA and protein level to be upregulated in pulmonary arteries during disease progression Sugen/hypoxia rats. In sum, our present results illustrate that the increased expression of FOXM1 and PLK1 in PAH leads directly to increased expression of CDC2 resulting in potentiated growth hyperactivity of PASMC from patients with pulmonary hypertension. Our results further suggest that the regulation of CDC2, or associated regulatory proteins, will prove beneficial in the treatment of this disease.

Imaging ◽  
2021 ◽  
I. Mitevska ◽  
E Grueva Nastevska ◽  
E. Kandic ◽  
O. Busljetik

AbstractThrombosis in general, and especially venous thromboembolism (VTE) is one of the most common complications associated with COVID-19 infection. We present a 48 years old male patient with dyspnea and severe multisite post Covid-19 disease thrombotic complications, with pattern never seen before, that includes both ventricles, pulmonary arteries and peripheral vein involvement, assessed by echocardiography, vascular ultrasound and pulmonary CT angiography.

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