MyMedR

The poorly understood yet potent risk of pulmonary artery thrombosis in-situ in Post-Acute COVID-19 syndrome

Payus AO, Lin CLS, Ibrahim A

J Cardiothorac Surg, 2023 Jan 20;18(1):42.

PMID: 36658637 DOI: 10.1186/s13019-023-02147-y

Pulmonary artery thrombosis in-situ is a term used to describe a pulmonary embolism occurs in the absence of deep vein thrombosis in the lower extremities. Most cases occur in a patient who had a recent traumatic injury to the chest. Other risk factors include the presence of hypercoagulable conditions, including inflammatory state, hypoxia and vascular endothelial injury. Although it has been discussed extensively in the acute COVID-19 disease, pulmonary artery thrombosis in-situ that occur in the setting of Post-Acute COVID-19 syndrome is not commonly reported and poorly understood.

Matched MeSH terms: Pulmonary Artery

Fulltext Severe and fatal postoperative bronchospasm in a child with a pulmonary artery sling

Norzila MZ, Azizi BH, Mazeni A, Ahmad S, Devadass P, Lokman S

Med J Malaysia, 1994 Jun;49(2):182-4.

PMID: 8090102

We report a case of left pulmonary artery sling in a child who also had duodenal atresia. He was admitted for respiratory failure requiring prolonged respiratory support due to a bronchiolitis-like illness at two months of age. Diagnostic procedures confirmed the presence of left pulmonary artery sling. He had a corrective procedure which relieved the compression. However postoperatively he had intermittent episodes of severe bronchospasm in addition to a persistent airway obstruction. Finally one such episode of severe bronchospasm did not respond to medical and resuscitative therapy and the baby succumbed. To our knowledge no case of left pulmonary artery sling has been described previously in a Malaysian child. This case also highlights the postoperative airway problems that may be encountered.

Matched MeSH terms: Pulmonary Artery/abnormalities*; Pulmonary Artery/surgery

Biologic valved conduits in infants

Corno AF

Ann Thorac Surg, 2014 May;97(5):1853.

PMID: 24792290 DOI: 10.1016/j.athoracsur.2013.12.010

Matched MeSH terms: Pulmonary Artery/surgery*

Fulltext Pneumonectomy for congenital isolated unilateral pulmonary artery agenesis

Britton J, Sachithanandan A, Srinivasan L, Ghosh S

Med J Malaysia, 2011 Oct;66(4):363-4.

PMID: 22299560 MyJurnal

Unilateral pulmonary artery agenesis (UPAA) is a rare congenital anomaly usually diagnosed in infancy due to associated cardiovascular malformations. We report a rare case of isolated right UPAA that presented atypically in adulthood with massive haemoptysis requiring a pneumonectomy. This case highlights the importance of maintaining a high clinical suspicion, the role of CT angiography and a multi disciplinary approach. Optimal management is often surgical however bronchial artery embolization (BAE) remains a useful adjunct.

Matched MeSH terms: Pulmonary Artery/abnormalities*

Surgical management of patent ductus arteriosus with endocarditis

Kareem BA, Kamarulzaman H, Koh GT

Ann Thorac Surg, 2010 Nov;90(5):1703-5.

PMID: 20971300 DOI: 10.1016/j.athoracsur.2010.04.105

A 9-year-old boy with patent ductus arteriosus complicated by infective endocarditis had not responded to antibiotic therapy and was referred to our institution. He had persistent fever and a chest roentgenogram demonstrated the presence of left lung pneumonic consolidation. An echocardiogram showed the presence of large vegetation in the pulmonary artery at the ductal opening. We successfully performed an open ductal ligation with the aid of cardiopulmonary bypass through a sternotomy and proceeded to resect the vegetation. We completed the procedure with reconstruction of the pulmonary artery. The postoperative course was uneventful. The patient was discharged after a week.

Matched MeSH terms: Pulmonary Artery/surgery

Fulltext eComment. Paradigm shift in surgery for massive pulmonary embolism: if not now then when?

Sachithanandan A

Interact Cardiovasc Thorac Surg, 2013 Aug;17(2):246.

PMID: 23868961 DOI: 10.1093/icvts/ivt274

Matched MeSH terms: Pulmonary Artery/surgery*

Fulltext Anomalous right pulmonary artery from aorta, surgical approach case report and literature review

Alhawri K, Alakhfash A, Alqwaee A, HassabElnabi M, Ahmed F, Alhawri M, et al.

J Card Surg, 2021 Aug;36(8):2890-2900.

PMID: 34047395 DOI: 10.1111/jocs.15618

BACKGROUND: Anomalous origin of one pulmonary artery from the aorta is a rare congenital anomaly affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. Early surgical treatment has been proven safe with excellent results. The surgical approach and technique is challenging and should be decided ahead before the patient to surgery. Different techniques were described including direct reimplantation, conduit interposition, aortic ring flap.

AIM: We present a neonate with anomalous origin of the right pulmonary artery from the aorta and discuss the surgical technique and complications in the literature.

Matched MeSH terms: Pulmonary Artery/surgery

Fulltext Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility

Ng BC, Kleinheyer M, Smith PA, Timms D, Cohn WE, Lim E

PLoS One, 2018;13(4):e0195975.

PMID: 29677212 DOI: 10.1371/journal.pone.0195975

Despite the widespread acceptance of rotary blood pump (RBP) in clinical use over the past decades, the diminished flow pulsatility generated by a fixed speed RBP has been regarded as a potential factor that may lead to adverse events such as vasculature stiffening and hemorrhagic strokes. In this study, we investigate the feasibility of generating physiological pulse pressure in the pulmonary circulation by modulating the speed of a right ventricular assist device (RVAD) in a mock circulation loop. A rectangular pulse profile with predetermined pulse width has been implemented as the pump speed pattern with two different phase shifts (0% and 50%) with respect to the ventricular contraction. In addition, the performance of the speed modulation strategy has been assessed under different cardiovascular states, including variation in ventricular contractility and pulmonary arterial compliance. Our results indicated that the proposed pulse profile with optimised parameters (Apulse = 10000 rpm and ωmin = 3000 rpm) was able to generate pulmonary arterial pulse pressure within the physiological range (9-15 mmHg) while avoiding undesirable pump backflow under both co- and counter-pulsation modes. As compared to co-pulsation, stroke work was reduced by over 44% under counter-pulsation, suggesting that mechanical workload of the right ventricle can be efficiently mitigated through counter-pulsing the pump speed. Furthermore, our results showed that improved ventricular contractility could potentially lead to higher risk of ventricular suction and pump backflow, while stiffening of the pulmonary artery resulted in increased pulse pressure. In conclusion, the proposed speed modulation strategy produces pulsatile hemodynamics, which is more physiologic than continuous blood flow. The findings also provide valuable insight into the interaction between RVAD speed modulation and the pulmonary circulation under various cardiovascular states.

Matched MeSH terms: Pulmonary Artery/physiology*

Effects of glycyrrhizic acid on right atrial pressure and pulmonary vasculature in rats

Ruszymah BH, Nabishah BM, Aminuddin S, Khalid BA

Clin Exp Hypertens, 1995 Apr;17(3):575-91.

PMID: 7613529

Glycyrrhizic acid (GCA) the active component of liquorice acts by inhibiting 11 beta-hydroxysteroid dehydrogenase (11 beta-OHSD) which catalyses the reversible conversion of cortisol to cortisone. The aim of this study was to examine the effect of GCA on pulmonary arterial pressure. Male Sprague-Dawley rats (200g) received drinking water containing 0.1 mg/ml and 1.0 mg/ml GCA for 12 weeks. Tail blood pressure (BP) was recorded every three weeks and serum Na+ and K+ were measured at the beginning and the end of the experiment. Right atrial pressure (RAP) were measured at the end of 12 weeks just before the animals were sacrificed. Lung tissues were taken for histological examination using the elastic-van Gieson (EVG) staining method. There was a significant increase in tail BP in GCA treated rats compared to controls, for both dosages used. This was associated with an increase in serum Na+ and a decrease in K+ level. The mean RAP increased significantly from 2.69 +/- 0.23 mmHg to 4.47 +/- 0.32 mmHg (P < 0.001) in 0.1 mg/ml GCA treated rats and 6.86 +/- 0.54 mmHg (P < 0.0001) in rats receiving 1.0 mg/ml GCA in their drinking water. Histological examination showed increased thickness of pulmonary arterial wall (P < 0.0001). In conclusion GCA caused an increase in right atrial pressure as well as thickening of the pulmonary vessels suggesting pulmonary hypertension.

Matched MeSH terms: Pulmonary Artery/drug effects*; Pulmonary Artery/pathology; Pulmonary Artery/physiology

Fulltext A case of two common culprits causing pulmonary embolism

Timothy, C.T.J., Mansor, A., Wengvei, C.T.K.

JUMMEC, 2017;20(1):1-3.

MyJurnal

Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.

Matched MeSH terms: Pulmonary Artery

A case of atheroma in the pulmonary arteries

Stephens GA

Lancet, 1931;218:1295.

DOI: 10.1016/S0140-6736(00)99682-X

Matched MeSH terms: Pulmonary Artery

Congenital cyanotic heart disease with situs inversus totalis: an autopsy case report

Dayapala A, Kumar V

Am J Forensic Med Pathol, 2009 Jun;30(2):171-4.

PMID: 19465810 DOI: 10.1097/PAF.0b013e3181875a79

Sudden deaths because of congenital heart diseases are infrequently referred to the forensic pathologist for autopsy. Many of such deaths, if already diagnosed are released directly from the hospital without autopsy. Even forensic pathologists face a few difficulties in performing the autopsy on such infrequent cases, as they are not always updated with the anatomy of anomalies. While dealing with such cases, the concerned forensic pathologist is compelled to refer literature and textbooks again to understand the nature of developmental defects. This is especially so when dealing with cases of situs inversus accompanied by transposition of great arteries and other congenital cardiac abnormalities and variants such as single ventricle, double outlet right ventricle, Taussig-Bing variety etc. In the present case also, situs inversus with transposition of great vessels and other anomalies have been noted and studied.

Matched MeSH terms: Pulmonary Artery/abnormalities; Pulmonary Artery/pathology

Fulltext Pulmonary arteriovenous malformation: a rare cause of cyanosis in a child

Sharifah AI, Jasvinder K, Rus AA

Singapore Med J, 2009 Apr;50(4):e127-9.

PMID: 19421665

Pulmonary arteriovenous malformations are rare vascular anomalies. We report a 12-year-old girl who presented with exertional dyspnoea, cyanosis and clubbing since the age of five years, and multiple pulmonary arteriovenous malformations. Computed tomography pulmonary angiogram showed a large pulmonary arteriovenous malformation at the lower lobe of the right lung. Pulmonary angiogram showed a large right lung arteriovenous malformation and two small left lung arteriovenous malformations. The multiple arteriovenous malformations were occluded with Gianturco coils. She is now asymptomatic and on regular follow-up.

Matched MeSH terms: Pulmonary Artery/abnormalities*; Pulmonary Artery/radiography

Fulltext Pulmonary artery aneurysm associated with severe degenerative aortic stenosis

Ling PK

Singapore Med J, 2009 Oct;50(10):e350-2.

PMID: 19907873

We report a pulmonary artery (PA) aneurysm associated with severe aortic stenosis and an aortic root dilatation occurring in a 59-year-old woman who presented with dyspnoea and chest pain. PA aneurysms are rare, and there are no definitive guidelines on its management. There are contentious opinions on whether such aneurysms should be managed conservatively or surgically. Our patient had associated aortic stenosis and underwent a successful aortic valve replacement and PA aneurysm repair. This case illustrates that concomitant PA repair with other cardiothoracic surgery can be performed safely, even in patients with moderate surgical risks. We also discuss the natural history, prognosis and management of PA aneurysms.

Matched MeSH terms: Pulmonary Artery/pathology*; Pulmonary Artery/surgery

Aneurysmal dilatation without distal obstruction: a rare complication of valved bovine jugular vein conduit

Qureshi AU, Abbaker AE, Sivalingam S, Latiff HA

World J Pediatr Congenit Heart Surg, 2014 Apr;5(2):348-51.

PMID: 24668992 DOI: 10.1177/2150135113509819

Valved bovine jugular vein (Contegra) conduit is considered a suitable choice for pediatric population with congenital heart defect requiring right ventricle to main pulmonary artery connection. Intermediate follow-up studies have shown the propensity of developing distal conduit stenosis and valve thrombosis. We present a rare case of aneurysmal dilatation of the conduit leading to valve failure requiring conduit explantation.

Matched MeSH terms: Pulmonary Artery/pathology; Pulmonary Artery/radiography; Pulmonary Artery/surgery

Fulltext Cor triatriatum dexter: A rare cause of childhood cyanosis

Zainudin AR, Tiong KG, Mokhtar SA

Ann Pediatr Cardiol, 2012 Jan;5(1):92-4.

PMID: 22529613 DOI: 10.4103/0974-2069.93725

Cor triatriatum dexter is a rare congenital heart anomaly where the right atrium is divided into two chambers by a membrane. We report a boy who had persistent mild cyanosis and diagnosed to have cor triatriatum dexter with secundum atrial septal defect by transoesophageal echocardiography. Interestingly, he had persistent mild cyanosis despite insignificant obstruction to the right ventricular inflow and normal pulmonary artery pressure. The pathophysiology, approach to the diagnosis, and mode of treatment are also discussed.

Matched MeSH terms: Pulmonary Artery

Cortical hyperostosis, rare adverse effect of prostaglandin

Ng RL, Koay HS, Jamil MT

Med J Malaysia, 2020 11;75(6):748-749.

PMID: 33219191

We describe here an infant girl with ductal dependent complex cyanotic heart disease, who required prostaglandin infusion for a total of five months prior to Blalock-Taussig shunt procedure. Her alkaline phosphatase activity was raised after seven weeks being on prostaglandin and only dropped to the normal range seven days after discontinuing prostaglandin infusion. During our review at five months old, her limbs were grossly swollen and radiographic examination showed dense periosteal reaction in the long bones. Based on the clinical findings and investigations, she was diagnosed to have cortical hyperostosis, which is an uncommon side effect of prostaglandin. She underwent right Blalock-Taussig Shunt procedure successfully with no major complications. Unfortunately, she succumbed to infection two months after surgery.

Matched MeSH terms: Pulmonary Artery

Fulltext Giant aneurysm of bilateral coronary arteries with multimodality imaging representations

Ab Hamid S, Joshi S

Oxf Med Case Reports, 2019 Apr;2019(4):omy137.

PMID: 31049209 DOI: 10.1093/omcr/omy137

Giant coronary artery aneurysms are rare, with reported incidence of 0.02-0.2% (Morita H, Ozawa H, Yamazaki S, Yamauchi Y, Tsuji M, Katsumata T, et al. A case of giant coronary artery aneurysm with fistulous connection to the pulmonary artery: a case report and review of the literature. Intern Med. 2012; 51:1361-6.). Multiple giant aneurysms involving all three coronary arteries are even rarer. We report a rare case of multiple giant aneurysms involving the right coronary, left anterior descending and left circumflex arteries, supplemented with excellent multimodality imaging representations, i.e. plain radiograph, echocardiography, magnetic resonance imaging and computed tomography coronary angiogram.

Matched MeSH terms: Pulmonary Artery

Fulltext An Accidental Finding of Pulmonary Sequestration in an Adult

Amran, A.R.

International Medical Journal Malaysia, 2006;5(1):1-6.

MyJurnal

Pulmonary sequestration is defined as a segment of ç separated from the tracheobronchial tree and receiving its blood supply from a systemic artery rather than a pulmonary arterial branch. Classically, it has been described in two forms: (1) intralobar sequestration (ILS), in which the sequestrated part of lung lies within normal pulmonary visceral pleura, and (2) extralobar sequestration (ELS), in which the abnormal segment of lung is completely separate and enclosed in its own pleural investment. The term sequestration was coined by Pryce in 1946 to describe a disconnected bronchopulmonary mass or cyst with an anomalous systemic artery. Since this original description, terminology has become confusing as investigator has recognized many variants of sequestration not strictly meeting the original description. The spectrum now recognized as a continuum, with normal vessels supplying abnormal lung at one end and abnormal vessels supplying normal lung at the other end. Recently, we incidentally found an asymptomatic, intralobar pulmonary sequestration during CT pneumocolon.

Matched MeSH terms: Pulmonary Artery

Fulltext Central Retinal Artery Occlusion with Sparing of Cilioretinal Artery Post Pulmonary Artery Stenting

Oo KT, Mohd-Zain MR, Shatriah I

Cureus, 2018 Jan 29;10(1):e2128.

PMID: 29607276 DOI: 10.7759/cureus.2128

Central retinal arterial occlusion is an ocular emergency. Central retinal artery occlusion following cardiac procedures have been described in adults. We describe a pediatric patient who developed central retinal artery occlusion following pulmonary artery stenting. It is important to highlight this potential risk to ensure early diagnosis and prompt treatment.

Matched MeSH terms: Pulmonary Artery

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