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This study sought to determine the prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to correlate their presence with the degree of clot burden. CTEPH is a treatable cause of severe pulmonary hypertension and right heart failure. Bronchopulmonary collateral vessels have been used as a supplementary diagnostic and prognostic tool for this disease. Coronary artery-pulmonary artery collaterals in this population have not been described. The coronary angiograms of 300 consecutive patients with CTEPH evaluated for pulmonary thromboendarterectomy (PTE) between January 1, 2007, and May 1, 2014, were examined. Of these patients, 259 (50% male; mean age, 58.3 ± 10.6 years) had cineangiographic images deemed adequate to definitively assess for the presence of coronary artery-pulmonary artery collaterals and were included in the final analyses. Pulmonary angiogram reports were reviewed for extent of pulmonary artery obstruction. The coronary angiograms of 259 age-and sex-matched control patients were also examined. Among 259 CTEPH patients with definitive imaging, 34 coronary artery-pulmonary artery collaterals were found in 28 patients (10.8%), versus 1 coronary artery-pulmonary artery collateral among control subjects (0.4%; P < 0.001). Compared with CTEPH patients without collaterals, patients with collaterals had a significantly higher prevalence of total occlusion of their right or left main pulmonary artery (P < 0.001) or lobar arteries (P < 0.001). In conclusion, the prevalence of coronary artery-pulmonary artery collaterals in CTEPH patients undergoing coronary angiography for possible PTE is approximately 11%. These vessels are associated with more severe pulmonary artery occlusion.Keywords: collateral vessels, pulmonary circulation, coronary arteries, pulmonary artery obstruction. Chronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of progressive pulmonary hypertension and right heart failure. Approximately 0.5%-3.8% of patients who suffer an acute pulmonary embolism will develop CTEPH, and many investigators believe the true incidence is higher because some patients are eventually diagnosed without a clear history of acute pulmonary embolism. [1][2][3][4][5][6] Unlike other forms of pulmonary hypertension, CTEPH is curable by pulmonary thromboendarterectomy (PTE). Considerations in proceeding with PTE include whether the disease is surgically accessible, whether hemodynamic normalization should be expected given other comorbidities or microvascular disease, and whether operative risks are worthwhile in mildly symptomatic patients knowing that foregoing early PTE allows for the chance that secondary vasculopathy and worsening hemodynamics might develop. 1,7 Preoperative evaluation of CTEPH patients includes right heart catheterization and pulmonary angiography. Coronary angiography is often performed to rule out obstructive coronary artery disease. During these workups at the University of California, ...

Alcohol consumption augmented and smoking diminished serum estrone levels achieved while women were taking hormone therapy.

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