Pulmonary artery dissection and conservative medical management

Lobato, Miguel Ángel Navas; Reyes, Roberto Martín; Lobo, P. Lurueña; Benito, I. Maté; Hernández, Ginés; Gracia, M. Martí De; Daza, José A. Sobrino; Sendón, José Luis López

doi:10.1016/j.ijcard.2007.01.088

Cited by 17 publications

(14 citation statements)

References 6 publications

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“…This case also highlights better prognosis for patients with PAD without underlying pulmonary hypertension. 8 Secondary PH from COPD Medical (diuretics, ACE inhibitor) Stable during 1 year of follow-up Lobato et al 9 Aortic valve replacement Medical (vasodilators, diuretics) Stable during 3 weeks of follow-up Smalcelj et al 10 Primary PH Medical (Sildenafil) Stable during 8 months of follow-up Song and Kolecki 11 Secondary PH from VSD, Eisenmenger's syndrome Medical (Nitroprusside) Patient died on day 4 of admission Steurer et al 15 Primary PH Medical (ACE inhibitor, CCB) Stable during 1 year of follow-up Wuyts et al 4 Secondary PH from VSD Surgical (heart lung transplant) Follow-up not mentioned Sakamaki et. al.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Unlike aortic dissection, which is fairly common, the reentry circuit for PAD is formed by the rupture of the free wall of the pulmonary artery leading to hemopericardium, cardiac tamponade, and sudden death. 2,8,9 There is wide variation in age of incidence, ranging from 26 to 85 years of age, with a slightly higher prevalence in females (male-to-female ratio 1:1.2). 1,2 The main pulmonary artery is usually involved, with or without involvement of its branches.…”

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Pulmonary artery dissection (PAD): A very unusual cause of chest pain

Sehdev

Dhoble

2010

Journal of Hospital Medicine

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A 51-year-old African American woman with medical history of essential hypertension and chronic obstructive pulmonary disease (COPD) presented to the hospital with chest pain and shortness of breath. The chest pain was retrosternal and radiated to the back. It lasted for about an hour and resolved without any intervention. After some time, she again felt discomfort in the chest, which was a constant and dull ache.She had similar episodes of chest pain 1 week prior, although less severe in intensity, for which she went to an outside hospital before coming to our hospital. Acute coronary syndrome was ruled out with serial cardiac enzymes measurements. An exercise stress test was also performed at that time, which failed to show any stress-induced ischemia.Her medications included lisinopril for hypertension and aspirin, which had been started 1 week prior to admission. She gave a 10-pack-year history of smoking tobacco. Family history was significant for hypertension in her father and coronary artery disease in her mother at the age of 58 years. A review of systems was negative for fever, cough, orthopnea, wheezing, palpitations, nausea, vomiting, recent surgery, or any significant trauma. AssessmentThe patient's physical examination was only remarkable for a blood pressure (BP) of 181/100 mm Hg. She did not have Marfanoid features, hyperflexible joints, or easy bruisability. Laboratory tests, including complete blood count, comprehensive metabolic panel, and cardiac enzymes, were within normal limits. A contrast-enhanced computed tomography (CT) of the chest showed a linear hypodense area in the left lateral aspect of the main pulmonary trunk, which suggested an intimal dissection of the main pulmonary artery. Magnetic resonance angiography/imaging (MRA/MRI) confirmed dissection of the main pulmonary artery extending into the proximal left pulmonary artery and associated with a 12 Â 8 mm 2 aneurysm (Figures 1 and 2). The entry site of dissection was located in the main pulmonary artery just after its origin and the exit site was located in the left pulmonary artery 5 mm distal to the bifurcation of main pulmonary artery. The pulmonary artery diameter at the dissection was 27 mm. DiagnosisTo investigate possible etiologies, a transthoracic echocardiogram with Doppler was done to look for pulmonary hypertension. The echocardiogram showed normal pulmonary artery pressure with normal right ventricular systolic pressure. There was no evidence of pericardial effusion or structural cardiac abnormality on echocardiogram. Further investigations including work up for connective tissue diseases and infectious etiologies (Table 1) were normal.According to Shilkin et al., 1 Helmbrecht first reported pulmonary artery dissection (PAD) in 1842. PAD is very rare and is usually diagnosed at autopsy. There are 71 other cases of PAD reported in the English literature, of which 16 cases are in living patients. 2-17 Unlike aortic dissection, which is fairly common, the reentry circuit for PAD is formed by the rupture of the free wall ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pulmonary artery dissection (PAD): A very unusual cause of chest pain

Sehdev

Dhoble

2010

Journal of Hospital Medicine

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“…Out of the reported patients that have presented emergently and that were diagnosed in a timely manner, three patients have had a successful intervention [13,14]. There is one previous report of a patient who was managed conservatively with diuretics and vasodilators although it is not known for how long the patient was followed up [20]. We offered an emergent thoracic surgery consultation to our patient for repair of the dissection.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic pulmonary artery dissection: a case report

et al. 2009

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IntroductionThe occurrence of pulmonary artery dissection is extremely rare in patients without pulmonary hypertension, congenital cardiac abnormalities or cardiac intervention. A diagnosis of pulmonary artery dissection is rarely made during life because it generally leads to cardiogenic shock and sudden death. The progression or natural course of pulmonary artery dissection is not known and the optimum management is not defined because of the paucity of cases in the literature.Case presentationWe report a rare case of a 51-year-old female patient, without pulmonary hypertension or other cardiac abnormalities, who presented with acute chest pain and was found to have a pulmonary artery dissection.. The diagnosis of pulmonary artery dissection was confirmed by computed tomography scan of the chest and cardiac magnetic resonance imaging. The patient declined surgical intervention and was followed up closely with medical therapy. At almost a year after her initial presentation, the patient is stable with no complications.ConclusionsTo our knowledge, there are no similar cases reported in the literature of people with pulmonary artery dissection who have been followed up and who have not had surgical intervention. We review the etiology, pathophysiology, clinical associations, diagnosis and management of patients with pulmonary artery dissection.

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“…5 Further dilatation of the pulmonary artery is an indication for surgery. Despite the presence of some complications, pulmonary balloon valvuloplasty by a skilled opera- tor is still the first line therapeutic option for treatment of pulmonary valvar stenosis.…”

Section: Discussionmentioning

confidence: 99%

Dissecting Aneurysm of the Main Pulmonary Artery

Wang

et al. 2009

Circulation

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Since the first introduction of pulmonary balloon valvuloplasty by Kan in 1982, the procedure has been used for relief of pulmonary valve stenosis. It is normally recommended that the procedure should be performed for peak-topeak gradients in excess of 50 mm Hg, 1 and the balloon/ annulus ratio should be 1.2 to 1.25 for effective and safe results. 2 Complications of the procedure are minimal and rare. We present the case of dissecting aneurysm of the main pulmonary artery, a dangerous complication of pulmonary balloon valvuloplasty performed in a child, which was successfully treated with surgical management.A 4-year-old boy was admitted to our hospital in December, 2007, whose history included 2 years of 4/6 systolic murmur heard over the pulmonary artery. The transthoracic echocardiogram showed severe pulmonary valve stenosis, and the Doppler-measured peak instantaneous gradient was 121 mm Hg, which was the indication for pulmonary balloon valvuloplasty. A 6F Mansfield balloon catheter was used (18/30 mm, balloon-to-annulus ratio 1.15). The catheterization-measured peak-to-peak gradient was 125 mm Hg. Manual inflation was performed until the balloon indentation disappeared, and 2 additional inflations were performed. After the inflations, the transvalvular pressure gradient was reduced to 28 mm Hg. The patient was observed in an intermediate care setting overnight, with monitoring of heart rate, pulse oximetry, blood pressure, pulses, and puncture site for bleeding. An echocardiogram performed on the morning after the procedure showed the transvalvular pressure gradient was 26 mm Hg, and no complications were revealed. The patient was asymptomatic.At follow-up 1 month later, the patient was still asymptomatic, but a 3/6 systolic murmur was heard over the pulmonary artery. Transthoracic x-ray examination showed the main pulmonary artery to be more dilated than before the valvuloplasty (Figure 1). A transthoracic echocardiogram showed a peak-to-peak gradient of 37 mm Hg and main pulmonary artery dissection (Figure 2). The obvious dilatation of the main pulmonary artery was noted, and a long, freely moving, intimal flap from the stenotic pulmonary valve to the crotch of the main pulmonary artery was revealed. The intimal flap separated the main pulmonary artery into a small true lumen and a large false lumen (32ϫ58 mm), and it also interfered with the motion of the pulmonary valvar leaflets and the blood flow of the left and right pulmonary arteries. The blood supply of right pulmonary artery was through the true lumen, whereas that of the left pulmonary artery was through a small break on the intimal flap. Computed tomography (CT) examination and a multislice CT scan confirmed the dissection and the presence of the dissecting aneurysm (Figure 3, Figure 4, and Figure 5).Because the dissecting aneurysm was very big and affected the normal pulmonary blood flow, and even though it was asymptomatic, the patient required surgery. After longitudinal incision of the main pulmonary artery, the situation of the pulmonary ...

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Pulmonary artery dissection and conservative medical management

Cited by 17 publications

References 6 publications

Pulmonary artery dissection (PAD): A very unusual cause of chest pain

Pulmonary artery dissection (PAD): A very unusual cause of chest pain

Idiopathic pulmonary artery dissection: a case report

Dissecting Aneurysm of the Main Pulmonary Artery

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