Compression of adjacent anatomical structures by pulmonary artery dilation

Dakkak, Wael; Tonelli, Adriano R.

doi:10.1080/00325481.2016.1157442

Cited by 22 publications

(23 citation statements)

References 63 publications

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“…The finding of an enlarged main PA can facilitate the recognition of pulmonary hypertension; furthermore, a dilated PA can compress the left main coronary artery, left recurrent laryngeal nerve and tracheobronchial tree, or predispose to PA dissection and rupture . Abundant information exists on the prevalence and degree of PA dilation in patients with PAH; however, little is known on the degree and direction of main PA diameter changes over time and particularly its prognostic implications in patients with PAH.…”

Section: Introductionmentioning

confidence: 99%

Changes in main pulmonary artery diameter during follow‐up have prognostic implications in pulmonary arterial hypertension

et al. 2017

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Background and objective A dilated pulmonary artery (PA) is a common finding in patients with pulmonary arterial hypertension (PAH). Little is known on the variations in PA size over time and whether these changes track with disease severity and/or predict long-term survival. Methods We included patients with PAH who had at least two computed tomography (CT) scans of the chest done on different visits. Both scans matched the use of i.v. contrast. Results Pairs of CT scans were compared in 113 PAH patients. During a median (interquartile range (IQR)) time difference between scans of 8 (IQR: 3.5–20.0) months, we noted an increase in main PA diameter of 0.5 ± 1.8 mm (mean ± SD) (P = 0.008). When CT scans were performed >12 months apart (n = 47), the main PA diameter increased or decreased by >1 mm in 40% and 13% of the patients, respectively. An increase in main PA diameter was associated with lower PA compliance, higher right ventricular (RV) systolic pressure, worse RV function and a decline in 6-min walk distance. During a median (IQR) follow-up of 33 (IQR: 4.5–47) months, 53 (46.9%) patients died. The change in PA diameter was a significant predictor of mortality (hazard ratio (HR) per mm increase: 1.33 (95% CI: 1.11–1.61), P = 0.002) when adjusted for difference in time and slice thickness between CT scans, age, gender, PAH aetiology and pulmonary vascular resistance. Conclusion In PAH patients, an increase in CT-derived main PA diameter over time is associated with progression in pulmonary pressures, RV dysfunction, a decline in functional capacity and higher mortality.

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Section: Introductionmentioning

confidence: 99%

Changes in main pulmonary artery diameter during follow‐up have prognostic implications in pulmonary arterial hypertension

et al. 2017

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“…Most reported cases were seen in patients with a severely dilated PA from PH in the setting of uncorrected congenital heart diseases. To our knowledge, only two cases have been reported in patients with IPAH 6 7. These patients had relatively prolonged survival (>6 years) and severely dilated MPA (>9 cm).…”

Section: Discussionmentioning

confidence: 91%

“…PA dilation is a common finding in PH; in fact, many cases of PH are suspected from the discovery of dilated PA on transverse imaging of the chest, performed for a different reason. However, profound PA dilation resulting in compression and obstruction of central airways is exceedingly rare 5–7. Most reported cases were seen in patients with a severely dilated PA from PH in the setting of uncorrected congenital heart diseases.…”

Section: Discussionmentioning

confidence: 99%

Central airway compression by massively dilated pulmonary artery in a patient with pulmonary arterial hypertension: a rare entity

Saha

Beegle

2019

BMJ Case Rep

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Patients with pulmonary arterial hypertension (PAH) usually die from progressive right ventricular failure. Mechanical complications due to pulmonary artery (PA) enlargement are rare and include tracheobronchial and left main coronary artery compression, and PA dissection. A 62-year-old female with PAH was seen in our office for follow-up. During the evaluation, spirometry was performed, which revealed a severe obstructive ventilatory limitation. Subsequent workup identified compression of bilateral mainstem bronchi from the dilated PA as the aetiology for the abnormal spirometry. Very few cases of this rare complication have been reported in the literature. A significant dilation of the PA is necessary (>4 cm) for the occurrence of these complications. Dilation of PA is an independent risk factor for sudden unexpected death in patients with PAH.

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“…In addition, preventive clamping can reduce pulmonary artery pressure, which may facilitate lymph node dissection-for lymph nodes or tumors with severe adhesions to blood vessels, pulmonary artery clamping can facilitate a difficult dissection [20,21]. Also, the reduced tension in the distal pulmonary artery greatly lowers the risk of pulmonary artery rupture during dissection [20,21]. Even if the pulmonary artery ruptures during dissection, no major bleeding will occur, and the repair can be unhurried.…”

Section: Discussionmentioning

confidence: 99%

“…This clamping technique occupies very minimal space with simple instrumentation [ 8 – 10 ], providing sufficient operating space for pulmonary artery repair and minimizes instrumentation interference. In addition, preventive clamping can reduce pulmonary artery pressure, which may facilitate lymph node dissection—for lymph nodes or tumors with severe adhesions to blood vessels, pulmonary artery clamping can facilitate a difficult dissection [ 20 , 21 ]. Also, the reduced tension in the distal pulmonary artery greatly lowers the risk of pulmonary artery rupture during dissection [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Pretreatment clamping of pulmonary artery during uniportal thoracoscopic lobectomy

Zhang¹,

Cai²,

Wang³

et al. 2020

BMC Surg

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Background: Intraoperative pulmonary artery (PA) hemorrhage is one of the leading reasons for conversion from uniportal VATS to open thoracotomy, especially for the small incision (≤3 cm) uniportal VATS performed by our department. So, We designed a technology called pretreatment clamping of the pulmonary artery, which may be helpful to solve the problem. Methods: A retrospective analysis of 19 patients who had pulmonary artery bleeding during uniportal thoracoscopic lobectomy in which one group had undergone preventive pulmonary artery clamping, the clamping group (n = 11), and one group which did not receive preventive clamping, the non-clamping group (n = 8). We compared the rates of conversion from the uniportal VATS approach to open thoracotomy or multi-incision operation, duration of pulmonary artery repair, blood loss, length of postoperative hospital stay and postoperative complications of the two groups. Results: Compared to the non-clamping group, the clamping group had lower rates of conversion to open thoracotomy (0% vs 62.5%, p < 0.05) and lower rates of conversion to multi-incision operations (18.2% of nonclamping converted to 2-port approach vs 12.5% of clamping converted to 2-port approach and 12.5% converted to 3-port approach, p < 0.05). Duration of pulmonary artery repair was reduced in the clamping group (10.1 ± 3.2 min vs 18.3 ± 5.5 min, p < 0.05). The clamping group also had decreased blood loss (23.6 ± 11.2 ml vs 47.5 ± 14.9 ml, p<0.05). There were no significant differences in postoperative hospital stay and postoperative complications between the two groups. Conclusion: Pretreatment clamping of the pulmonary artery in VATS lobectomy can decrease conversion rates, decrease blood loss, shorten repairing time of the pulmonary artery, and feasibly can be applied in uniportal thoracoscopic lobectomy.

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Compression of adjacent anatomical structures by pulmonary artery dilation

Cited by 22 publications

References 63 publications

Changes in main pulmonary artery diameter during follow‐up have prognostic implications in pulmonary arterial hypertension

Changes in main pulmonary artery diameter during follow‐up have prognostic implications in pulmonary arterial hypertension

Central airway compression by massively dilated pulmonary artery in a patient with pulmonary arterial hypertension: a rare entity

Pretreatment clamping of pulmonary artery during uniportal thoracoscopic lobectomy

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