Isolated Peripheral Pulmonary Artery Stenoses in the Adult

Kreutzer, Jacqueline; Landzberg, Michael J.; Preminger, Tamar J.; Mandell, Valerie S.; Treves, S. Ted; Reid, L; Lock, James E.

doi:10.1161/01.cir.93.7.1417

Cited by 92 publications

(103 citation statements)

References 41 publications

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“…5,6 Over the past decade, improvements have included use of (1) soft-tipped, highly maneuverable guidewires; (2) a modified pigtail catheter that permits angiography while maintaining wire position 7 ; (3) low profile balloons; (4) improved nonionic contrast agents; and (5) full heparin anticoagulation before, during, and after the procedure. The BPA of experimentally induced pulmonary arterial narrowings in animals, in conjunction with registry collection of clinical experience in patients with congenital peripheral pulmonary stenoses, has confirmed that optimal dilation can be obtained with balloons sized 200% to 400% the diameter of the stenotic region but Յ150% the diameter of the surrounding vessel.…”

Section: Discussionmentioning

confidence: 99%

“…The BPA of experimentally induced pulmonary arterial narrowings in animals, in conjunction with registry collection of clinical experience in patients with congenital peripheral pulmonary stenoses, has confirmed that optimal dilation can be obtained with balloons sized 200% to 400% the diameter of the stenotic region but Յ150% the diameter of the surrounding vessel. 6 At present, there are insufficient pathological studies of the vascular wall and its response to injury in distal vessels affected by CTEPH. Therefore, to minimize the potential for vessel rupture, we reasoned that the maximal balloon size should be less than or equal to the surrounding vessel size.…”

Section: Discussionmentioning

confidence: 99%

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Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension

Feinstein

Goldhaber²,

Lock³

et al. 2001

Circulation

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459

274

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Background —Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA). Methods and Results —Eighteen patients (mean age, 51.8 years; range, 14 to 75 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 to 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segments for dilation required (1) complete occlusion, (2) filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (range, 0.5 to 66 months), the average New York Heart Association class improved from 3.3 to 1.8 ( P <0.001), and 6-minute walking distances increased from 209 to 497 yards ( P <0.0001). Pulmonary artery mean pressures decreased from 43.0±12.1 to 33.7±10.2 mm Hg ( P =0.007). Eleven patients developed reperfusion pulmonary edema; 3 required mechanical ventilation. Conclusions —BPA reduces pulmonary artery hypertension in patients with CTEPH and is associated with long-term improvement in New York Heart Association class and 6-minute walking distances. BPA is a promising interventional technique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension

Feinstein

Goldhaber²,

Lock³

et al. 2001

Circulation

Self Cite

459

274

View full text Add to dashboard Cite

show abstract

“…10 In addition, Takayasu arteritis and Behçet disease have been associated with pulmonary artery stenoses that required immunosuppressive therapy and pulmonary artery balloon angioplasty with or without stenting. [11][12][13][14][15] Isolated cases of PPAS in adulthood have been seldom reported, 7,8,16 a fact that can reflect a low prevalence of the disease in addition to underrecognition and misdiagnosis. 16 These last two factors are of great relevance, since patients may not receive appropriate treatment (i.e., balloon or stent angioplasty) or the therapy might be inappropriate for PPAS (i.e., PH-specific therapies or pulmonary thromboendarterectomy).…”

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confidence: 99%

Peripheral Pulmonary Artery Stenosis as a Cause of Pulmonary Hypertension in Adults

et al. 2015

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Peripheral pulmonary artery stenosis (PPAS) is an underrecognized condition in the adult population. PPAS can lead to pulmonary hypertension but is likely misdiagnosed as either idiopathic pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. We retrospectively identified adult patients with PPAS either in its isolated form or related to other congenital defects from January 1998 to September 2012. We reviewed the patients' clinical data by using our hospital electronic medical records and/or their paper charts. We identified 6 adult patients with PPAS with an age range of 16-56 years (1 woman and the rest men). Presenting signs and symptoms were thoracic murmurs, progressive dyspnea, and syncope. Three patients had Williams-Beuren syndrome. Pulmonary angiography showed that PPAS was predominantly located in main branches or lobar pulmonary arteries in 5 patients, while in 1 patient the arterial narrowing was at the level of the segmental pulmonary arteries. Right heart catheterization showed a mean pulmonary artery pressure (PAP) ranging from 35 to 60 mmHg. Balloon dilation was performed in all patients, predominantly in the lobar arteries, and it caused a decrease in mean PAP that ranged from 16% to 46% in 5 patients. In 1 patient the mean PAP did not decrease. All but 1 patient had follow-up echocardiograms at 1 year that showed stable echocardiographic findings. Pulmonary hypertension due to PPAS continues to presents a diagnostic challenge. Therefore, a high index of suspicion during the initial evaluation of pulmonary hypertension is essential for its prompt diagnosis and adequate treatment.

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“…10,11,14 However, the problems of these surgical procedures including graft reocclusion, anastmotic site aneurysm, and morbidity have precluded the widespread use of reconstructive surgery. Kreutzer et al 15 performed balloon dilation of multiple vessels in 11 patients. The authors suggested that balloon dilation offered successful short-term reduction in right ventricular hypertension and alleviation of symptomatology.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transluminal Angioplasty and Stenting for Pulmonary Stenosis Due to Takayasu's Arteritis: Clinical Outcome and Four‐year Follow‐up

Luo

Zhang

Liu

et al. 2009

Clinical Cardiology

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Background: Percutaneous transluminal angioplasty and stent implantation for stenotic lesions of renal arteries and other branches of the aorta in Takayasu's arteritis have been reported to show good outcomes. However, this form of therapy has been reported in few cases with pulmonary artery involvement. Hypothesis: The aim of this study was to evaluate the role of this interventional treatment for pulmonary stenosis due to Takayasu's arteritis. Methods: A total of 4 patients (3 female and 1 male, ages 30-40 yrs) with Takayasu's pulmonary arteritis underwent percutaneous transluminal balloon angioplasty and stent implantation and were followed up for 1 to 4 years. Results: One patient underwent balloon angioplasty alone, 3 patients underwent balloon angioplasty and stent implantation. The stenoses were relieved acutely, oxygen saturation improved immediately due to improvement in lung perfusion and relief of dyspnea. The pressure gradient fell from 58.3 ± 8.7 mm Hg to 14 ± 3.2 mm Hg and mean pulmonary arterial pressure decreased from 48.5 ± 12.0 mm Hg to 37.3 ± 6.0 mm Hg. At a follow-up period of 34.5 ± 15.8 months, the patient with balloon angioplasty alone developed a recurrence of symptoms 18 months after the procedure. The other 3 patients continued to be asymptomatic and the stent remained patent without restenosis after the procedure. Conclusion: Percutaneous transluminal angioplasty and stent implantation is a safe and effective treatment in patients with pulmonary stenosis caused by Takayasu's arteritis.

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Isolated Peripheral Pulmonary Artery Stenoses in the Adult

Cited by 92 publications

References 41 publications

Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension

Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension

Peripheral Pulmonary Artery Stenosis as a Cause of Pulmonary Hypertension in Adults

Percutaneous Transluminal Angioplasty and Stenting for Pulmonary Stenosis Due to Takayasu's Arteritis: Clinical Outcome and Four‐year Follow‐up

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