Prevalence of Coronary Artery–Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension

Abstract

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, ...

Atypical chest pain due to multiple coronary arteries fistulas occluded with percutaneous interlock coils: A case report

“…Chronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of progressive pulmonary hypertension and right heart failure. Yet, systemic and coronary artery collaterals to the pulmonary circulation may help maintain pulmonary parenchymal viability, especially among patients with more significant pulmonary artery obstruction, in whom the prevalence of coronary fistulas is $11% [2]. This is similar to our case that presented proximal occlusion of the right pulmonary artery, with multiple systemic fistulas to the right pulmonary circulation, in addition to the coronary-bronchial fistulas.…”

“…Chest pain is a common complaint among middle-aged women and is often atypical and rarely associated with coronary artery disease. Differential diagnoses include various diseases and more infrequently coronary artery fistulas [1][2][3]. Coronary artery fistulas although rare, are generally disclosed by cardiac catheterization or multidetector computed tomography (MDCT) in the evaluation of chest pain.…”

Prevalence of Coronary Artery to Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension: Retrospective Analysis from a Single Center

“…A computed tomography study reported a prevalence rate of 0.32% for coronary artery À pulmonary artery collaterals in the general population, which is similar to one reported by Lee et al for the control group. 22 Our prevalence rate for coronary artery À pulmonary artery collaterals is higher than the one reported by Lee et al 9 Although we did not have a control group, it seems that our prevalence rate for coronary artery À pulmonary artery collaterals is higher than the general population. Lee et al 9 also reported that CTEPH patients with collaterals had a higher ratio of total occlusion of main pulmonary artery and/or lobar arteries compared with patients without collaterals.…”

“…To our knowledge, only one study has previously given information about the prevalence of coronary artery À pulmonary artery collaterals and their clinical significance in patients with CTEPH. It this recent study, Lee et al 9 reported a prevalence rate of 11.5% for coronary artery À pulmonary artery collaterals in CTEPH patients, which was significantly higher than the rate of 0.4% in the control group. A computed tomography study reported a prevalence rate of 0.32% for coronary artery À pulmonary artery collaterals in the general population, which is similar to one reported by Lee et al for the control group.…”

“…Recently, increased prevalence of coronary artery À pulmonary artery collaterals has been reported in CTEPH patients. 9 Although there is more evidence regarding increased prevalence of bronchopulmonary collaterals in CTEPH patients, [10][11][12][13][14][15] data regarding coronary artery À pulmonary artery collaterals is limited. The aim of the present study was to determine the prevalence of coronary artery À pulmonary artery collaterals by retrospectively evaluating coronary angiograms and medical records of consecutive CTEPH patients who had undergone PEA.…”