Pulmonary artery-to-pulmonary artery anastomoses: angiographic demonstration in patients with chronic thromboembolic pulmonary hypertension

Hodson, James; Graham, Alison; Hughes, J. M. B.; Gibbs, J. Simon R.; Jackson, James E.

doi:10.1016/j.crad.2005.11.004

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…In fact, TLCO is overestimated because of back-perfusion of the capillary bed by the extensive bronchial arterial collateral flow. This “luxury perfusion” plays a role in the maintenance of pulmonary parenchymal viability and in carbon monoxide exchange, although it does not improve the oxygen exchange [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Radiological differences between chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH)

et al. 2021

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Objectives The aim of this study was to describe the radiological features of chronic thromboembolic pulmonary disease (CTEPD), not yet systematically described in the literature. Furthermore, we compared vascular scores between CTEPD and chronic thromboembolic pulmonary hypertension (CTEPH) patients, trying to explain why pulmonary hypertension does not develop at rest in CTEPD patients. Methods Eighty-five patients (40 CTEPD, 45 CTEPH) referred to our centre for pulmonary endarterectomy underwent dual-energy computed tomography pulmonary angiography (DE-CTPA) with iodine perfusion maps; other 6 CTEPD patients underwent single-source CTPA. CT scans were reviewed independently by an experienced cardiothoracic radiologist and a radiology resident to evaluate scores of vascular obstruction, hypoperfusion and mosaic attenuation, signs of pulmonary hypertension and other CT features typical of CTEPH. Results Vascular obstruction burden was similar in the two groups (p = 0.073), but CTEPD patients have a smaller extension of perfusion defects in the iodine map (p = 0.009) and a smaller number of these patients had mosaic attenuation (p < 0.001) than CTEPH patients, suggesting the absence of microvascular disease. Furthermore, as expected, the two groups were significantly different considering the indirect signs of pulmonary hypertension (p < 0.001). Conclusions CTEPD and CTEPH patients have significantly different radiological characteristics, in terms of signs of pulmonary hypertension, mosaic attenuation and iodine map perfusion extension. Importantly, our results suggest that the absence of peripheral microvascular disease, even in presence of an important thrombotic burden, might be the reason for the absence of pulmonary hypertension in CTEPD. Key Points • CTEPD and CTEPH patients have significantly different radiological characteristics. • The absence of peripheral microvascular disease might be the reason for the absence of pulmonary hypertension in CTEPD.

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Section: Discussionmentioning

confidence: 99%

Radiological differences between chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH)

et al. 2021

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“…Other sources of collateral flow in CTEPH patients include the inferior phrenic, intercostal, and internal mammary arteries 18 . Pulmonary artery–to–pulmonary artery collaterals have also been noted 20 …”

Section: Discussionmentioning

confidence: 99%

“…Further investigation is needed to understand the stimuli for coronary artery-pulmonary artery collateralization in CTEPH, whether they be pressure gradients or vascular damage that results from obstruction, as has been proposed in studies of other collateral vessels in CTEPH. 8,20 Our study has a few limitations. It did not evaluate whether coronary artery-pulmonary artery collaterals are associated with bronchopulmonary collaterals.…”

Section: -32mentioning

confidence: 99%

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

et al. 2015

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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, ...

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“…This is postulated to be because of back-perfusion of the capillary bed by the extensive bronchial arterial collateral flow. This ''luxury perfusion'' plays a role in the maintenance of pulmonary parenchymal viability and in carbon monoxide exchange, although it does not improve the oxygen exchange (29). The preoperative overestimation of TL CO by the single breath method masks the effect of PEA on the time trend of this parameter.…”

Section: Clinical and Functional Changes Occurring Over 4 Years Of Fomentioning

confidence: 96%

Long-term Outcome after Pulmonary Endarterectomy

Corsico

D’Armini

Cerveri

et al. 2008

Am J Respir Crit Care Med

205

129

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Pulmonary artery-to-pulmonary artery anastomoses: angiographic demonstration in patients with chronic thromboembolic pulmonary hypertension

Cited by 7 publications

References 8 publications

Radiological differences between chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH)

Radiological differences between chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH)

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

Long-term Outcome after Pulmonary Endarterectomy

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