The Diagnosis of Bilateral Stenosis of the Primary Pulmonary Artery Branches Based on Characteristic Pulmonary Trunk Pressure Curves

Agustsson, Magnus H.; Arcilla, René A.; Gasul, Benjamin M.; Bicoff, J.P.; Nassif, Sami I.; Lendrum, Bessie L.

doi:10.1161/01.cir.26.3.421

Cited by 49 publications

(13 citation statements)

References 17 publications

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“…Observations of the pressure pulses proximal and distal to the zones of obstruction show that continuous gradients are not the rule. The central pulmonary artery pulse is characterized by a raised systolic pressure but a rapid fall to a diastolic level that is normal or nearly so (Agustsson et al, 1962) (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, membranous obstruction occurs just above the pulmonary valve (Franch and Gay, 1963;Arvidsson et al, 1961;Smith, 1958). Pulmonary artery stenosis may be unilateral (Luan et al, 1960) or bilateral (Agustsson et al, 1962), single or multiple (D'Cruz et al, 1964); it may involve a localized arterial site with poststenotic dilatation or varying lengths of a branch from segmental narrowing to diffuse tubular hypoplasia (D'Cruz et al, 1964;Franch and Gay, 1963). Though pulmonary artery stenosis occurs as an isolated congenital malformation, it frequently coexists with other anomalies, especially valvular pulmonary stenosis (Hall et al, 1961;Franch and Gay, 1963;D'Cruz et al, 1964;Rowe, 1963), atrial septal defect (Shafter and Bliss, 1959;Franch and Gay, 1963), ventricular septal defect (D'Cruz et al, 1964), patent ductus arteriosus (Rowe, 1963;D'Cruz et al, 1964;Venables, 1965), and Fallot's tetralogy (Baum et al, 1964;D'Cruz et al, 1964).…”

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“…The presence of pulmonary artery stenosis was established by: (1) careful continuous withdrawal of the catheter * This patient represents, to the best of our knowledge, a unique example of pulmonary artery stenosis occurring with subvalvular rather than supravalvular aortic stenosis. 514 from the peripheral branches of both right and left pul-RESULTS monary arteries into the right ventricle, (2) inspection of the contour of the pressure pulse recorded from the Haemodynamic and angiocardiographic data are proximal pulmonary trunk (Agustsson et al, 1962), and summarized in Table II. Severity of pulmonary (3) selective pulmonary angiocardiography (Arvidsson, artery stenosis ranged from mild to marked.…”

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Auscultatory and phonocardiographic manifestations of isolated stenosis of the pulmonary artery and its branches.

Perloff¹,

LeBauer²

1969

Heart

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Auscultatory and phonocardiographic manifestations of isolated stenosis of the pulmonary artery and its branches.

Perloff¹,

LeBauer²

1969

Heart

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“…For this reason we consider angiography to be essential in differentiating between extrinsic compression and intrinsic obstruction of the pulmonary artery and infundibulum. Agustsson, Arcilla, Gasul, Bicoff, Nassif, and Lendrum (1962), in cases of bilateral pulmonary artery stenosis, described a characteristic waveform in the pressure records taken from the main pulmonary artery, and D'Cruz and his colleagues observed this type of pressure record in most of 52 patients with bilateral pulmonary artery stenosis (D'Cruz, Agustsson, Bicoff, Weinberg, and Arcilla, 1964). We have been unable to find in the literature any example of extrinsic compression of both pulmonary arteries as a cause for this type of pressure tracing and believe that our patient (case 2, Fig.…”

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Acquired pulmonary stenosis and pulmonary artery compression

Gough

Gold

Gibson

1967

Thorax

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Three patients suffering from acquired pulmonary stenosis are described resulting from compression of the main pulmonary artery by anterior mediastinal teratoma, Hodgkin's disease, and aneurysm of the ascending aorta, respectively; also four others who had compression of the right or left primary branch of the pulmonary artery. The pulmonary artery compression was demonstrated angiographically in every case, and in the patient with right and left pulmonary artery compression the main pulmonary artery pressure tracing was characteristic of bilateral pulmonary artery stenosis. Cardiac catheterization and selective angiography are indicated in patients who have evidence of right ventricular outflow obstruction to determine the site and severity of the obstruction and to differentiate between extrinsic compression and intrinsic stenosis.There are two main types of acquired pulmonary stenosis; both are rare. The first is due to intrinsic disease of the pulmonary valve itself. The second results from extrinsic compression of the pulmonary artery and it is this with which we are concerned here. We believe it to be more common than has been realized, mainly because angiographic studies are not usually carried out on these patients.In this paper we report three cases of acquired compression of the main pulmonary artery and four of compression of its right or left primary branch. All patients have been studied by right heart catheterization and angiography at Brompton Hospital during the past four years. CASE REPORTS CASE 1 (E. T.) A completely symptom-free girl of 15 years was found on routine chest radiography to have a mass at the left hilum.On examination there was a loud pulmonary systolic ejection murmur and thrill and a single second sound. Abnormal pulsation was palpable in the second and third left intercostal spaces near the sternal edge. The electrocardiogram showed a mean frontal QRS vector of + 110' and suggested mild right ventricular hypertrophy. Chest radiography showed an oval mass in the left hilar region which measured 10 cm. in its long diameter and was continuous with the mediastinal shadow (Fig. 1). In the lateral view this mass lay anteriorly and contained a fleck of calcification. The heart appeared normal.Cardiac catheterization showed a right ventricular pressure of 90/0 mm. Hg. and a right pulmonary artery pressure of 17/3 mm. Hg. The left pulmonary artery could not be entered. The cardiac output was 4 0 1./min. and pulmonary vascular resistance 1-7units.An angiocardiogram showed that the mass was compressing and displacing the pulmonary infundibulum and main pulmonary artery downwards and backwards. The mass itself did not opacify (Figs 2 and 3).Left thoracotomy revealed a smooth, pale yellow, cystic mass, approximately 10x 7*5 cm., protruding from the mediastinum towards the left. Medially and inferiorly the mass contained a soft cystic area which rested on the pericardium over the region of the pulmonary valve, and a firmer more solid bar of tumour extended backwards from this above and lat...

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“…Diagnoses of atrial septal defects (Case 5, ostium primum) were confirmed by cardiac catheterization in six patients (Table II) and at open operation in two (one of whom was catheterized elsewhere). In the five subjects studied in our laboratory, coexisting pulmonary branch stenosis was deliberately sought by, (1) careful continuous withdrawal of the catheter tip from the peripheral branches of both right and left pulmonary arteries into the right ventricle, (2) inspection of the contour of the pressure pulse recorded from the main pulmonary artery (Agustsson et al, 1962), and (3) selective pulmonary angiocardiography (Arvidsson, Karnell, and Moller, 1955). The catheter crossed an atrial septal defect in each of the five patients.…”

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