Pulmonary Artery – ABC CARDIOL

ABCIC

Case Report

A Hidden Connection: Anomalous Left Circumflex Artery Arising From the Right Pulmonary Artery Unveiled by Cardiovascular Computed Tomography

Mubariz Ahmed Hassan et al. Ashraf Alzahrani Mohammad Mhanna Ola Abdelkarim … Rodrigo Bello Paulo Savoia Promporn Suksaranjit Kimberly Delcour

Introduction

Congenital coronary artery anomalies are uncommon but clinically significant conditions that may present across a broad spectrum, ranging from incidental findings to myocardial ischemia, ventricular arrhythmias, heart failure (HF), and sudden cardiac death (SCD). In adults, anomalous coronary origins may be particularly challenging to recognize because symptoms are often nonspecific and may overlap with more prevalent causes of chest pain, dyspnea, or palpitations.

In rare cases, a coronary artery may originate from the pulmonary arterial circulation, resulting in myocardial perfusion that depends on collateral flow from the remaining coronary arteries arising from the aorta, thereby predisposing the myocardium to ischemia-related electrical instability. Noninvasive anatomical imaging plays a pivotal role in establishing a definitive diagnosis, particularly when conventional angiography is inconclusive.

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IJCS

Case Report

Left Pulmonary Artery Aneurysm in an Adult Patient With Uncorrected Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Miguel Bernardino Antunes Vicente et al. Elsa Fernandes Roger Dopico Luis Mariano … Odete Mingas Domingos Ramos Lino Gonçalves

Abstract

The authors describe a case of an infrequent triple association: left pulmonary artery aneurysm (PAA), uncorrected tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), diagnosed in a 45-year-old adult patient during a check-up. The patient refused to undergo surgery and is currently being followed clinically.

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ABCIC

Case Report

Patent Foramen Ovale: An Unusual Cause of Refractory Hypoxemia

Inês Miranda et al. Christopher Strong Pedro Póvoa

Case Report

We report the case of a 70-year-old woman with a history of cryptogenic ischemic stroke for which she underwent intravenous fibrinolysis with no neurological sequelae. She had no known history of pulmonary or heart disease.

Approximately 1.5 years later, she presented to the Emergency Department (ED) with a one-week history of cough, fatigue, and shortness of breath. She denied fever, chest pain, orthopnea, or paroxysmal nocturnal dyspnea.

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IJCS

Original Article

The Relationship between Basal Serum Lipoprotein(a) Levels and the Pulmonary Artery to Ascending Aorta Ratio in COVID-19 Survivors

Uğur Küçük et al. Bahadır Kırılmaz

Abstract

Background:

Coronavirus disease (COVID-19) can cause permanent damage to vascular structures by directly or indirectly affecting the cardiopulmonary system. Lipoprotein(a) [Lp(a)] is an important identified risk factor for vascular endothelial cell dysfunction.

Objective:

The aim of this study was to reveal the relationship between Lp(a) levels measured at the time of COVID-19 diagnosis and the pulmonary artery (PA) to the ascending aorta (Ao) ratio (PA:Ao ratio) in survivors evaluated by transthoracic echocardiography (TTE).

Methods:

The study sample consisted of 100 patients who recovered from COVID-19 in the past 3 to 6 months. The relationship between the change in the PA:Ao ratio (ΔPA:Ao) and the Lp(a) levels measured at the time of diagnosis was evaluated. Diameter measurements at baseline and follow-up were evaluated with TTE.

Results:

A significant increase was found in PA, Ao, and epicardial adipose tissue (EAT) thickness in TTE (p< 0.001 for all). There was a weak correlation between D-dimer and high-sensitivity cardiac troponin measured at the time of diagnosis and ΔPA:Ao and ΔEAT in survivors. However, a positive and strong correlation was observed between Lp(a) levels and ΔPa:Ao (r = 0.628, p< 0.001) and ΔEAT (r = 0.633, p< 0.001).

Conclusion:

There may be dysfunction in vascular structures due to COVID-19. For the first time in the literature, a strong correlation was shown between the Lp(a) levels measured at the time of diagnosis and ΔPA:Ao and ΔEAT values in patients with COVID-19.

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ABCIC

Case Report

Controversial Fibrinolytic Therapy for Submassive Pulmonary Embolism Related to Right Heart Thrombus

Eduardo Cavalcanti Lapa Santos et al. Diego Roberto Barbosa Pereira Sergio Oliveira de Lima Alexandre de Matos Soeiro … Maria Amellia do Rego Aquino Luca Terracini Dompieri

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ABC

Case Report

Anomalous Origin of the Circumflex Coronary Artery from the Right Pulmonary Artery: Diagnosis Through Cardiac CT

Bebiana Faria et al. Lucy Calvo Sílvia Ribeiro Catarina Ruivo António Lourenço

Introduction

Anomalous origin of the left circumflex coronary artery (LCx) from the right pulmonary artery (PA) is an extremely rare coronary anomaly. Although the clinical course may be silent, the risk of sudden cardiac death is increased. The symptoms are related to collateralization and amount of myocardium that it supplies, and some patients need surgical treatment.^,

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Pulmonary Arterial Intramural Hematoma Due to Acute Aortic Dissection

Lucas de Pádua Gomes de Farias et al. Ana Cristina Favaretto Luciana de Pádua Silva Baptista Gustavo Borges da Silva Teles

A 54-year-old male patient, who was a smoker, was admitted to the emergency room with acute chest pain and dyspnea. Investigation was initiated by means of computed tomography angiography of the chest, which showed extensive dissection of the thoracic aorta, beginning in the ascending segment (Stanford type A), associated with intramural hematoma of the pulmonary artery trunk and its main branches. It was more evident on the right, which determines local pulmonary luminal reduction, in addition to a small para-aortic and subaortic mediastinal hematoma. There were no signs of pulmonary thromboembolism, and the evaluation of the parenchyma showed no signs of pulmonary hemorrhage ( and ).

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Clinicoradiological Correlation

Case 3/2020 – Pulmonary Atresia, Interventricular Communication and Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta developing after Prior Left Central Shunt, in a Symptomatic 40-year-old Adult.

Edmar Atik et al. Maria Angélica Binotto Alessandra Costa Barreto

Complementary examinations

Electrocardiogram: Sinus rhythm, signs of right cavity overload, with apiculate P wave + 70º, QRS complex showing predominance of S waves from V4 to V6 and axis deviated to the right (AQRS= +110°). The T wave was negative in the precordial leads with diffuse ventricular repolarization changes in all other leads ( ).

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Case Report

A Rare Cause of Angina After Coronary Bypass Grafting; Left İnternal Mammary Artery to Pulmonary Artery Fistula and Successful Treatment with Transcatheter Coil Embolization

Ali Nazmi Calik et al. Can Yücel Karabay Evliya Akdeniz Yiğit Çanga … Baris Gungor Omer Kozan

Abstract

Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery.

A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom.

In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient’s symptoms, surgical compatibility and anatomy of fistula.

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Left Internal Mammary Artery Graft-to-Pulmonary Artery Fistula

Emmanouil Petrou et al. Ioannis Iakovou

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Artigo Original

Hemodynamic profile of severity at pulmonary vasoreactivity test in schistosomiasis patients

Flávio A. A. Japyassú et al. Adriano A. Mendes Ângela P. Bandeira Flávio R. A. Oliveira Dário Sobral Filho

BACKGROUND: The pulmonary vasoreactivity rate of Schistosomal Pulmonary Artery Hypertension (SPAH) is not known. Hemodynamic data obtained by cardiac catheterization are associated with the most commonly used clinical criteria of severity. OBJECTIVE: To estimate the percentage of positive vasoreactivity to nitric oxide in schistosomal pulmonary arterial hypertension and verify the association of hemodynamic parameters with WHO functional classification and the six-minute walk test in these patients. METHODS: A total of 84 patients with schistosomal pulmonary hypertension were selected from a database, who had been submitted to the right and left cardiac catheterization and pulmonary vasoreactivity test with nitric oxide. Data on WHO functional classification and six-minute walk test were collected for comparison with invasive data. RESULTS: Of the 84 patients with SPAH, 3 (3.5%) had positive criteria for pulmonary vasoreactivity. The increase in pulmonary vascular resistance was significantly associated with lower exercise capacity measured by the six-minute walk test (p = 0.045) and greater symptom severity by higher functional classifications (WHO class III/IV) (p = 0.013). The decrease in oxygen saturation in the pulmonary artery was significantly associated with higher functional classifications (p = 0.041). CONCLUSION: The pulmonary response rate to the vasodilation test of schistosomiasis patients is below the values found for idiopathic pulmonary hypertension. Pulmonary vascular resistance and oxygen saturation in the pulmonary artery are hemodynamic data that can be used as markers of severity in schistosomal pulmonary hypertension.

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Case Report

Pulmonary hypertension secondary to coronary-to-pulmonary artery fistula

José Ramos Filho et al. Otávio Andrade Carneiro da Silva Diego Oliveira Vilarinho Filipe Giordano Guilherme … Jomara Custódio Ferreira Aline Miranda de Souza

The coronary fistula is an anomaly characterized by the communication between a coronary artery and a cardiac chamber, pulmonary artery, coronary sinus and pulmonary veins. It represents 0.2 to 0.4% of the congenital cardiopathies and 0.1% to 0.2% of the adult population submitted to coronary angiography. We report the clinical case of a 64-year-old female patient, whose anomaly was diagnosed during a clinical investigation due to chest discomfort, dyspnea and syncope; the surgical correction was indicated, with opening of the pulmonary artery through extracorporeal circulation.

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Case Report

Adult patient with anomalous origin of anterior interventricular artery at main pulmonary artery

Haroldo Adans Ferraz et al. Leonardo Alves Batista Fernando Mendes Sant'Anna Leonardo da Costa Buczynski … Marcelo Bastos Brito Carlos Alberto Mussel Barrozo

From all congenital cardiopathies, anomalous origin of anterior interventricular artery occurs once per 300,0000 live births, reporting high mortality in the first year after birth. However, if good collateral circulation is available for the artery related to the abnormality, the patient may be kept asymptomatic until mature age. This is the report on a rare case of a 43-year-old patient who was oligosymptomatic, with normal ventricular function in this pathology presentation. The patient was submitted to surgical treatment with no extracorporeal circulation.

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