Prevalence and prognostic significance of pulmonary artery aneurysms in adults with congenital heart disease
| Autor: | Luis S. Díaz de la Llera, Israel Valverde, Antonio González-Calle, Begoña Manso, Antonio Ordóñez, Pastora Gallego, Alejandro Adsuar, Pilar Serrano Gotarredona, Amir-Reza Hosseinpour, Jose M. Cubero, María José Rodríguez-Puras |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty Heart disease Pulmonary Artery 030204 cardiovascular system & hematology Sudden death 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine Aneurysm Internal medicine medicine.artery Prevalence medicine Humans Aged Univariate analysis business.industry Middle Aged Prognosis medicine.disease Pulmonary hypertension Thrombosis Stenosis Pulmonary artery Cardiology Female Cardiology and Cardiovascular Medicine business Dilatation Pathologic Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 270:120-125 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2018.05.129 |
| Popis: | Prevalence and prognostic significance of pulmonary artery (PA) dilatation in congenital heart disease (CHD) have never been studied systematically.Chest X-rays of 1192 consecutive adults with CHD were reviewed. Major diameter of the PA was determined by imaging techniques in those with PA dilatation. A value29 mm was considered abnormal. Data on anatomy, hemodynamics, residual lesions and outcomes were retrospectively collected.Overall prevalence of PA dilatation was 18%. A minority of patients (5.5%) reached 40 mm (aneurysm; PAA) and 1.8% exceeded 50 mm. The most common PAA underlying malformations were pulmonary stenosis (21%), and shunts (55%). Significantly larger diameters were observed in hypertensive shunts (40 mm; IQR 36.7-45 mm vs. 34 mm; IQR 32-36 mm) (p 0.0001). However, the largest diameters were found in cono-truncal anomalies. There was no significant correlation between PA dimensions and systolic pulmonary pressure (r = -0.196), trans-pulmonary gradient (r = -0.203), pulmonary regurgitation (PR) (r = 0.071) or magnitude of shunt (r = 0.137) (p 0.05 for all). Over follow-up, 1 sudden death (SD) occurred in one Eisenmenger patient. Complications included coronary (3), recurrent laryngeal nerve (1) and airway (1) compressions, progressive PR (1), and PA thrombosis (1). Coronary compression and SD were strongly associated (univariate analysis) with pulmonary hypertension (120 vs. 55 mm Hg; p = 0.002) but not with extreme PA dilatation (range: 40-65 mm).PA dilatation in CHD is common but only a small percentage of patients have PAA. Clinical impact on outcomes is low. Complications occurred almost exclusively in patients with pulmonary hypertension whereas PA diameter alone was not associated with adverse outcomes. |
| Databáze: | OpenAIRE |
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