Reconstruction of Bilateral Branch Pulmonary Artery Stenosis Caused by Takayasu's Aortitis

Nonspecific aortoarteritis as a Cause of Aortic Dissection in a Middle Aged Man

Nonspecific aortoarteritis (Takayasu's disease) is a systemic inflammatory disease characterized by granulomatous lesions of the aorta and its large branches. The article describes the clinical manifestations, methods of diagnosis and treatment of this pathology. It also describes a clinical observation that illustrates the delayed diagnosis of the disease in a 47-year-old man, where Takayasu arteritis with lesions of the root, ascending aorta, both common carotid arteries, thoracic and abdominal aorta (type V according to the angiographic classification proposed by Moriwaki R.) manifested a syncopal state, just a few days before the development of a life – threatening complication-aortic dissection of type I according to the DeBakey classification. From a clinical point of view, it is important that Takayasu's disease does not always develop in young people, women, and Asian origin, and, unfortunately, it is often very late to diagnose, although the effectiveness of therapy, including surgical correction of this disease, is entirely determined by the timeliness of its diagnosis.

Lumped-Parameter Circuit Platform for Simulating Typical Cases of Pulmonary Hypertensions from Point of Hemodynamics

Pulmonary hypertension (PH) presents unusual hemodynamic states characterized by abnormal high blood pressure in pulmonary artery. The objective of this study is to simulate how the hemodynamics develops in typical PH cases without treatment. A lumped-parameter circuit platform of human circulation system is set up to simulate hemodynamic abnormalities of PH in different etiologies and pathogenesis. Four typical cases are considered, which are distal pulmonary artery stenosis, left ventricular diastolic dysfunction, ventricular septal defect, and mitral stenosis. The authors propose regulation laws for chambers and vessels to adapt the abnormal hemodynamic conditions for each PH case. The occurrence and development of each PH case are simulated over time using the lumped-parameter circuit platform. The blood pressure, blood flow, pressure-volume relations for chambers and vessels are numerically calculated for each case of PH progression. The model results could be a quite helpful to understand the hemodynamic mechanism of typical PHs. Graphical Abstract.

A successful surgical repair of pulmonary stenosis caused by isolated pulmonary Takayasu's arteritis

A 48-year-old man underwent surgery to treat pulmonary stenoses of unknown origin. The right main pulmonary artery was severely stenotic, and the orifice of the left pulmonary artery was focally constricted. The patient was nearly asymptomatic, despite marked pulmonary hypertension and right heart strain. The pressure gradients beyond the stenotic regions were 88 mmHg bilaterally. The cause of the stenoses could not be established before operation. The right main pulmonary artery and ascending aorta were successfully replaced. It was suspected that the ascending aorta was involved because it was markedly thickened and adhered tightly to the right pulmonary artery. It was therefore also replaced. However, only the transected right pulmonary artery showed histological evidence consistent with a diagnosis of Takayasu's arteritis. The postoperative course was uneventful. The patient was completely free of symptoms six months after the operation. To our knowledge, this is the thirteenth surgically treated case of isolated pulmonary Takayasu's arteritis to be reported.

Pulmonary artery replacement for pulmonary Takayasu's arteritis

Takayasu's arteritis is a chronic inflammatory disease that affects the pulmonary artery, as well as the aorta and its major branches. A 59-year-old man presented with a 2-month history of progressive exertional dyspnea. Further examination revealed marked wall thickening of the pulmonary trunk and bilateral proximal pulmonary artery, resulting in severe stenoses with high pressure gradient of 60 mmHg. The patient underwent graft replacement of the bilateral pulmonary artery and the pulmonary trunk with a 16-mm ring-supported extended polytetrofluoroethylene graft under extracorporeal circulation. Histopathological findings were consistent with Takayasu's arteritis with pulmonary artery involvement. After the operation, the pressure gradient decreased to 6 mmHg and the patient was free from exertional dyspnea.

Pulmonary artery bypass for in-stent stenosis following angioplasty for isolated pulmonary Takayasu arteritis

Pulmonary artery (PA) stenosis due to Takayasu Arteritis (TA) is usually managed by angioplasty techniques. We present a patient with isolated PA stenosis with TA with in-stent stenosis. The surgical management and pathophysiology of this disease are reviewed.

Percutaneous transluminal angioplasty and stenting for pulmonary stenosis due to Takayasu's arteritis: clinical outcome and four-year follow-up

BACKGROUND

Percutaneous transluminal angioplasty and stent implantation for stenotic lesions of renal arteries and other branches of the aorta in Takayasu's arteritis have been reported to show good outcomes. However, this form of therapy has been reported in few cases with pulmonary artery involvement.

HYPOTHESIS

The aim of this study was to evaluate the role of this interventional treatment for pulmonary stenosis due to Takayasu's arteritis.

METHODS

A total of 4 patients (3 female and 1 male, ages 30-40 yrs) with Takayasu's pulmonary arteritis underwent percutaneous transluminal balloon angioplasty and stent implantation and were followed up for 1 to 4 years.

RESULTS

One patient underwent balloon angioplasty alone, 3 patients underwent balloon angioplasty and stent implantation. The stenoses were relieved acutely, oxygen saturation improved immediately due to improvement in lung perfusion and relief of dyspnea. The pressure gradient fell from 58.3 +/- 8.7 mm Hg to 14 +/- 3.2 mm Hg and mean pulmonary arterial pressure decreased from 48.5 +/- 12.0 mm Hg to 37.3 +/- 6.0 mm Hg. At a follow-up period of 34.5 +/- 15.8 months, the patient with balloon angioplasty alone developed a recurrence of symptoms 18 months after the procedure. The other 3 patients continued to be asymptomatic and the stent remained patent without restenosis after the procedure.

CONCLUSION

Percutaneous transluminal angioplasty and stent implantation is a safe and effective treatment in patients with pulmonary stenosis caused by Takayasu's arteritis.

Congenital pulmonary artery stenoses masquerading as chronic thromboembolic disease

Stenotic pulmonary vascular lesions, often amenable to balloon angioplasty, can erroneously appear to suggest chronic thromboembolic disease on ventilation/perfusion (V/Q) scan. We report a case of multiple peripheral pulmonary artery stenoses and describe radiologic findings and treatment options.

[Severe pulmonary hypertension and Takayasu arteritis]

Takayasu arteritis is an inflammatory disease that affects large vessels, especially the aorta and its branches. The clinical features of the disease depend on which arteries are affected. Although pulmonary artery involvement is common, only rarely is this the main clinical manifestation. We describe the case of a young woman with dyspnea who had severe pulmonary hypertension secondary to Takayasu arteritis of the pulmonary artery. She was administered corticosteroid (methylprednisolone) and immunosuppressant (azathioprine) therapy and a stent was implanted in the left pulmonary artery. Both hemodynamic and clinical signs improved.

Usefulness of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in a Patient With Takayasu's Arteritis Associated With Antiphospholipid Syndrome

A 36-year-old woman was admitted for recurring chest pain and hemoptysis. Blood pressure in the right and left arms was equal, and no murmurs or bruits were heard. Body temperature was normal on admission and remained within the normal range during the hospital stay. C-reactive protein was slightly elevated (2.3 mg/dL) and lupus anticoagulant was positive. Angiography showed no abnormality of the aorta or its branches, but the left pulmonary artery showed occlusion at the proximal portion. Computed tomography (CT) revealed segmental wall thickening of the thoracic aorta. Fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG PET) showed high uptake in the proximal portion of the left pulmonary artery and in the thoracic aorta with wall thickening on CT. Based on these findings, a diagnosis of Takayasu's arteritis associated with antiphospholipid syndrome was made and high-dose steroid therapy (prednisolone 30 mg/day) was started. Two months later, the C-reactive protein level had decreased from 2.3 mg/dL to 1.1 mg/dL, and both the focal wall thickening and (18)FDG uptake of the thoracic aorta were decreased. 18FDG PET was useful for evaluating the efficacy of the steroid therapy in addition to making a diagnosis of Takayasu's arteritis associated with antiphospholipid syndrome.