1/11. Acquired coropulmonary and bronchopulmonary anastomoses occurring in association with pulmonary arterial occlusion and veno-occlusive disease generating potential coronary steal.The development of collateral circulation is a general vascular response which is well characterised in the heart. The most common precipitant of this is ischaemia and the most common manifestation is intra coronary collateralisation. Collateral flow between the heart and other thoracic structures is also documented albeit rarely and can be congenital or acquired. In this case report we define a unique case of collateral flow between the coronary and pulmonary circulations in a complex case of mediastinal fibrosis.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/11. Total pulmonary vein occlusion as a consequence of catheter ablation for atrial fibrillation mimicking primary lung disease.INTRODUCTION: catheter ablation has recently been used for curative treatment of atrial fibrillation. methods AND RESULTS: Three of 239 patients who underwent ablation close to the pulmonary vein (PV) ostia at our institute developed severe hemoptysis, dyspnea, and pneumonia as early as 1 week and as late as 6 months after the ablation. Because the patients were arrhythmia-free, the treating physician initially attributed the symptoms to new-onset pulmonary disease (e.g., bronchopulmonary neoplasm). After absent PV flow was confirmed by transesophageal echocardiography, transseptal contrast injection depicted a totally occluded PV in all three patients. Successful recanalization, even in chronically occluded Pvs, was performed in all patients. During follow-up, Doppler flow measurements by transesophageal echocardiography demonstrated restenosis in all primarily dilated PV, which led to stent implantation. CONCLUSION: PV stenosis/occlusion after catheter ablation of atrial fibrillation occurs in a subset of patients. However, because in-stent restenosis occurred in two patients after 6 to 10 weeks, final interventional strategy for PV stenosis or occlusion remains unclear. To prevent future PV stenosis or occlusion, a decrease in target temperature and energy of radiofrequency current or the use of new energy sources (ultrasound, cryothermia, microwave) seems necessary.- - - - - - - - - - ranking = 1.5490674556213keywords = neoplasm (Clic here for more details about this article) |
3/11. Total anomalous pulmonary venous return with the circular pulmonary venous connection: outcome of common pulmonary venous agenesis.A rare case of total anomalous pulmonary venous return, in which the right and left peripheral pulmonary veins connected circularly and there was no central part of the pulmonary vein or the common pulmonary vein, is presented. To our knowledge, total anomalous pulmonary venous return with circular pulmonary venous connection has not been reported previously in the literature. It is thought that the complex connection between peripheral pulmonary veins with the absence of the central part of the pulmonary vein as well as the common pulmonary vein results from common pulmonary venous agenesis.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/11. cor triatriatum with isolated pulmonary venous stenosis in an adult: diagnosis with transesophageal two-dimensional echocardiography.The diagnosis of cor triatriatum in an adult was made from routine two-dimensional transthoracic echocardiography. The findings of aliasing and turbulence in the roof of the left atrium suggested pulmonary venous stenosis. A transesophageal echocardiogram defined both the hemodynamic features of nonobstructing cor triatriatum and the presence of isolated pulmonary venous stenosis. The clinical use of transesophageal echocardiography with color flow Doppler in the elucidation of complex anatomic substrate is demonstrated.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/11. Absent aortic valve: a complex anomaly.Seven patients (four previously cited and three new cases) with absent aortic valve cusps (leaflets), a rare and underrecognized complex congenital heart defect, are discussed. All patients were male, six full-term and one premature with nonimmunologic hydrops. None underwent operation; all died within the first week of life from low cardiac output and hypoxemia. In most instances, the only remnant of the aortic valve was a nonobstructive fibrous ridge; occasionally, it was accompanied by rudimentary leaflets or sinuses of Valsalva. Absent aortic valve was associated with other significant structural malformations in all instances, including atrioventricular valve atresia, hypoplasia or dysplasia, less commonly double outlet right ventricle, abnormal pulmonary venous connection, or left ventricular endomyocardial abnormalities. Recognition of this unusual lesion is important since it is associated with other complex malformations, causes hypoxemia (for which early positive pressure ventilation is indicated), and could be possibly palliated using the right ventricle as the systemic ventricle.- - - - - - - - - - ranking = 6keywords = complex (Clic here for more details about this article) |
6/11. pulmonary veno-occlusive disease following therapy for malignant neoplasms.We report three cases of pulmonary veno-occlusive disease which developed following treatment for malignant neoplasms. Two patients received single agent BCNU chemotherapy for malignant gliomas. The third patient underwent combination radiation and chemotherapy for Hodgkin's disease. Isolated case reports of pulmonary veno-occlusive disease following therapy for malignant disease are reviewed and clinical features summarized. pulmonary veno-occlusive disease in this setting is thought to be rare. However, the diagnosis is rarely suspected clinically and is difficult to diagnose pathologically. Therefore, the true incidence of this complication is unknown and may be higher than believed. It is important that both clinician and pathologist be aware of this entity; otherwise, elastic tissue stains may not be performed and the diagnosis missed.- - - - - - - - - - ranking = 7.7453372781065keywords = neoplasm (Clic here for more details about this article) |
7/11. Isolated pulmonary vein stenosis in complex congenital heart disease, simulating cor triatriatum by cardiac catheterization and transoesophageal echocardiography.A case of localized stenosis of the lower left pulmonary vein, associated with perimembranous ventricular septal defect (VSD) and secundum atrial defect (ASD), a borderline sized mitral valve apparatus and left ventricle, is described. This final diagnosis was made at surgery, as the localized stenosis of the left pulmonary vein was misinterpreted as partial cor triatriatum by cardiac catheterization, cineangiocardiography and extensive echocardiographic studies. Surgical correction of all the defects was successful, but pulmonary vascular resistance was still increased 2 years after surgery.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
8/11. Transesophageal echo-guided balloon dilatation for postoperative pulmonary venous obstruction.Pulmonary venous obstruction (PVO), or stenosis, is still a major complication of postoperative total anomalous pulmonary venous return, being very complex in its pathogenesis. For some types of PVO, surgery is effective, but a reoperation under cardiopulmonary bypass is generally difficult and carries a high risk. The operative balloon dilatation method performed under the guidance of transesophageal echography and fluoroscopic monitering is simple as well as safe. We describe herein the technique involved in performing this procedure through the case of a 10-month-old boy.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/11. Immunohistochemical detection of carcinoembryonic antigen (CEA) in non-neoplastic lung disease.carcinoembryonic antigen (CEA), though typically associated with malignant epithelial neoplasms, is known to be present at elevated levels even in the serum of normal individuals and of patients suffering from interstitial diseases of the lung. Few reports have addressed the question of the possible source of CEA immunoreactivity within the lung parenchyma. Two patients with elevated CEA serum levels were studied by immunohistochemistry on open lung biopsy specimens. Two different antibodies (one absorbed with non-specific cross-reacting antigen, NCA) were used. The results show that bronchiolar cells and type II pneumocytes are focally positive with both antibodies; the immunoreaction is preserved even after absorption with NCA. In agreement with experimental data on CEA synthesis in fetal bronchial cell lines, these findings indicate that interstitial lung disorders may induce abnormal CEA-like substance expression. In these cases, where no epithelial neoplasms subsequently develop, the cutoff level for CEA in serum should be raised. Bronchiolar and alveolar cells appear primarily responsible for CEA-like substance production.- - - - - - - - - - ranking = 3.0981349112426keywords = neoplasm (Clic here for more details about this article) |
10/11. Human alveolar capillaries undergo angiogenesis in pulmonary veno-occlusive disease.The bronchial circulation undergoes angiogenesis in several pathological conditions, such as lung neoplasm and bronchiectasis, but whether the pulmonary circulation can do this has been questioned. A woman treated with mitomycin C and 5-fluorouracil developed progressive, fatal pulmonary hypertension over 5 months. In addition to light and transmission electron microscopic examination of her lung, her pulmonary vasculature was cast and the casts were studied with scanning electron microscopy. light microscopy showed that she had pulmonary veno-occlusive disease and angiomatoid capillary growth in the alveolar walls. Transmission electron microscopy confirmed the presence of pulmonary hypertension and showed thickened endothelial basement membrane. Scanning electron microscopy of the cast blood vessels showed distortion and destruction of alveolar capillaries prohibiting the passage of erythrocytes. Large new capillaries developed on top of, and were connected to, the shrivelled capillaries that made up the alveolar wall. The new capillaries were larger and fewer, which reduced the alveolar-capillary interface. arteries and veins were irregularly narrowed and the veins had broad muscularity. Oedema was present, and the pulmonary lymphatics were extensively cast, especially in the lobular septa, but the lymphatics had a normal appearance. It appears that this patient suffered extensive capillary damage and venous occlusion and that the response was extensive new capillary formation, sometimes in angiomatoid configurations, and hypertrophy of pulmonary veins and arteries. Casting the microvasculature and viewing it with scanning electron microscopy identified new alveolar capillaries in this patient with acquired pulmonary hypertension.- - - - - - - - - - ranking = 1.5490674556213keywords = neoplasm (Clic here for more details about this article) |
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