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Prevalence of coronary artery-pulmonary artery collaterals in patients with
chronic thromboembolic pulmonary hypertension
#MMPMID26064456
Lee NS
; Blanchard DG
; Knowlton KU
; McDivit AM
; Pretorius V
; Madani MM
; Fedullo PF
; Kerr KM
; Kim NH
; Poch DS
; Auger WR
; Daniels LB
Pulm Circ
2015[Jun]; 5
(2
): 313-21
PMID26064456
show ga
This study sought to determine the prevalence of coronary artery-pulmonary artery
collaterals in patients with chronic thromboembolic pulmonary hypertension
(CTEPH) and to correlate their presence with the degree of clot burden. CTEPH is
a treatable cause of severe pulmonary hypertension and right heart failure.
Bronchopulmonary collateral vessels have been used as a supplementary diagnostic
and prognostic tool for this disease. Coronary artery-pulmonary artery
collaterals in this population have not been described. The coronary angiograms
of 300 consecutive patients with CTEPH evaluated for pulmonary
thromboendarterectomy (PTE) between January 1, 2007, and May 1, 2014, were
examined. Of these patients, 259 (50% male; mean age, 58.3 ± 10.6 years) had
cineangiographic images deemed adequate to definitively assess for the presence
of coronary artery-pulmonary artery collaterals and were included in the final
analyses. Pulmonary angiogram reports were reviewed for extent of pulmonary
artery obstruction. The coronary angiograms of 259 age- and sex-matched control
patients were also examined. Among 259 CTEPH patients with definitive imaging, 34
coronary artery-pulmonary artery collaterals were found in 28 patients (10.8%),
versus 1 coronary artery-pulmonary artery collateral among control subjects
(0.4%; P < 0.001). Compared with CTEPH patients without collaterals, patients
with collaterals had a significantly higher prevalence of total occlusion of
their right or left main pulmonary artery (P < 0.001) or lobar arteries (P <
0.001). In conclusion, the prevalence of coronary artery-pulmonary artery
collaterals in CTEPH patients undergoing coronary angiography for possible PTE is
approximately 11%. These vessels are associated with more severe pulmonary artery
occlusion.