Pulmonary Artery Dissection

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J Thorac Cardiovasc Surg. 2006 Jul;132(1):205-6.
Extensive dissection of the pulmonary artery treated with combined heart-lung transplantation.
Wuyts WA, Herijgers P, Budts W, De Wever W, Delcroix M.
Department of Respiratory Medicine, Pulmonary Hypertension, UZ Gasthuisberg, Leuven, Belgium.

Ann Thorac Surg. 2006 Jan;81(1):360-2.
Pulmonary artery dissection complicating lung transplantation for primary pulmonary hypertension.
Sakamaki Y, Minami M, Ohta M, Takahashi T, Matsumiya G, Miyoshi S, Matsuda H.
Department of Surgery, Course of Interventional Medicine E1, Osaka University Graduate School of Medicine, Osaka, Japan.

We report a case of pulmonary artery (PA) dissection complicating lung transplantation. A 30-year-old man with primary pulmonary hypertension underwent bilateral single lung transplantation. Thirty hours postoperatively he had signs of obstruction of the right main pulmonary artery develop due to dissection demonstrated on transesophageal echocardiography and pulmonary arteriography. Surgical repair of the dissection with reanastomosis of the pulmonary artery was successfully carried out, and the patient subsequently improved to a favorable condition. Pulmonary hypertension is a risk factor of pulmonary artery dissection; our case suggested that underlying chronic pulmonary hypertension might have led to this rare and life-threatening anastomotic problem after lung transplantation.

J Cardiol. 2005 Jul;46(1):33-7.
Silent pulmonary artery dissection in a patient with Eisenmenger syndrome due to ventricular septal defect: a case report.
Ejima K, Uchida T, Hen Y, Nishio Y, Nomoto F, Uchida Y, Suzuki A, Sato T, Tanino S.
Department of Cardiology, Sendai Cardiovascular Center, Sendai.

A 62-year-old woman was admitted to our hospital because of fever in August 2002. She had been treated under a diagnosis of Eisenmenger syndrome with ventricular septal defect since 1988. On admission, echocardiography and color Doppler echocardiography revealed a markedly enlarged pulmonary artery with a mobile flap, and dissection of the pulmonary artery. The origin of the fever could not be identified, and the fever subsided spontaneously without specific treatment. She had no chest pain, but fever might have been a sign of dissection in this patient. Longstanding pulmonary hypertension may cause dissection, which may lead to sudden death or pulmonary hemorrhage often seen in patients with Eisenmenger syndrome. Our patient was a rare survivor without serious bleeding complication.

Heart. 2005 Feb;91(2):142-5.
Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension.
Khattar RS, Fox DJ, Alty JE, Arora A.
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. rskhattar@hotmail.com

Pulmonary arterial dissection is an extremely rare and usually lethal complication of chronic pulmonary hypertension. The condition usually manifests as cardiogenic shock or sudden death and is therefore typically diagnosed at postmortem examination rather than during life. However, recent isolated reports have described pulmonary artery dissection in surviving patients. The first case of pulmonary artery dissection in a surviving patient with cor pulmonale caused by chronic obstructive pulmonary disease is presented. The aetiology, pathophysiology, and clinical presentation of pulmonary artery dissection are reviewed and factors that may aid diagnosis during life are discussed.

Ann Thorac Surg. 2004 Oct;78(4):e67-8.
Pulmonary artery dissection and rupture associated with aortopulmonary window.
Le Bret E, Lupoglazoff JM, Bachet J, Carbognani D, Bouabdallah K, Folliguet T, Laborde F.
Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France. emmanuel.lebret@imm.fr

A 31-year-old man with uncorrected aortopulmonary window and fixed pulmonary hypertension experienced dissection of the pulmonary artery, rapidly complicated by a fatal spontaneous rupture into the pericardium. In the setting of pulmonary hypertension, the diagnosis of dissection and rupture of the pulmonary artery should be considered in cases of thoracic pain or cardiogenic shock.

Cardiovasc Pathol. 2004 Jul-Aug;13(4):230-2.
Fatal pulmonary arterial dissection and sudden death as initial manifestation of primary pulmonary hypertension: a case report.
Arena V, De Giorgio F, Abbate A, Capelli A, De Mercurio D, Carbone A.
Department of Morbid Pathology, Faculty of Medicine A. Gemelli, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy.

We report a rare case of sudden death due to cardiac tamponade following intrapericardial rupture of a main pulmonary artery dissecting aneurysm. On pathology examination, the pulmonary artery showed an intimal tear in an arterial wall area with reduced thickness. However, no degenerative, inflammatory or necrotic processes were evident within the vessel wall. Hypertrophy of the wall of vasa vasorum in the adventitia of the pulmonary artery was found, as well as bilaterally diffuse myointimal arterial hyperplasia of the lung vasculature. According to these findings, we conclude that pulmonary artery rupture occurred in a patient with chronic unrecognized primary pulmonary hypertension.

Eur J Echocardiogr. 2004 Jun;5(3):228-30.
Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation.
Tonder N, Kober L, Hassager C.
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark. niels_tonder@dadlnet.dk

We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation.

Can J Cardiol. 2004 Jun;20(8):822-4.
Eisenmenger syndrome: a case of survival after ventricular tachycardia due to inferior myocardial infarction in a 48-year-old patient with congenital large ventricular septal defect.
Passarani S, Vignati G, Einaudi A.
Anesthesia/Surgical Intensive Care Unit, De Gasperis Niguarda Ca' Granda Hospital, Milan, Italy. simonetta.passarani@bresciaonline.it

Eisenmenger syndrome is the most common consequence of congenital cyanotic heart disease seen in adults; survival to the fifth decade of life is rare. Death is very difficult to predict: it is related to sudden cardiac ventricular arrhythmia, massive hemoptysis and right heart failure. In this paper, a patient with ventricular septal defect and Eisenmenger reaction is described. The patient was relatively well until 48 years of age, when she underwent surgery because of a cerebral abscess without cerebral complications but with some deterioration of her cardiac function. After discharge, the patient was readmitted to the hospital because the electrocardiogram showed persistent ST inferior elevation. Echocardiography demonstrated poor contractility and inferior akinesia. Sudden ventricular tachycardia occurred and the patient became unconscious. She was successfully resuscitated and, following a period of ventilation, the hemodynamics stabilized and she was discharged 17 days later. She remained well two years later.

Echocardiography. 2003 May;20(4):375-7.
Pulmonary artery dissection: echocardiographic findings and diagnosis.
Areco D, Pizzano N.
Echo-Lab, Casa de Galicia Hospital, Montevideo, Uruguay. dag22@movinet.com.uy

Pulmonary artery dissection is a rare but life-threatening event, predisposing to sudden cardiac death or cardiogenic shock. It is often associated with underlying congenital disorders predisposing to pulmonary hypertension. Rarely, it is diagnosed by echocardiography or other image techniques. We present a case report of a pulmonary artery dissection, diagnosed primarily by echocardiography. The patient died soon after refusing any interventional approach after a short period under medication.

J Comput Assist Tomogr. 1992 May-Jun;16(3):481-3.
Pulmonary artery dissection: MR findings.
Stern EJ, Graham C, Gamsu G, Golden JA, Higgins CB.
Department of Radiology, University of California, San Francisco 94143-0628.

We report a case of pulmonary artery dissection imaged by MR. Dissection of a markedly dilated pulmonary artery is a rare and usually fatal complication of chronic pulmonary arterial hypertension. The diagnosis is made at autopsy, with only two cases having previously been documented (by Doppler echocardiography) during life. The hallmark of an arterial dissection is the finding of an intimal flap and a false lumen. In our case, spin echo MR imaging failed to show either the intimal flap or any intraluminal signal defects. The dissection was presumably obscured by nonhomogeneous intraluminal signal caused by the slow blood flow associated with severe pulmonary arterial hypertension. Cine MR imaging, however, demonstrated different signal intensity within the true and false lumens of the dissection, thereby outlining the intimal flap between the two channels.

Am Rev Respir Dis. 1990 Nov;142(5):1219-21.
Dissecting aneurysm of the pulmonary artery with pulmonary hypertension.
Steurer J, Jenni R, Medici TC, Vollrath T, Hess OM, Siegenthaler W.
Department of Medicine, University Hospital, Zurich, Switzerland.

Pulmonary artery dissection was observed in a 64-yr-old female patient with severe pulmonary hypertension, which was probably primary (pulmonary vascular resistance, 817 dyn.s.cm-5; normal range less than or equal to 200 dyn.s.cm-5). The patient was admitted to the hospital because of severe dyspnea on exertion. Echocardiography demonstrated a dissecting aneurysm of the pulmonary artery. Right heart catheterization revealed severe pulmonary hypertension (mean pulmonary artery pressure, 64 mm Hg; normal range, 10 to 22 mm Hg); dissection of the pulmonary artery was confirmed by pulmonary arteriography. One-year follow-up was uneventful. In the literature, 28 patients with dissecting aneurysm of the pulmonary artery are reviewed. The dissection has only been diagnosed in life in one patient (by echocardiography).

Pathology. 1990 Jan;22(1):1-4.
Pulmonary arterial dissections and ruptures: to be considered in patients with pulmonary arterial hypertension presenting with cardiogenic shock or sudden death.
Walley VM, Virmani R, Silver MD.
University of Ottawa Heart Institute, Ottawa Civic Hospital, Canada.

Four unusual cases of sudden death due to pulmonary arterial hypertension complicated by dissection and/or rupture of the main pulmonary artery are reported. The patients, 3 males and 1 female, ranged from 17 to 77 years old. Each had chronic pulmonary arterial hypertension, marked pulmonary arterial dilation and degenerative medial changes of the large elastic pulmonary arteries. The first patient had a partial thickness tear of the main pulmonary artery with local dissection without external rupture and died of shock. The other three patients died after external rupture of the main pulmonary artery, based on a full thickness tear in one case, a small dissection in another and extensive dissection in the third. In the setting of pulmonary arterial hypertension, dissection, rupture, or dissection and rupture of the pulmonary artery should be considered in the differential diagnosis when patients present in cardiogenic shock or with sudden death.

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