Intraoperative pulmonary artery stenting in aortoarteritis: a hybrid procedure
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CASE REPORT
Intraoperative pulmonary artery stenting in aortoarteritis: a hybrid procedure Khandenahally Shankarappa Ravindranath • Kapil Rangan • Padebettu Subramanya Seetharama Bhat • Arkalgud Marigowda Jagadeesh Cholenahally Nanjappa Manjunath
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Received: 12 October 2010 / Accepted: 17 December 2010 / Published online: 20 January 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract A 40-year old male presented with history of dyspnea and recurrent syncope. Preliminary evaluation revealed findings suggestive of severe pulmonary hypertension. His echocardiogram revealed severe stenosis of the right pulmonary artery (RPA) with severe pulmonary hypertension, which was confirmed on 64-slice MSCT. On cardiac catheterization, the stenotic segment could not be crossed. Hence he underwent surgical reconstruction of the RPA. Post-operatively, he developed arterial desaturation and hypotension due to compression of the reconstructed segment by the ascending aorta. Subsequently, intraoperative direct stenting of the RPA was performed on a beating heart. Post-procedure there was a significant drop in right heart pressures which was sustained on 3-month follow up. The patient also had occlusion of the Coeliac and Superior Mesenteric arteries which was demonstrated on MSCT and angiography, suggesting Aortoarteritis as the etiology. This case illustrates an unusual presentation of Aortoarteritis and the role of hybrid procedures
K. S. Ravindranath (&) K. Rangan C. N. Manjunath Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jaya Nagar 9th Block, BG Road, Bangalore 560069, Karnataka, India e-mail: [email protected] P. S. S. Bhat Department of Cardio-Thoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India A. M. Jagadeesh Department of Cardiac Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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in situations where percutaneous intervention may not be technically feasible. Keywords Intraoperative pulmonary artery stenting Pulmonary artery stenosis Hybrid procedure Aortoarteritis Arch of Riolan
Background Pulmonary artery involvement in Takayasu’s arteritis was first described by Lupi Harrera et al. [1] and has been implicated in the development of pulmonary arterial hypertension in these patients [2]. Angiographic involvement of the pulmonary arteries can occur in 40–50% of patients with Takayasu’s arteritis most often involving the right pulmonary artery [3, 4] and is usually asymptomatic. Isolated symptomatic involvement of the pulmonary tree is exceedingly rare and can mimic pulmonary thromboembolism or idiopathic pulmonary hypertension [5]. We describe a rare case of symptomatic pulmonary artery stenosis in Takayasu’s arteritis which was managed using a hybrid technique of surgical reconstruction followed by stenting.
Case report A 40-year-old gentleman presented with a two-year history of exertional dyspnea and recurre
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