Prevalence of Coronary Artery to Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension: Retrospective Analysis from a Single Center
22 February 2016
13 May 2016
21 June 2016 (eFirst)
Background Our aim was to determine the prevalence of coronary artery − pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by retrospectively evaluating coronary angiograms of eligible consecutive patients who had undergone pulmonary endarterectomy (PEA). We also aimed to evaluate predictors and potential clinical associates of these collaterals.
Methods Coronary angiograms of 83 consecutive CTEPH patients who had undergone coronary angiography before PEA operation between January 1, 2012 and June 1, 2015 were retrospectively evaluated for presence of coronary artery − pulmonary artery collaterals. Medical records of all patients were also retrospectively reviewed for demographic information, cardiovascular risk factors, preoperative right heart catheterization reports, operation reports, and follow-up data. Data of CTEPH patients with coronary artery − pulmonary artery collaterals were compared with data of CTEPH patients without such collaterals.
Results There were 15 patients (18.1%) with definite and 4 patients (4.8%) with probable coronary artery − pulmonary artery collaterals among the study population. CTEPH patients with collaterals had higher preoperative pulmonary artery pressures, higher pulmonary vascular resistance (PVR) and lower cardiac index values compared with CTEPH patients without collaterals. However, CTEPH patients with collaterals displayed higher amount of reduction in PVR after PEA compared with patients without collaterals. There were no significant differences between groups regarding incidence of reperfusion injury or mortality.
Conclusion Prevalence of coronary artery − pulmonary artery collaterals seems to be increased in our CTEPH patients compared with the general population. The presence of coronary artery − pulmonary artery collaterals is often combined with proximal disease with the possibility of increased reduction of PVR after PEA operation.
- 1 Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001; 345 (20) 1465-1472
- 2 Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation 2006; 113 (16) 2011-2020
- 3 Pengo V, Lensing AW, Prins MH , et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350 (22) 2257-2264
- 4 Thistlethwaite PA, Madani M, Jamieson SW. Pulmonary thromboendarterectomy surgery. Cardiol Clin 2004; 22 (3) 467-478 , vii
- 5 Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2011; 364 (4) 351-360
- 6 Piovella F, D'Armini AM, Barone M, Tapson VF. Chronic thromboembolic pulmonary hypertension. Semin Thromb Hemost 2006; 32 (8) 848-855
- 7 Corsico AG, D'Armini AM, Cerveri I , et al. Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med 2008; 178 (4) 419-424
- 8 Bonow RO, Carabello BA, Chatterjee K , et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48 (3) e1-e148
- 9 Lee NS, Blanchard DG, Knowlton KU , et al. Prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension. Pulm Circ 2015; 5 (2) 313-321
- 10 Endrys J, Hayat N, Cherian G. Comparison of bronchopulmonary collaterals and collateral blood flow in patients with chronic thromboembolic and primary pulmonary hypertension. Heart 1997; 78 (2) 171-176
- 11 Heinrich M, Uder M, Tscholl D, Grgic A, Kramann B, Schäfers HJ. CT scan findings in chronic thromboembolic pulmonary hypertension: predictors of hemodynamic improvement after pulmonary thromboendarterectomy. Chest 2005; 127 (5) 1606-1613
- 12 Remy-Jardin M, Duhamel A, Deken V, Bouaziz N, Dumont P, Remy J. Systemic collateral supply in patients with chronic thromboembolic and primary pulmonary hypertension: assessment with multi-detector row helical CT angiography. Radiology 2005; 235 (1) 274-281
- 13 Shimizu H, Tanabe N, Terada J , et al. Dilatation of bronchial arteries correlates with extent of central disease in patients with chronic thromboembolic pulmonary hypertension. Circ J 2008; 72 (7) 1136-1141
- 14 Hoey ET, Mirsadraee S, Pepke-Zaba J, Jenkins DP, Gopalan D, Screaton NJ. Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR Am J Roentgenol 2011; 196 (3) 524-532
- 15 Kauczor HU, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M. Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 1994; 18 (6) 855-861
- 16 Nakwan N. Congenital unilateral pulmonary atresia with coronary-to-pulmonary collateral artery originating from left circumflex coronary artery. Eur J Cardiothorac Surg 2015; 47 (4) 744-746
- 17 Issitt RW, Robertson DA, Crook RM, Cross NT, Shaw M, Tsang VT. Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral vessels. Perfusion 2014; 29 (6) 567-570
- 18 Nørgaard MA, Alphonso N, Cochrane AD, Menahem S, Brizard CP, d'Udekem Y. Major aorto-pulmonary collateral arteries of patients with pulmonary atresia and ventricular septal defect are dilated bronchial arteries. Eur J Cardiothorac Surg 2006; 29 (5) 653-658
- 19 Choi HM, Kim HK, Shin HS , et al. Total occlusion of right main pulmonary artery in a patient with Takayasu's arteritis and severe pulmonary hypertension. J Cardiovasc Ultrasound 2012; 20 (4) 189-192
- 20 Amin Z, McElhinney DB, Reddy VM, Moore P, Hanley FL, Teitel DF. Coronary to pulmonary artery collaterals in patients with pulmonary atresia and ventricular septal defect. Ann Thorac Surg 2000; 70 (1) 119-123
- 21 Madani MM, Auger WR, Pretorius V , et al. Pulmonary endarterectomy: recent changes in a single institution's experience of more than 2,700 patients. Ann Thorac Surg 2012; 94 (1) 97-103 , discussion 103
- 22 Kim MS, Jung JI, Chun HJ. Coronary to pulmonary artery fistula: morphologic features at multidetector CT. Int J Cardiovasc Imaging 2010; 26 (Suppl. 02) 273-280