Author + information
- Received October 23, 2017
- Accepted October 31, 2017
- Published online March 19, 2018.
- Erden Goljo, MDa,∗ (, )
- Isabel S. Bazan, MDb,
- Eric J. Brandt, MDc,
- Wassim H. Fares, MD, MScb and
- Jeremy D. Asnes, MDc
- aDepartment of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- bSection of Pulmonary, Critical Care, & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- cSection of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Erden Goljo, Yale New Haven Hospital, 789 Howard Avenue, New Haven, Connecticut 06519.
- balloon angioplasty
- pulmonary artery catheterization
- pulmonary hypertension
- right heart failure
- stent angioplasty
A 29-year-old woman with a history of clinically diagnosed sarcoidosis presented with acute onset dyspnea and chest pain. Chest computed tomography showed bilateral pulmonary artery (PA) stenosis, with complete occlusion of the left PA (LPA) (Figure 1) and 50% stenosis of the right PA (RPA) (Figure 2).
Catheterization was performed revealing a PA systolic pressure of 140 mm Hg, compared with systemic systolic pressure of 120 mm Hg. Severe stenosis of the mid-RPA was seen (Figure 3, image A). Mean main pulmonary artery (MPA) and distal RPA pressures were 68 mm Hg and 30 mm Hg, respectively. Stent angioplasty of the RPA was performed using a Genesis 3910B stent (Cordis Corp., Milpitas, California) post-dilated to 12 mm (Figure 3, image B) with improvement of mean MPA and mean distal RPA pressures to 35 mm Hg and 30 mm Hg, respectively. No attempt at recannulation of the LPA was made.
The patient returned 7 weeks later for the second stage of intervention (Figure 3, image C). A 4.5-mm covered Mounted CP Stent (NuMED Inc., Hopkinton, New York) pre-mounted on an 18-mm balloon-in-balloon catheter was placed within the existing RPA stent (Figure 3, image D). Post-stenting, mean pressure was 30 mm Hg in both the MPA and distal RPA, leaving no residual obstruction. The LPA was investigated but could not be recannulated.
The patient returned in 7 weeks for the third stage of intervention to attempt recannulation of the LPA. Initial angiography showed total occlusion of the LPA (Figure 3, image E) although a proximal stump could be seen on lateral view (Figure 3, image G). A guidewire was directed across the upper lobe branch and positioned distally. Serial balloon dilations of the LPA led to improvement in flow (Figure 3, images F and H). The procedure was terminated with plans to later attempt cannulation of the left lower lobe branch.
The patient returned in 9 weeks and angioplasty of the lower branch was attempted, but it was found to be completely occluded and not amenable to intervention.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2017.
- Accepted October 31, 2017.
- 2018 American College of Cardiology Foundation