Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis
Background: Pulmonary artery dissection (PAD) is an uncommon condition associated with high mortality rates. To date, a comprehensive examination of various underlying causes of PAD remains unexplored. Methods: We used the search words ''pulmonary artery dissection,'' ''...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023097785 |
| _version_ | 1797384028376006656 |
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| author | Qi-xian Zeng Qun-ying Xi Qin Luo Zhi-hong Liu Chang-ming Xiong |
| author_facet | Qi-xian Zeng Qun-ying Xi Qin Luo Zhi-hong Liu Chang-ming Xiong |
| author_sort | Qi-xian Zeng |
| collection | DOAJ |
| description | Background: Pulmonary artery dissection (PAD) is an uncommon condition associated with high mortality rates. To date, a comprehensive examination of various underlying causes of PAD remains unexplored. Methods: We used the search words ''pulmonary artery dissection,'' ''pulmonary artery dilatation,'' and ''pulmonary artery rupture'' in the public database, and examined the medical records of PAD patients treated in our hospital. Data on demographics, aetiology, PAD locations, histopathology, treatments, and outcomes, were collected. Results: A total of 145 patients with PAD (135 cases from the literature and 10 cases from our hospital) were analysed. PAD aetiology was categorized into four groups: congenital heart diseases (CHD) associated with pulmonary arterial hypertension (PAH), non-CHD associated with pulmonary hypertension (PH), aortic dissection-related, and miscellaneous causes. The most frequent cause, accounting for 32.4 % of PAD cases, was congenital heart disease, followed by idiopathic PAH (13 %) and chronic obstructive pulmonary disease (6 %). Patients with CHD were typically younger at the time of PAD diagnosis (median age: 35 years old) when compared with those suffering from aortic dissection, PH-associated conditions, or other causes (median age: 45, 55, and 56 years old, respectively). Imaging of the pulmonary artery proved effective in diagnosing PAD. The outcomes were generally poor. 44.7 % (21/47) of patients with CHD associated with PAH and 47.7 % (21/44) of non-CHD PH-associated diseases died during follow-up. Multidisciplinary team consultations are crucial when making decisions on management of PAD. Characteristic PAD histopathology features included thickened intima and hypertrophied media with atheromatous degeneration, disrupted elastic fibres, and lymphocytic infiltration. Conclusions: PAD aetiology can be divided into four main categories, with CHD associated with PAH being the leading cause. Despite the similar histopathology features, clinical manifestations and outcomes vary according to the aetiology. |
| first_indexed | 2024-03-08T21:29:30Z |
| format | Article |
| id | doaj.art-cb0d8029364546ecbe196c441ed0434b |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T21:29:30Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-cb0d8029364546ecbe196c441ed0434b2023-12-21T07:33:51ZengElsevierHeliyon2405-84402023-12-01912e22570Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysisQi-xian Zeng0Qun-ying Xi1Qin Luo2Zhi-hong Liu3Chang-ming Xiong4State Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, North Lishi Road, Xicheng District, No. 167, Beijing, 100037, ChinaCenter for Pulmonary Vascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, No. 12, Langshan Road, Nanshan District, Shenzhen, 518057, ChinaState Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, North Lishi Road, Xicheng District, No. 167, Beijing, 100037, ChinaState Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, North Lishi Road, Xicheng District, No. 167, Beijing, 100037, ChinaState Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, North Lishi Road, Xicheng District, No. 167, Beijing, 100037, China; Corresponding author. North Lishi Road, Xicheng District, Beijing No.167, China.Background: Pulmonary artery dissection (PAD) is an uncommon condition associated with high mortality rates. To date, a comprehensive examination of various underlying causes of PAD remains unexplored. Methods: We used the search words ''pulmonary artery dissection,'' ''pulmonary artery dilatation,'' and ''pulmonary artery rupture'' in the public database, and examined the medical records of PAD patients treated in our hospital. Data on demographics, aetiology, PAD locations, histopathology, treatments, and outcomes, were collected. Results: A total of 145 patients with PAD (135 cases from the literature and 10 cases from our hospital) were analysed. PAD aetiology was categorized into four groups: congenital heart diseases (CHD) associated with pulmonary arterial hypertension (PAH), non-CHD associated with pulmonary hypertension (PH), aortic dissection-related, and miscellaneous causes. The most frequent cause, accounting for 32.4 % of PAD cases, was congenital heart disease, followed by idiopathic PAH (13 %) and chronic obstructive pulmonary disease (6 %). Patients with CHD were typically younger at the time of PAD diagnosis (median age: 35 years old) when compared with those suffering from aortic dissection, PH-associated conditions, or other causes (median age: 45, 55, and 56 years old, respectively). Imaging of the pulmonary artery proved effective in diagnosing PAD. The outcomes were generally poor. 44.7 % (21/47) of patients with CHD associated with PAH and 47.7 % (21/44) of non-CHD PH-associated diseases died during follow-up. Multidisciplinary team consultations are crucial when making decisions on management of PAD. Characteristic PAD histopathology features included thickened intima and hypertrophied media with atheromatous degeneration, disrupted elastic fibres, and lymphocytic infiltration. Conclusions: PAD aetiology can be divided into four main categories, with CHD associated with PAH being the leading cause. Despite the similar histopathology features, clinical manifestations and outcomes vary according to the aetiology.http://www.sciencedirect.com/science/article/pii/S2405844023097785Pulmonary artery dissectionAetiologyPathologyPulmonary hypertensionoutcomes |
| spellingShingle | Qi-xian Zeng Qun-ying Xi Qin Luo Zhi-hong Liu Chang-ming Xiong Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis Heliyon Pulmonary artery dissection Aetiology Pathology Pulmonary hypertension outcomes |
| title | Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis |
| title_full | Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis |
| title_fullStr | Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis |
| title_full_unstemmed | Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis |
| title_short | Etiological classification and manifestation of pulmonary artery dissection: A literature review and case analysis |
| title_sort | etiological classification and manifestation of pulmonary artery dissection a literature review and case analysis |
| topic | Pulmonary artery dissection Aetiology Pathology Pulmonary hypertension outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023097785 |
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