Anomalous origin of the left circumflex coronary artery: is surgery required? A case report.

Background: Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation which is rarely seen. We present the case of a 26-year-old male with this coronary artery distribution presenting with an episode of ventricular flutter with late gadolinium enhancement and pluri-morphological ventricular arrhythmias. Case summary: A 26-year-old male with a history of cardiac surgery presented to his local hospital with an episode of symptomatic broad-complex tachycardia (BCT). It failed to revert to sinus rhythm following intravenous beta-blockers and amiodarone and required external cardioversion. Subsequently, the patient developed a aspiration pneumonia requiring ICU admission, after which he was transferred to our institute for ongoing cardiac management. Cardiac computed tomography CTA and coronary angiography revealed that the LCx was found to originate from the pulmonary artery. He underwent insertion of a subcutaneous pacemaker and was subsequently discharged. Despite the potential for steal syndrome of viable coronary territories. Multidisciplinary team discussion determined him to be fit for conservative management and not for surgical correction of his anomalous coronary artery anatomy. Discussion: Aberrant coronary artery anatomy can lead to diverse outcomes for patients in terms of both morbidity and mortality. The need for surgery in these situations varies on a case-by-case basis and little research exists to guide decision-making for healthcare professionals. As such there is a need for further study both to guide treatment and to ensure high-quality outcomes for patients with this condition.

Aorta and main pulmonary artery segmentation using stacked U-Net and localization on non-contrast-enhanced computed tomography images.

BACKGROUND: The contact between the aorta, main pulmonary artery (MPA), main pulmonary vein, vena cava (VC), and esophagus affects segmentation of the aorta and MPA in non-contrast-enhanced computed tomography (NCE-CT) images. PURPOSE: A two-stage stacked U-Net and localization of the aorta and MPA were developed for the segmentation of the aorta and MPA in NCE-CT images. METHODS: Normal-dose NCE-CT images of 24 subjects with chronic thromboembolic pulmonary hypertension (CTEPH) and low-dose NCE-CT images of 100 subjects without CTEPH were used in this study. The aorta is in contact with the ascending aorta (AA) and MPA, the AA with the VC, the aortic arch (AR) with the VC and esophagus, and the descending aorta (DA) with the esophagus. These contact surfaces were manually annotated. The contact surfaces were quantified using the contact surface ratio (CSR). Segmentation of the aorta and MPA in NCE-CT images was performed by localization of the aorta and MPA and a two-stage stacked U-Net. Localization was performed by extracting and processing the trachea and main bronchus. The first stage of the stacked U-Net consisted of a 2D U-Net, 2D U-Net with a pre-trained VGG-16 encoder, and 2D attention U-Net. The second stage consisted of a 3D U-Net with four input channels: the CT volume and three segmentation results of the first stage. The model was trained and tested using 10-fold cross-validation. Segmentation of the entire volume was evaluated using the Dice similarity coefficient (DSC). Segmentation of the contact area was also assessed using the mean surface distance (MSD). The statistical analysis of the evaluation underwent a multi-comparison correction. CTEPH and non-CTEPH cases were classified based on the vessel diameters measured from the segmented MPA. RESULTS: For the noncontact surfaces of AA, the MSD of stacked U-Net was 0.31 ± 0.10 mm (p < 0.05) and 0.32 ± 0.13 mm (p < 0.05) for non-CTEPH and CTEPH cases, respectively. For contact surfaces with a CSR of 0.4 or greater in AA, the MSD was 0.52 ± 0.23 mm (p < 0.05), and 0.68 ± 0.29 mm (p > 0.05) for non-CTEPH and CTEPH cases, respectively. MSDs were lower than those of 2D and 3D U-Nets for contact and noncontact surfaces; moreover, MSDs increased slightly with larger CSRs. However, the stacked U-Net achieved MSDs of approximately 1 pixel for a wide contact surface. The area under the receiver operating characteristic curve for CTEPH and non-CTEPH classification using the right main pulmonary artery (RMPA) diameter was 0.97 (95% confidence interval [CI]: 0.94-1.00). CONCLUSIONS: Segmentation of the aorta and MPA on NCE-CT images were affected by vascular and esophageal contact. The application of stacked U-Net and localization techniques for non-CTEPH and CTEPH cases mitigated the impact of contact, suggesting its potential for diagnosing CTEPH.

Assessment of fetal lung maturity in severe preeclampsia using main pulmonary artery accelerated systolic time/ejection time ratio / 中国医科大学学报

Objective To investigate the assessment of fetal lung maturity using main pulmonary artery accelerated systolic time(AT)/ejection time(ET)ratio in patients with severe preeclampsia.Methods A total of 65 pregnant women who were hospitalized in our hos-pital due to severe preeclampsia,from January 2021 to December 2022,and voluntarily underwent ultrasound examination were enrolled in this study.The patients were divided into early-onset(20 to 33+6 weeks gestation)severe preeclampsia group(group A,n= 30)and late-onset(34 to 40 weeks)severe preeclampsia group(group B,n= 35).Healthy pregnant women with gestational age-matched to groups A and B via ultrasound examination were selected as controls(n= 30 andn= 35,respectively).Fetal main pulmonary artery blood flow parameters were measured using ultrasound Doppler:AT,ET,AT/ET,and peak systolic flow rate(PSV).Amniotic fluid(approximately 15 mL)was collected immediately after delivery,and the lecithin/sphingomyelin(L/S)values were measured.The blood flow parameters of the main pulmonary artery of the fetuses in groups A and B were compared,and whether there was any difference between them and the control group was analyzed.The correlation between the blood flow parameters and amniotic fluid L/S was also analyzed.Results There were statistically significant differences in AT,ET,AT/ET,and PSV in the fetal main pulmonary artery between groups A and group B(P＜0.05),and all of them were smaller than those in the control group(P＜0.05).The AT/ET ratio of the fetal main pulmonary artery in groups A and B was positively correlated with amniotic fluid L/S(r= 0.821 and 0.383,respectively,P＜0.05).Receiver operating charac-teristic curve analysis showed that the area under the curve of AT/ET in the diagnosis of early-onset and late-onset preeclampsia was 0.839 and 0.833,respectively,and the sensitivity was 0.853 and 0.912,the specificity was 0.583 and 0.611,and the cut-off values were 0.185 and 0.255,respectively.The false positive rate was 5%.Conclusion The AT/ET value of the fetal main pulmonary artery can be used to make a preliminary diagnosis of severe preeclampsia and quantitatively assess fetal lung maturity,which can provide a new,simple,non-invasive,and reproducible assessment method for clinical practice.

Relationship of Main Pulmonary Artery (Truncus Pulmonalis) Diameter With Hospital Stay and Mortality in Pulmonary Hypertension Patients Admitted to the Emergency Department.

INTRODUCTION: Pulmonary hypertension (PH) is a haemodynamic and pathophysiological disease significantly associated with morbidity and mortality. The increase in pulmonary vascular resistance, high pulmonary artery pressure and wall tension that occurs in PH results in dilatation of the main pulmonary artery (truncus pulmonalis), one of the largest and most important vessels in the body. The aim of this study is to investigate the relationship between the diameter of the truncus pulmonalis and hospitalization, length of hospital stay, and mortality in patients diagnosed with PH. METHODS: Demographic characteristics, number of Emergency Department (ED) admissions, post-admission status, treatment, truncus pulmonalis diameter, and mortality were evaluated statistically through the patient files of 115 PH patients who presented to the ED of Firat University Faculty of Medicine, Elazig, Türkiye, between January 2022 and December 2022. RESULTS: Of the 115 PH patients who came to the ED, 70 (60.8%) were women and 45 (39.2%) were men, with a mean age of 78.77±8.72 years. Fifty-one of these patients were discharged from the ED after treatment, and 64 were hospitalized. The mean length of hospital stay was two (min=0, max=38) days. Thoracic CT scans demonstrated that the mean diameter of the truncus pulmonalis of the patients was 34.874±3.288 mm (35.20±3.6509 mm in women, 34.367±2.5836 mm in men; p₌0.351) and there was no statistically significant relationship with mortality (p=0.496), hospitalization (p=0.806), and length of hospital stay (p=0.416). There was a statistically significant relationship between mortality rate and male gender (p=0.02) and comorbidity (p=0.001). CONCLUSION: It was determined that there was no statistically significant relationship between the truncus pulmonalis diameter and gender, comorbidity, hospitalization, length of hospital stay, and mortality in this study in which single-centre one-year admissions of PH, which differ in aetiology, epidemiology, and demographic features were examined. However, among the patient demographics, a significant relationship was determined between gender and the number of comorbidities and mortality.

Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults.

BACKGROUND: Four-dimensional flow (4D flow) MRI has become a clinically utilized cardiovascular flow assessment tool. However, scans can be lengthy and may require anesthesia in younger children. Adding compressed sensing can decrease scan time, but its impact on hemodynamic data accuracy needs additional assessment. OBJECTIVE: To compare 4D flow hemodynamics acquired with and without compressed sensing. MATERIALS AND METHODS: Twenty-seven patients (median age: 13 [IQR: 9.5] years) underwent conventional and compressed sensing cardiovascular 4D flow following informed consent. Conventional 4D flow was performed using parallel imaging and an acceleration factor of 2. Compressed sensing 4D flow was performed with an acceleration factor of 7.7. Regions of interest were placed to compare flow parameters in the ascending aorta and main pulmonary artery. Paired Student's t-tests, Wilcoxon signed-rank tests, Bland-Altman plots, and intraclass correlation coefficients were conducted. A P-value of < 0.05 was considered statistically significant. RESULTS: Mean scan acquisition time was reduced by 59% using compressed sensing (3.4 vs. 8.2 min, P < 0.001). Flow quantification was similar for compressed sensing and conventional 4D flow for the ascending aorta net flow: 47 vs. 49 ml/beat (P = 0.28); forward flow: 49 vs. 50 ml/beat (P = 0.07), and main pulmonary artery net flow: 49 vs. 51 ml/beat (P = 0.18); forward flow: 50 vs. 55 ml/beat (P = 0.07). Peak systolic velocity was significantly underestimated by compressed sensing 4D flow in the ascending aorta: 114 vs. 128 cm/s (P < 0.001) and main pulmonary artery: 106 vs. 112 cm/s (P = 0.02). CONCLUSION: For both the aorta and main pulmonary artery, compressed sensing 4D flow provided equivalent net and forward flow values compared to conventional 4D flow but underestimated peak systolic velocity. By reducing scan time, compressed sensing 4D flow may decrease the need for anesthesia and increase scanner output without significantly compromising data integrity.

Experimental and histological evaluation of different clamp technique for pulmonary artery.

OBJECTIVES: The double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique. METHODS: The double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp. RESULTS: The experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples. CONCLUSIONS: The double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the 3rd notch.

Normative reference values of major thoracic arterial vasculature in Turkiye.

OBJECTIVE: The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender. METHODS: Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; ≥40 years) and gender (male to female) was evaluated by statistical methods. The Student's t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations. RESULTS: Totally 777 cases between the ages of 18-96 (43.80±15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52±5.13 mm (12-48 mm in range) for AAD, 30.83±5.25 mm (12-52 mm in range) for ARCAD, DAD 21.27±3.57 mm (11-38 mm in range) for DAD; 23.27±4.03 mm (14-40 mm in range) for MPAD, 17.27±3.19 mm (10-30 mm in range) for RPAD, and 17.62±3.06 mm (10-37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females. CONCLUSION: The diameters of all thoracic main vascular structures are larger in men than in women and increase with age.

Sonographic prediction of fetal main pulmonary artery (MPA) Doppler indices of lung maturity and neonatal respiratory distress syndrome (RDS) development.

PURPOSE: The aim of this study is to highlight the predictive role of perinatal fetal main pulmonary artery (MPA) Doppler measurements in neonatal respiratory distress syndrome development. Respiratory distress syndrome (RDS) is one of the lead causes of neonatal respiratory distress as well as neonatal death. Thus, it seems logic to evaluate fetal lung maturity before labour. METHODS: The study is a prospective cohort study performed in tertiary hospital over a period of one-year duration. 70 pregnant ladies between 34 and 38 weeks of gestation were referred for fetal echo, when pregnancy was considered a high risk. A trained radiologist using dedicated ultrasound machine with updated obstetric and fetal echo software performed the fetal echo. Doppler mode and curvilinear probe of 5.7 MHz transducer. Pediatric neonatologist observed the neonatal outcome post-natally. RESULTS: A total of 70 pregnant patients with risk factors underwent fetal echo, 26/70 (37.1%) were diagnosed with RDS conforming to the neonatal criteria. The mean acceleration time/ejection time ratio (At/Et ratio) of the fetal pulmonary artery was significantly reduced in fetuses that subsequently developed RDS than those without RDS. Contrarily, the mean pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) of the fetal pulmonary artery were significantly high in fetuses who later developed RDS than in those who did not. CONCLUSION: Fetal MPA Doppler measurements have a major role in anticipating the development of neonatal RDS in preterm and early term neonates.

Transcatheter closure of main pulmonary artery pseudoaneurysm using atrial septal occluder device in an infant.

We present a case of percutaneous closure of main pulmonary artery pseudoaneurysm using an atrial septal occluder device in a seven-month-old infant. The infant had tetralogy of Fallot repair followed by transcatheter left pulmonary artery stenting. The occlusion of the wide neck of the pseudoaneurysm was performed successfully using the atrial septal occluder with no detected complications in his six-month follow-up post-catheterisation.

EVALUATION OF PATIENTS WITH COVID-19 IN THE EARLY HYPOXEMIC STAGE AND PATIENTS WITH VIRAL RESPIRATORY TRACT INFECTION IN TERMS OF PULMONARY HYPERTENSION.

Arterial hypoxemia occurs in many COVID-19 patients. Hypoxemia is one of the causes of pulmonary hypertension (PH). Main pulmonary artery dilatation and the main pulmonary artery diameter (mPAD) to ascending aorta diameter (AAD) ratio of ≥1 are significant findings regarding PH. In this study, COVID-19 patients and non-COVID-19 patients with viral respiratory tract infection were evaluated retrospectively in terms of PH. A total of 124 patients (71 male and 53 female), age range 18-85 years, were included in the study as case group and control group. Thoracic computed tomography (CT) images, blood and biochemical parameters, and demographic information were compared between the case group and control group. The normality of numerical variables was examined with Kolmogorov-Smirnov test and homogeneity of the variances with Levene's test. This is the first study researching the effect of early hypoxemic stage COVID-19 infection on development of PH. As a result, it was specified that COVID-19 infection had no effects on mPAD, whereas it had a positive effect on AAD and thus led to a decrease in the mPAD/AAD ratio. Through these values, which could be easily calculated from thoracic CT images, the changes caused by COVID-19 infection on vessel diameters were put forward.

Continuous mechanical aspiration thrombectomy performs equally well in main versus branch pulmonary emboli: A subgroup analysis of the EXTRACT-PE trial.

INTRODUCTION: The EXTRACT-PE trial evaluated the safety and performance of the Indigo Aspiration System (Penumbra Inc.) with an 8F continuous mechanical aspiration thrombectomy system for the treatment of pulmonary embolism (PE). This subgroup analysis evaluates performance outcomes of patients with main pulmonary artery (PA) emboli versus discrete unilateral or bilateral PA emboli without main PA involvement. METHODS: The EXTRACT-PE trial was a prospective, single-arm, multicenter trial that enrolled 119 patients with acute submassive PE. Emboli location was collected at the time of enrollment, CT obstruction was measured and assessed by a Core Lab, and patients were grouped on whether emboli involved the main PA (with or without branch vessels) or not (branch vessels alone). Procedural device time, changes in the right ventricle to left ventricle (RV/LV) ratio, and systolic PA pressure from pre-and posttreatment were compared between the two groups. RESULTS: Out of the 119 patients enrolled, 118 had core lab-assessed clot locations. Forty-five (38.1%) had emboli that involved the main PA and 73 (61.9%) had only branch emboli. No significant difference was observed between these groups for 30-day mortality, procedural device time, changes in RV/LV ratio, reduction in CT Obstruction Index, or for systolic PA pressure from pre-and posttreatment. The mean absolute reduction in clot burden was significant in both groups. CONCLUSION: Continuous mechanical aspiration thrombectomy with the 8F Indigo Aspiration System was effective at improving clinical outcomes for submassive PE patients regardless of emboli location, and clot burden was significantly reduced in both groups.

Alternative Hybrid Approach to Promote Native Pulmonary Artery Growth in Pulmonary Atresia VSD MAPCAs.

We present a case of right ventricle to pulmonary artery hybrid perforation and stenting in a patient with pulmonary atresia with ventricular septal defect major aortopulmonary collaterals and diminutive native pulmonary arteries, then discuss how it compares with established approaches. (Level of Difficulty: Advanced.).

Right ventricle outflow tract dilatation and pulmonary artery aneurysm, rare cardiac conditions.

We describe a rare case of simultaneous idiopathic right ventricular outflow tract dilatation and idiopathic main pulmonary artery aneurysm. A 59-year-old male presented with complaints of exertional shortness of breath and a cardiac murmur since childhood. CT pulmonary angiogram showed main pulmonary artery dilatation with a diameter of 5.8 cm. Cardiac MRI revealed right ventricular outflow tract dilatation with a diameter of 5.4 cm and a main pulmonary artery aneurysm with a 5.6 cm diameter. Cardiothoracic surgery was consulted for surgical repair. Definitive management of right ventricular outflow tract dilatation and pulmonary artery aneurysms is challenging due to their infrequent diagnosis and lack of established guidelines. The treatment for central aneurysms is surgery which includes aneurysmectomy and right ventricular outflow tract repair or replacement.

Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital.

INTRODUCTION:  Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population. METHOD:  In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT's diagnostic capability and cut-off values. RESULT:  The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p<0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively. CONCLUSIONS:  The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.

Wharton's Jelly-Mesenchymal Stem Cell-Engineered Conduit for Pulmonary Artery Reconstruction in Growing Piglets.

Surgical treatment of congenital heart defects affecting the right ventricular outflow tract often requires complex reconstruction and multiple reoperations. With a randomized controlled trial, we compared a novel tissue-engineered small intestine submucosa-based graft for pulmonary artery reconstruction (seeded with mesenchymal stem cells derived from Wharton's Jelly) with conventional small intestine submucosa in growing piglets. Six months after implantation, seeded grafts showed integration with host tissues at cellular level and exhibited growth potential on transthoracic echocardiography and cardiovascular magnetic resonance. Our seeded graft is a promising biomaterial for pulmonary artery reconstruction in pediatric patients with right ventricular outflow tract abnormalities.

Clinical and Predictive Value of Computed Tomography Angiography in High-Altitude Pulmonary Hypertension.

Background: High-altitude pulmonary hypertension (HAPH), as the group 3 pulmonary hypertension, has been less studied so far. The limited medical conditions in the high-altitude plateau are responsible for the delay of the clinical management of HAPH. Objectives: This study aims to identify the imaging characteristics of HAPH and explore noninvasive assessment of mean pulmonary arterial pressure (mPAP) based on computed tomography angiography (CTA). Methods: Twenty-five patients with suspected HAPH were enrolled. Right heart catheterization (RHC) and pulmonary angiography were performed. Echocardiography and CTA image data were collected for analysis. A multivariable linear regression model was fit to estimate mPAP (mPAPpredicted). A Bland-Altman plot and pathological analysis were performed to assess the diagnostic accuracy of this model. Results: Patients with HAPH showed slow blood flow and coral signs in lower lobe pulmonary artery in pulmonary arteriography, and presented trend for dilated pulmonary vessels, enlarged right atrium, and compressed left atrium in CTA (P for trend <0.05). The left lower pulmonary artery-bronchus ratio (odds ratio: 1.13) and the ratio of right to left atrial diameter (odds ratio: 1.09) were significantly associated with HAPH, and showed strong correlation with mPAPRHC, respectively (r = 0.821 and r = 0.649, respectively; all P < 0.0001). The mPAPpredicted model using left lower artery-bronchus ratio and ratio of right to left atrial diameter as covariates showed high correlation with mPAPRHC (r = 0.907; P < 0.0001). Patients with predicted HAPH also had the typical pathological changes of pulmonary hypertension. Conclusions: Noninvasive mPAP estimation model based on CTA image data can accurately fit mPAPRHC and is beneficial for the early diagnosis of HAPH.

Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models.

Objective: Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models. Methods: Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression. Results: Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS. Conclusions: Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.

Screening for portopulmonary hypertension using computed tomography-based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension.

AIM: This study aimed to demonstrate the feasibility of identifying candidates of portopulmonary hypertension (PoPH) from general portal hypertension patients based on chest computed tomography (CT) results. METHODS: One hundred and thirty patients with portal hypertension who had undergone interventional radiology therapies at our hospital between August 2011 and July 2021 were included, and preoperative clinical data were collected. Suspicious PoPH was defined as main pulmonary artery diameter (mPA-D) ≥ 29 mm or the ratio of mPA-D to ascending aorta diameter (mPA-D/aAo-D) ≥ 1.0, and probable PoPH as mPA-D ≥ 33 mm based on the chest CT. Prevalence of suspicious and probable PoPH was evaluated, and the differences in clinical characteristics of each population were compared. RESULTS: Overall, 29 (22.3%) and 5 (3.8%) patients were categorized as suspicious and probable PoPH, respectively. Univariate analyses revealed that female sex, higher shortest diameter of inferior vena cava, presence of portosystemic shunts ≥ 5 mm, and lower blood urea nitrogen levels were significantly associated with suspicious PoPH (p < 0.05). Multivariate analyses identified all four factors as significantly independent determinants of suspicious PoPH (p < 0.05). In addition, among the population of suspicious PoPH, there were significant differences in seven parameters, including total bilirubin levels and spleen volume between patients with and without probable PoPH (p < 0.05). However, no significant independent indicators of probable PoPH were found. CONCLUSIONS: CT-based measurements of mPA-D and mPA-D/aAo-D have the potential to screen patients with suspicious PoPH in clinical practice focused on portal hypertension.