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Pulmonary Artery Stump Thrombus in a Patient With Remote History of Rastelli Procedure.

ABSTRACT:

SUBMITTER: Li W

PROVIDER: S-EPMC10954566 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Pulmonary Artery Stump Thrombus in a Patient With Remote History of Rastelli Procedure.

Li Weijia W Guan Xuan X Nguyen James J Lee Kelvin K

CASE (Philadelphia, Pa.) 20240308 3Part A

PMID: 38524974

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Supravalvular thrombus after pulmonary artery banding and fontan procedure evaluated by multidetector-row computed tomography.

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Stagnating blood flow related to thrombus formation in pulmonary vein stump after left upper lobectomy.

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Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy.

Project description:BackgroundPulmonary vein (PV) stump thrombus, a known source of cerebral infarction, develops almost exclusively after left upper lobectomy; however, the mechanism remains unclear. We therefore evaluated the hemodynamics in the left atrium with four-dimensional flow magnetic resonance imaging (4D-flow MRI), which enables the simultaneous depiction of blood flow at three locations and the evaluation of hemodynamics.Methods4D-flow MRI was basically performed 7 days after lobectomy for cancer arising in the right upper lobe (n=11), right lower lobe (n=8), left upper lobe (n=13), or left lower lobe (n=8). We evaluated dynamic blood movement from the ipsilateral remaining PV, the resected PV stump, and the contralateral PVs into the left atrium using 4D-flow MRI.ResultsThere were some characteristic blood flow patterns that seemed to either promote or prevent PV stump thrombus. Promotive flow patterns were significantly more frequent and preventive flow patterns were significantly less frequent in patients who had undergone left upper lobectomy than in those who had undergone other lobectomy. Accordingly, the degree of blood turbulence near the vein stump, as measured by the extent of change in the blood movement, was significantly higher in patients who had undergone left upper lobectomy than in patients who had undergone other lobectomy.ConclusionsOur study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.

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