Usefulness of exercise stress echocardiography in a patient with unilateral pulmonary branch stenosis

Q4 Medicine
Ryohei Yokoyama MD , Yoshihiko Kodama MD, PhD , Kazunari Takamura MD , Masako Takahashi MD , Miyo Tanaka MT , Nozomi Watanabe MD, PhD, FJCC , Hiroshi Moritake MD, PhD
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Abstract

Exercise stress echocardiography (ESE) is a feasible and valuable tool for evaluating subclinical pulmonary hypertension (PH). However, its utility in patients with unilateral pulmonary branch stenosis remains unclear. We present a case involving a 17-year-old patient with left pulmonary branch stenosis who exhibited exercise-induced PH in the contralateral pulmonary artery as detected by ESE. Standard echocardiography was unable to visualize the left pulmonary artery clearly; therefore, computed tomography was performed, revealing a left pulmonary branch stenosis with a minimum diameter of 4.2 mm. Resting echocardiography showed a pressure gradient of 17 mmHg, calculated using the tricuspid regurgitant velocity. During ESE with a prone ergometer, the slope of the mean pulmonary arterial pressure to systemic cardiac output was 3.1 mmHg/L/min, meeting the diagnostic criteria for exercise-induced PH. The patient underwent stent implantation to treat the left pulmonary branch stenosis. Follow-up ESE demonstrated improvement, with the slope of the mean pulmonary arterial pressure to systemic cardiac output decreasing to 1.5 mmHg/L/min. These findings underscore that ESE is both feasible and effective for assessing subclinical unilateral pulmonary branch stenosis.

Learning objective

Patients with congenital unilateral peripheral branch pulmonary artery stenosis usually do not have pulmonary hypertension at rest, and identifying patients who require treatment is challenging. Exercise stress echocardiography can detect latent pulmonary hypertension of the contralateral pulmonary artery in some patients, providing valuable insights for determining treatment indications and evaluating the efficacy of catheter interventions for the stenotic lesion.
运动应激超声心动图在单侧肺分支狭窄患者中的应用价值
运动应激超声心动图(ESE)是评估亚临床肺动脉高压(PH)的一种可行且有价值的工具。然而,其在单侧肺分支狭窄患者中的应用尚不清楚。我们报告了一个17岁的左肺动脉分支狭窄患者,通过ESE检测,他表现出运动诱导的对侧肺动脉PH。标准超声心动图不能清晰显示左肺动脉;因此,行计算机断层扫描,发现左肺分支狭窄,最小直径4.2 mm。静息超声心动图显示压力梯度为17 mmHg,使用三尖瓣反流速度计算。在俯卧式测力仪下进行ESE时,平均肺动脉压对全身心输出量的斜率为3.1 mmHg/L/min,符合运动性ph的诊断标准。患者行左肺支狭窄支架置入术。随访ESE显示改善,平均肺动脉压与全身心输出量的斜率降至1.5 mmHg/L/min。这些发现强调了ESE评估亚临床单侧肺分支狭窄的可行性和有效性。学习目的先天性单侧肺动脉外周分支狭窄的患者在静息时通常不会出现肺动脉高压,因此确定需要治疗的患者具有挑战性。运动应激超声心动图可检出部分患者对侧肺动脉潜伏性肺动脉高压,为确定治疗指征和评价导管介入狭窄病变的疗效提供有价值的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiology Cases
Journal of Cardiology Cases Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
177
审稿时长
59 days
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