title: Prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension.
abstract: This study sought to determine the prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to correlate their presence with the degree of clot burden. CTEPH is a treatable cause of severe pulmonary hypertension and right heart failure. Bronchopulmonary collateral vessels have been used as a supplementary diagnostic and prognostic tool for this disease. Coronary artery-pulmonary artery collaterals in this population have not been described. The coronary angiograms of 300 consecutive patients with CTEPH evaluated for pulmonary thromboendarterectomy (PTE) between January 1, 2007, and May 1, 2014, were examined. Of these patients, 259 (50% male; mean age, 58.3 ± 10.6 years) had cineangiographic images deemed adequate to definitively assess for the presence of coronary artery-pulmonary artery collaterals and were included in the final analyses. Pulmonary angiogram reports were reviewed for extent of pulmonary artery obstruction. The coronary angiograms of 259 age- and sex-matched control patients were also examined. Among 259 CTEPH patients with definitive imaging, 34 coronary artery-pulmonary artery collaterals were found in 28 patients (10.8%), versus 1 coronary artery-pulmonary artery collateral among control subjects (0.4%; P < 0.001). Compared with CTEPH patients without collaterals, patients with collaterals had a significantly higher prevalence of total occlusion of their right or left main pulmonary artery (P < 0.001) or lobar arteries (P < 0.001). In conclusion, the prevalence of coronary artery-pulmonary artery collaterals in CTEPH patients undergoing coronary angiography for possible PTE is approximately 11%. These vessels are associated with more severe pulmonary artery occlusion.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Blanchard
authors.affiliation: Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Kirk U
authors.initials: KU
authors.lastname: Knowlton
authors.affiliation: Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: McDivit
authors.affiliation: Department of Surgery, University of California, San Diego, La Jolla, California, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Pretorius
authors.affiliation: Department of Surgery, University of California, San Diego, La Jolla, California, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Madani
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Fedullo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Kerr
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Nick H
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Poch
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Auger
authors.affiliation: Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
keywords: collateral vessels; coronary arteries; pulmonary artery obstruction; pulmonary circulation