Hemoptysis requiring bronchial artery embolization in pulmonary arterial hypertension.
Hemoptysis requiring bronchial artery embolization in pulmonary arterial hypertension.
复制标题
DOI：
10.1097/smj.0b013e3181eb5649
复制
发表时间：
2010-09
影响因子：
1.1
通讯作者：
Safdar Z
中科院分区：
文献类型：
--
作者：
Cantu JA;Safdar Z
咯血是肺动脉高压（PAH）患者中一种罕见的并发症。虽然咯血的机制尚不清楚，但支气管动脉栓塞（BAE）治疗被认为是一种安全可靠的治疗方法。我们报告贝勒PH中心治疗PAH患者急性咯血需要多次BAEs治疗的经验。女性3例，男性1例，年龄45±9岁（平均±SD），出现急性咯血。首次咯血时右心室收缩压为85±17 mm Hg，心脏指数为2.7±0.7L / min / m2分别。4例患者中有2例咯血复发，需要多次BAEs治疗。四人都在静脉注射前列环素类似物。没有人在发作时接受华法林或内皮素受体拮抗剂。每次咯血时INR为1.09±0.11单位，血小板计数为124,000±47,000 /微升。每次咯血发作均以BAE急性终止。在大多数病例中，患者有多个异常支气管动脉栓塞，平均每次栓塞2.3条动脉（1-4条栓塞动脉）。每个BAE都使用250-500微米的聚乙烯醇颗粒进行。14例BAE手术无并发症报道。虽然咯血的发生率是未知的，可能被低估，我们报告我们的经验，复发性咯血是治疗多次BAE程序。本报告强调BAE在终止严重PAH患者复发性咯血发作中的有效性和安全性。
Hemoptysis is an uncommon complication in patients with pulmonary arterial hypertension (PAH). Although the mechanism of hemoptysis is unknown, treatment with bronchial artery embolization (BAE) is proposed as a safe and reliable method of treatment. We report Baylor PH Center experience in treating PAH patients presenting with acute hemoptysis that required multiple BAEs. Three female and one male PAH patients ages 45±9 years (mean±SD) presented with acute hemoptysis. Right ventricular systolic pressure and cardiac index at the time of first episode of hemoptysis was 85±17 mm Hg and 2.7±.7 L/min/m2 respectively. Two of the four patients had recurrent episode of hemoptysis requiring multiple BAEs. All four were on intravenous prostacyclin analogue. None were receiving warfarin or endothelin receptor antagonist at the time of the episode. During each episode of hemoptysis INR was 1.09 ±0.11 units and platelet count was 124,000±47,000 per microliter. Each episode of hemoptysis was acutely terminated with BAE. In majority of cases, patients had multiple aberrant bronchial arteries embolized and an average of 2.3 arteries was embolized per session (1–4 embolized arteries). Each BAE was performed utilizing polyvinyl alcohol particles ranging from 250–500 microns. There were no reported complications of the 14 BAE procedures performed. Although the incidence of hemoptysis is unknown and likely underreported, we report our experience where recurrent hemoptysis was treated with multiple BAE procedures. This report emphasizes the efficacy and safety of BAE in terminating episodes of recurrent hemoptysis in patients with severe PAH.