Pulmonary atherosclerosis observed by intravascular ultrasound

Objective: To assess data of intravascular ultrasound (IVUS) in female patient with pulmonary artery hypertension (PAH) and atherosclerosis of pulmonary arteries. Design and Method: We studied the condition of vessels in a patient with PAH. She underwent right heart catheterization and pulmonary angiography. In addition we used IVUS (Eagle Eye Gold, catheter 20 MHz; Volcano Therapeutics, Inc., USA) and radiofrequency backscatteter spectral analysis- virtual histology (VH). Results: Pulmonary angiography identified irregular borders of segmental pulmonary artery. IVUS with VH demonstrates proximal right pulmonary artery with irregular intimal surface and intimal disruption. The soft tissue echoes are consistent with an atherosclerotic lesion. We investigated stretch of 63.7 mm in the segmental branches of the pulmonary artery. In the place of maximum narrowing of the pulmonary artery minimal lumen diameter was 1.5 mm and a maximum 2,2 mm, lumen area 2,6 mm ². According to the VH - the majority is represented by fibrous and fibrofatty tissue 73, 4 %, necrotic core 23,7% and areas of calcification 2,1%. Conclusions: In vivo identification of pulmonary atherosclerosis has been impossible noninvasively and unreliable by invasive means short of thoracotomy with open-lung biopsy. IVUS give unique information about morphology of pulmonary artery.