大鼠肺小动脉重构发生在肺动脉压增高之前

目的探讨野百合碱(MCT)所致大鼠肺小动脉重构与肺动脉压力增高的关系。方法雄性SD大鼠32只,体质量200~230g,随机均分为肺动脉高压(PAH)组和对照组。PAH组一次性腹腔注射MCT40mg/kg,对照组一次性腹腔注射相同体积的生理盐水。于注射MCT后2周及4周,分别从以上两组大鼠中随机选择8只,测定肺动脉平均压(MPAP)和右心室肥厚指数(RVHI),并运用ipp6.0图像分析软件分析肺组织切片,测定肺小动脉管壁厚度(WT)占动脉外径(ED)的百分比(WT%)及管壁面积(WA)占血管总面积的百分比(WA%)。结果腹腔注射MCT2周后MPAP和RVHI在对照组与PAH间差异无统计学意义[(23.6±2.1)vs(26.0±2.8)mmHg,(23.4±4.6)vs(24.7±3.9)%,P均>0.05],但是与对照组相比,PAH的WT%、WA%均明显增高[WT:(39.1±2.8)vs(50.8±3.1)%,WA:(51.2±3.0)vs(74.5±2.9)%,P均<0.05];4周后与对照组相比,PAH的MPAP、RVHI、WT%、WA%都明显增高[MPAP:(24.0±3.0)vs(35.7±3.1)mmHg,RVHI:(24.2±3.7)vs(44.6±4.3)%,P均<0.01;WT:(40.1±3.1)vs(57.5±2.0)%,WA:(51.1±2.0)vs(78.3±2.0)%,P均<0.05]。结论MCT所致大鼠肺小动脉的重构先于肺动脉压力的增高。     

多廿烷醇对野百合碱诱导的肺动脉高压大鼠肺动脉重构的影响

目的观察多廿烷醇对野百合碱诱导的肺动脉高压(PAH)大鼠的平均肺动脉压(MPAP)与肺动脉重构的影响及可能的机制。方法雄性SD大鼠60只随机数字法分为正常对照组、PAH组、多廿烷醇组,每组20只。野百合碱(40mg/kg)一次性腹腔注射建立大鼠PAH模型,多廿烷醇组以多廿烷醇[10 mg/(kg·d)]灌胃,对照组和PAH组给予等量的生理盐水灌胃4周。肺动脉导管法测定大鼠MPAP;称重法测右心室肥厚指数(RVHI);HE染色观察肺小动脉病理形态改变,测定肺小动脉管壁厚度占血管外径的百分比(WT%)、肺小动脉管壁总面积占血管总面积的百分比(WA%);TUNEL染色法观察肺小动脉内皮细胞凋亡情况;Western blot法测肺组织凋亡相关蛋白Bax、Bcl-2表达;酶联免疫吸附试验测定血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平。结果与正常对照组相比,PAH组MPAP[(33.91±4.72)比(17.57±3.44)mm Hg]、RVHI[(69.25±8.42)%比(24.91±2.82)%]、肺小动脉WT%[(66.53±10.01)%比(32.08±4.98)%]和WA%[(86.52±4.97)%比(52.96±6.65)%]增加(均P0.01);与PAH组相比,多廿烷醇组MPAP[(26.94±6.02)比(33.91±4.72)mm Hg]、RVHI[(55.27±9.89)%比(69.25±8.42)%]、肺小动脉WT%[(41.66±10.47)%比(66.53±10.01)%]和WA%[(64.10±12.80)%比(86.52±4.97)%]减少(均P0.01)。与正常对照组相比,PAH组大鼠肺小动脉内皮细胞凋亡增多,PAH组肺组织凋亡蛋白Bax表达增加,抗凋亡蛋白Bcl-2表达减少,Bax与Bcl-2比值增加;与PAH组相比,多廿烷醇组大鼠肺小动脉内皮细胞凋亡减少,肺组织Bax表达减少,Bcl-2表达增加,Bax与Bcl-2比值减少(均P0.01)。与正常对照组相比,PAH组大鼠血清细胞因子IL-6、TNF-α水平升高;与PAH组相比,多廿烷醇组血清IL-6、TNF-α水平降低(均P0.01)。结论多廿烷醇改善野百合碱诱导的PAH大鼠的MPAP及肺血管重构,可能与其减少细胞凋亡、抑制炎症反应有关。     

褪黑素干预动脉性肺动脉高压大鼠的实验研究

目的探讨褪黑素(MEL)干预对野百合碱(MCT)诱导的动脉性肺动脉高压(PAH)大鼠肺动脉压及肺组织环氧合酶-2(COX-2)表达情况的影响。方法 36只大鼠按随机数表法分为对照组、造模组(MCT)、干预组(MCT+MEL)。造模组和干预组分别按2.5 ml/kg(50 mg/kg,溶于无水乙醇+生理盐水混合液)规格腹膜内注射MCT溶液。对照组按2.5 ml/kg接受腹膜内注射溶媒。造模后第1～28天,干预组予以MEL 10 ml/kg (10 mg/kg,溶于无水乙醇+生理盐水混合液)腹膜内注射,1次/d,对照组和造模组予以单位等体积溶媒腹膜内注射,1次/d。测量并记录3组大鼠平均肺动脉压(mPAP)、右心室肥厚指数(RVHI)、肺小动脉管壁厚度占血管外径的百分比(WT%)、肺小动脉血管壁面积占血管总面积的百分比(WA%)及肺小动脉COX-2平均光密度值(AOD)。应用SPSS 22.0统计软件对数据进行分析。结果与对照组比较,造模组大鼠mPAP、RVHI、WT%、WA%、AOD显著升高;与造模组比较,干预组大鼠上述指标均有不同程度降低,但仍高于对照组,差异均具有统计学意义(P0.001)。相关性分析显示,AOD与mPAP、RVHI、WT%、WA%呈显著正相关(r依次为0.836、0.749、0.823、0.821,P均0.01)。结论 MEL能够降低MCT诱导的PAH大鼠的肺动脉压,改善肺血管重塑,这可能与其抑制COX-2表达水平有关。     

槲皮素对野百合碱诱导的大鼠肺动脉高压的影响

目的:观察槲皮素对野百合碱(MCT)诱导的肺动脉高压大鼠的治疗效果。方法:30只成年雄性SD大鼠随机分成3组:MCT诱导的肺动脉高压组(MCT组)、治疗组和对照组。MCT组和治疗组一次性皮下注射MCT 50mg/kg,饲养21d;对照组一次性皮下注射等量0.9%氯化钠溶液,饲养21d。造模后治疗组以槲皮素100mg.kg-1.d-1灌胃20d;MCT组和对照组以0.9%氯化钠溶液2ml/d灌胃20d。20d后,测定3组大鼠平均肺动脉压(mPAP),计算右心室肥大指数(RVHI);光镜下观察大鼠肺组织形态学的改变及肺血管增殖细胞核抗原(PCNA)增殖度的变化,并计算肺中、小动脉管壁厚度占血管外径的百分比(WT%)和肺动脉管壁面积/管总面积的百分比(WA%)。结果:MCT组的mPAP、RVHI、肺中、小动脉WT%、WA%及PCNA增殖度均显著高于对照组及治疗组。结论:槲皮素可降低MCT所致的大鼠肺血管PCNA表达,抑制MCT诱导的肺部炎症、肺血管重建和肺动脉高压形成,对MCT所致的大鼠肺动脉高压具有治疗作用。     

阿托伐他汀改善野百合碱诱导的慢性肺动脉高压大鼠肺动脉血管重塑与功能

目的探索阿托伐他汀对20mg/kg野百合碱隔周2次腹腔注射诱导的肺动脉高压(PAH)的影响。方法雄性成年SD大鼠96只随机分为3组:空白对照组、PAH组以及阿托伐他汀组。在第0周(第1天)和第1周末(第8天)以野百合碱(20mg/kg)2次腹腔注射建立大鼠PAH模型。首次腹腔注射的同时,阿托伐他汀组大鼠通过灌胃接受10mg/(kg·d)的阿托伐他汀。第2周和第4周末分别检测平均肺动脉压(mPAP)、右心室肥厚指数(RVHI)、管壁厚度占血管外径百分比(WT%)、管壁面积占血管总面积百分比(WA%)、内皮依赖性舒张功能(EDdR)、非内皮依赖性舒张功能(EDiR)。结果野百合碱腹腔注射后第2周末,3组大鼠mPAP差异无统计学意义;在第4周末,与空白对照组比较,PAH组和阿托伐他汀组mPAP明显升高[mPAP:(33.55±3.47)、(25.46±4.04)比(18.91±2.13)mmHg],但阿托伐他汀组低于PAH组(均P0.05)。野百合碱腹腔注射后的第2周和第4周末,与空白对照组相比,PAH组和阿托伐他汀组WT%、WA%水平较高[第2周:WT%:(42.17±4.12)%、(33.83±1.23)%比(28.95±2.97)%;WA%:(65.91±4.92)%、(58.37±3.42)%比(49.08±2.84)%;第4周:WT%:(55.79±4.15)%、(40.69±2.53)%比(29.38±4.50)%;WA%:(79.75±3.30)%、(64.11±3.18)%比(49.44±6.28)%],但阿托伐他汀组低于PAH组(均P0.05)。同时,阿托伐他汀显著改善野百合碱腹腔注射后大鼠肺小动脉的EDdR和EDiR;但野百合碱腹腔注射和阿托伐他汀治疗后,血管收缩功能未发生改变。结论以20mg/kg野百合碱隔周2次腹腔注射可以建立稳定的PAH模型。阿托伐他汀通过改善肺动脉血管重塑以及血管舒张功能缓解野百合碱诱导的PAH。     

低氧大鼠肺内硝基酪氨酸的变化研究

目的 观察在低氧大鼠肺组织中氧化产物硝基酪氨酸(nitrotryrosine,NT)表达的变化,探讨氧化应激机制在低氧性肺动脉高压形成中的作用.方法 将14只雄性Wistar大鼠随机分为对照组、低氧组.以常压低氧3周制备肺动脉高压模型,测量各组大鼠平均肺动脉压(mean pulmonary arterial pressure,mPAP)和右心肥厚指数(right ventricle hypertrophy index,RVHI);图像技术测定管壁厚度占血管外径的百分比(wall thickness %,WT %)和管壁面积占总面积的百分比(wall area%,WA%);采用免疫组织化学法观察两组大鼠肺小动脉管壁NT的表达.结果 ①低氧组大鼠mPAP(22.84±1.79)mm Hg和RVHI(29.78±1.07)%与对照组mPAP(16.67±0.97)mm Hg和RVHI(24.22±0.48)%相比,差异有统计学意义(P均＜0.01).②低氧组WT%(24.96±3.70)%和WA%(73.31 ±6.51)%与对照组WT%(14.19±2.61)%和WA%(46.67±7.42)%相比,差异有统计学意义(P均＜0.01).③低氧组大鼠近端肺小动脉管壁的NT染色强度(1.52±0.07)与对照组(1.00±0.00)相比,差异有统计学意义(P＜0.01).两组大鼠远端肺小动脉管壁NT染色强度无明显变化(P＞0.05).低氧组大鼠近端肺小动脉管壁NT表达强度与mPAP值呈正相关(r=0.867,P＜0.05).结论 低氧可诱导大鼠mPAP增高及肺组织内NT产生增加,其作用机制可能与低氧诱导氧化应激有关.     

人源性脐带间充质干细胞治疗实验性肺动脉高压所致右心衰竭的疗效观察

目的 拟通过建立MCT诱导的PAH大鼠模型,观察人脐带间充质干细胞（UC-MSCs）干预对大鼠PAH和右心衰竭的治疗效应。方法 实验动物分为3组（空白对照组、PAH组和UC-MSCs组）,在MCT腹腔注射1周后进行干预,UC-MSCs组舌下静脉注射UC-MSCs悬液,空白对照组和PAH组舌下静脉注射等量生理盐水。第4周大鼠行右心超声心动图、右心导管测压、右心肥厚指数以及肺组织病理等检测。结果 与对照组相比,PAH组大鼠右心室游离壁厚度(RVWT)和右心室内径(RVID)显著增大,肺动脉血流加速时间与射血时间比值（PAT/PET）显著下降,右心收缩压（RVSP）和右心肥厚指数(RVHI)显著增高,肺小动脉血管壁厚度（WT）明显增厚。与PAH组相比,UC-MSCs组RVWT和RVID显著减小,PAT/PET明显升高,RVSP和RVHI明显降低,WT明显变薄。结论 利用MCT腹腔注射成功制备PAH大鼠模型,经舌下静脉注射UC-MSCs可以显著降低肺动脉压力,改善右心功能,逆转肺血管重构。     

槲皮素对肺动脉高压大鼠肺动脉平滑肌细胞凋亡和结构重建的影响

目的探讨槲皮素对肺动脉高压的预防及治疗作用。方法将成年雄性SD大鼠40只随机分为模型组、预防组、治疗组及对照组各10只。前三组采用野百合碱(MCT)诱导制作肺动脉高压模型,对照组注射等量生理盐水。制模后模型组及对照组予生理盐水2 mL/d灌胃,预防组制模同时、治疗组制模20 d予槲皮素100 mg/(kg.d)灌胃,均为20 d。干预后测定各组平均肺动脉压力(mPAP)、肺小动脉管壁厚度(WT)占动脉外径(ED)的百分比(WT%)及管壁面积(WA)占血管总面积的百分比(WA%);采用免疫组化和Western blot法检测肺小动脉平滑肌细胞Bcl-2表达。结果与对照组、预防组和治疗组比较,模型组mPAP、WT%、WA%和Bcl-2%显著升高(P<0.05),Bcl-2的表达显著增多(P<0.05)。结论槲皮素对MCT诱导的大鼠肺动脉高压有预防和治疗作用,其机理可能是通过下调肺血管中小动脉平滑肌细胞Bcl-2表达,促进细胞凋亡,改善肺血管重构。     

内皮祖细胞移植对肺动脉高压大鼠血流动力学及肺血管结构的影响

目的 探讨大鼠内皮祖细胞(EPC)移植对野百合碱(MCT)所致大鼠肺动脉高压(PAH)的血流动力学及肺血管结构的影响.方法 体外培养,鉴定EPCs.用MCT诱发的PAH模型组(n=11)大鼠,由尾静脉注入标记的EPC,移植第21天测定肺血流动力学参数,计算平均肺动脉压(MPAP),右心指数.观察EPCs移植后分化为血管内皮细胞的能力及肺血管结构变化.结果 移植EPC 3周后,荧光显微镜观察部分标记的EPCs分化为血管内皮细胞.与模型组相比,EPC治疗组(n=10)MPAP明显下降[(25.9±0.7)比(29.35±2.2)mmHg,P<0.05],右心指数明显下降(0.43±0.04比0.49±0.05,P<0.05),肺小动脉厚度指数[WT%:(17.7±3.8)%比(29.8±4.3)%]和面积指数[WA%:(54.6±3.9)%比(74.8±4.5)%]明显下降(P均<0.05).结论 同种异体EPC移植可有效降低肺动脉压力,肺动脉血管壁厚度指标和面积指数,改善右心肥厚.作用机制尚需进一步研究.     

内皮祖细胞移植对肺动脉高压大鼠血流动力学及肺血管结构的影响

目的探讨大鼠内皮祖细胞(EPC)移植对野百合碱(MCT)所致大鼠肺动脉高压(PAH)的血流动力学及肺血管结构的影响。方法体外培养,鉴定 EPCs。用 MCT 诱发的 PAH 模型组(n=11)大鼠,由尾静脉注入标记的 EPC,移植第21天测定肺血流动力学参数,计算平均肺动脉压(MPAP),右心指数。观察 EPCs 移植后分化为血管内皮细胞的能力及肺血管结构变化。结果移植 EPC 3周后,荧光显微镜观察部分标记的 EPCs 分化为血管内皮细胞。与模型组相比,EPC 治疗组(n=10)MPAP 明显下降[(25.9±0.7)比(29.3±2.2)mmHg,P<0.05],右心指数明显下降(0.43±0.04比0.49±0.05,P<0.05),肺小动脉厚度指数[WT%:(17.7±3.8)%比(29.8±4.3)%]和面积指数[WA%:(54.6±3.9)%比(74.8±4.5)%]明显下降(P 均<0.05)。结论同种异体 EPC 移植可有效降低肺动脉压力,肺动脉血管壁厚度指标和面积指数,改善右心肥厚。作用机制尚需进一步研究。     

Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension

Background: Determination of pulmonary vascular resistance (PVR) in patients with suspected or known pulmonary hypertension (PH) requires right heart catheterization. Our purpose was to use Doppler echocardiography to estimate PVR in patients with PH. Methods: Patient population consisted of 52 patients (53 ± 12 years; 35 females) who underwent Doppler echocardiography and right heart catheterization within 24 hours of each other. The ratio of peak tricuspid regurgitation velocity (TRV) and right ventricular outflow time-velocity integral (VTI_RVOT) was measured via transthoracic echocardiography and correlated to invasively determined PVR. A linear regression equation was generated to determine PVR by echocardiography based upon the TRV/VTI_RVOT ratio. PVR by echocardiography was compared to invasive PVR using Bland-Altman analysis. Results: Significant correlation was demonstrated between TRV/VTI_RVOT and PVR by catheterization (r = 0.73; P < 0.001). However, Bland-Altman analysis showed that agreement between PVR determined by echocardiography and invasive PVR was poor (bias = 0; standard deviation = 4.3 Wood units). In a subset of patients with invasive PVR < 8 Wood units (26 patients), correlation between TRV/VTI_RVOT and invasive PVR was strong (r = 0.94; P < 0.001). In these patients, agreement between PVR by echocardiography and invasive PVR was satisfactory (bias = 0; standard deviation = 0.5 Wood units). There was no correlation between TRV/VTI_RVOT and invasive PVR in patients with PVR > 8 Wood units (n = 26; r = 0.17). Conclusion: While TRV/VTI_RVOT correlates significantly with PVR, using it to estimate PVR in a PH patient population cannot be recommended.     

Balloon Pulmonary Angioplasty in Patients With Thromboembolic Pulmonary Hypertension

Purpose of review

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of precapillary pulmonary hypertension. Although pulmonary endarterectomy (PEA) is the preferred management strategy, a significant number of CTEPH patients will have an inoperable disease. As drug therapy is not expected to offer relief from the mechanical component of the disease, the novel technique of balloon pulmonary angioplasty (BPA) has provided a new therapeutic option for patients with inoperable CTEPH. This review will discuss the contemporary use of BPA technique in inoperable CTEPH patients highlighting the effectiveness and safety of this therapeutic option.

Recent findings

Data supporting the role of BPA in inoperable CTEPH are limited to observational studies. However, these observational studies report consistent findings that BPA results in marked improvements in pulmonary hemodynamics and exercise capacity indicating its efficacy and safety as a treatment strategy in inoperable CTEPH patients.

Summary

Summarizing, BPA is an emerging treatment option providing marked improvements in parameters affecting the outcome of CTEPH patients, but multicenter studies are needed to confirm the safety and the long-term efficacy of the procedure, before BPA can be recommended as an established treatment for CTEPH.

     

Partitioning of Pulmonary Vascular Resistance in Primary Pulmonary Hypertension

Objectives. This study sought to determine the site of increased pulmonary vascular resistance (PVR) in primary pulmonary hypertension by standard bedside hemodynamic evaluation.Background. The measurement of pulmonary vascular pressures at several levels of flow (Q) allows the discrimination between active and passive, flow-dependent changes in mean pulmonary artery pressure (Ppa), and may detect the presence of an increased pulmonary vascular closing pressure. The determination of a capillary pressure (Pc′) from the analysis of a Ppa decay curve after balloon occlusion allows the partitioning of PVR in an arterial and a (capillary + venous) segment. These approaches have not been reported in primary pulmonary hypertension.Methods. Ppa and Pc′ were measured at baseline and after an increase in Q induced either by exercise or by an infusion of dobutamine, at a dosage up to 8 μg/kg body weight per min, in 11 patients with primary pulmonary hypertension. Reversibility of pulmonary hypertension was assessed by the inhalation of 20 ppm nitric oxide (NO), and, in 6 patients, by an infusion of prostacyclin.Results. At baseline, Ppa was 52 ± 3 mm Hg (mean value ± SE), Q 2.2 ± 0.2 liters/min per m², and Pc′ 29 ± 3 mm Hg. Dobutamine did not affect Pc′ and allowed the calculation of an averaged extrapolated pressure intercept of Ppa/Q plots of 34 mm Hg. Inhaled NO had no effect. Prostacyclin decreased Pc′ and PVR. Exercise increased Pc′ to 40 ± 3 mm Hg but did not affect PVR.Conclusions. These findings are compatible with a major increase of resistance and reactivity at the periphery of the pulmonary arterial tree.     

Unfavourable Effect of Pulmonary Arterial Dilatation in Pulmonary Hypertension

No abstract available.     

Chymase在肺动脉高压疾病的肺动脉重构中的表达

目的探讨了慢性香烟暴露诱导的PAH病变过程中仓鼠肺组织chymase的表达变化。方法将12只雄性仓鼠随机分为：对照组、香烟暴露组;仓鼠暴露于香烟烟雾中4个月建立肺动脉高压模型;免疫组织化学染色法检测肺小动脉中chymase的蛋白表达。结果Chymase在香烟暴露组仓鼠的肺小动脉中的表达增加,尤其在肺小动脉外膜及增生的内皮细胞中,染色呈强阳性。结论随着肺结构的改变,香烟暴露可刺激chymase的表达增加,表明chymase在PAH中肺小动脉的重构病变中起作用,因此,抑制chymase的形成将有助于阻止香烟诱导的肺动脉高压疾病的发生、发展。     

Pulmonary Artery Pulse Wave Velocity in Idiopathic Pulmonary Arterial Hypertension

Background

Idiopathic pulmonary artery (PA) hypertension (IPAH) is associated with severe PA remodelling. Although the resulting increase in pulse wave velocity (PWV) might be of major pathophysiological relevance, little is known about PA-PWV in IPAH. The aim of this study was to characterize PA-PWV and its predictors in patients with IPAH.

Methods

We studied 26 consecutive patients with incident IPAH aged 55.0 (45.0-66.0) years (62% female) and 10 control subjects without pulmonary hypertension. PA-PWV was measured invasively; PA wall thickness and diameter were assessed using intravascular and transthoracic ultrasonography.

Results

PA-PWV was higher in IPAH than in control subjects (10.0 [7.5-14.0] m/s vs 3.5 [1.9-4.0] m/s; P < 0.001) as was also PA diameter and PA wall thickness. In IPAH patients, in univariate analysis PA-PWV was greater in men than in women and in patients with body mass index (BMI) < 25 kg/m² than with BMI ≥ 25 kg/m² and correlated positively with symptomatic disease duration, mean PA pressure, pulmonary vascular resistance, creatinine level, and negatively with low-density lipoprotein (LDL) cholesterol and triglyceride level but not with PA diameter or PA wall thickness. In multiple regression analysis mean PA pressure, LDL cholesterol level and BMI < 25 kg/m² were the main predictors of PA-PWV in IPAH patients (R² = 77%; P < 0.001).

Conclusions

PA-PWV is increased in IPAH patients. High PA pressure, low LDL cholesterol level, and BMI < 25 kg/m² explain most of its variability in this group.     

Pulmonary Artery Elastic Properties After Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

Background

A significant proportion of the right ventricular afterload is determined by the elastic properties of the pulmonary artery (PA). We aimed to assess the effect of balloon pulmonary angioplasty (BPA) on PA elastic properties in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

Pulmonary Artery Sarcoma Mimicking Pulmonary Embolism

Primary sarcomas that arise from major blood vessels are exceedingly rare, and some of the published cases have been autopsy reports. Most patients are adults. We report a case of pulmonary artery sarcoma in a 77-year-old man who presented with acute onset of dyspnea. Magnetic resonance imaging of the chest revealed a large mass within the pulmonary trunk and its main branches. Because massive pulmonary embolism was suspected, both anticoagulant and thrombolytic therapies were initiated. The patient responded poorly to these therapies, which then necessitated resection of both the mass and the pulmonary valve. A bioprosthetic porcine valve replaced the native valve, and we reconstructed the right ventricular outflow tract with a Dacron patch. Histopathologic examination revealed a high-grade sarcoma with focal myogenic and chondrogenic differentiation. The patient tolerated the procedure well and was discharged from the hospital on postoperative day 7. He was subsequently treated with chemotherapy and radiation and continued to show no evidence of disease.The diagnosis of pulmonary artery sarcoma should be suspected in patients who present with manifestations of pulmonary embolism, especially when there is no evidence of deep venous thrombosis and poor response to anticoagulant therapy. Multimodal therapy can provide prolonged survival.