-
Interactive Cardiovascular and Thoracic... Nov 2020We aimed to describe the anatomic distribution of periarterial pulmonary sympathetic nerves and to observe the long-term morphometric and functional changes after...
OBJECTIVES
We aimed to describe the anatomic distribution of periarterial pulmonary sympathetic nerves and to observe the long-term morphometric and functional changes after pulmonary artery denervation (PADN), a novel therapy for pulmonary arterial hypertension (PAH).
METHODS
A total of 45 beagles were divided into a sympathetic innervation group (n = 3, 33.3% were females), a PAH group (n = 35, 34.3% were females) and a control group (n = 7, 28.5% were females). The PAH group was randomly divided into no-PADN (n = 7), instant-PADN (n = 7), 1M-PADN (n = 7), 2M-PADN (n = 7) and 3M-PADN (n = 7) subgroups. The sympathetic innervation group was sacrificed to reveal the sympathetic innervation of pulmonary arteries. PAH was induced by injecting dehydromonocrotaline (DHMCT) through the right atrium. The pulmonary capillary wedge pressure, right ventricular systolic pressure, right ventricular mean pressure, pulmonary artery systolic pressure and pulmonary artery mean pressure of each group were continuously measured. The cardiac output was detected to calculate the pulmonary vascular resistance. PAH and control groups were subjected to immunofluorescence assay, sympathetic nerve conduction velocity measurement and transmission electron microscopy.
RESULTS
The no-PADN group had significantly higher PVSP, PVMP, pulmonary artery systolic pressure, pulmonary artery mean pressure and pulmonary vascular resistance but lower cardiac output than those of the control group (P < 0.05). Instant-PADN, 1M-PADN, 2M-PADN and 3M-PADN groups had significantly lower PVSP, PVMP, pulmonary artery systolic pressure, pulmonary artery mean pressure and pulmonary vascular resistance but higher cardiac output than those of the no-PADN group (P < 0.05). Most sympathetic nerves were located within 2.5 mm of the intimae of the bifurcation and proximal trunk, mainly in the left trunk. The diameter and cross-sectional area of myelinated fibres in the PAH group were significantly larger than those of the control group. Sympathetic nerve conduction velocity of the PAH group gradually decreased, and nerve fibres were almost demyelinated 3 months after PADN.
CONCLUSIONS
PADN effectively relieved dehydromonocrotaline-induced canine PAH and decreased sympathetic nerve conduction velocity.
Topics: Animals; Disease Models, Animal; Dogs; Hypertension, Pulmonary; Lung; Monocrotaline; Pulmonary Artery; Sympathectomy; Sympathetic Nervous System; Vascular Resistance
PubMed: 33057705
DOI: 10.1093/icvts/ivaa166 -
BMC Pulmonary Medicine Dec 2021Mechanisms of positive effects of pulmonary artery (PA) denervation (PADN) remain poorly understood. The study aimed to evaluate pulmonary hemodynamic changes after PADN... (Comparative Study)
Comparative Study
BACKGROUND
Mechanisms of positive effects of pulmonary artery (PA) denervation (PADN) remain poorly understood. The study aimed to evaluate pulmonary hemodynamic changes after PADN and their association with the extent of PA wall damage in an acute thromboxane A2 (TXA2)-induced pulmonary hypertension (PH) model in swine.
METHODS
In this experimental sham-controlled study, 17 normotensive male white Landrace pigs (the mean weight 36.2 ± 4.5 kg) were included and randomly assigned to group I (n = 9)-PH modeling before and after PADN, group II (n = 4)-PADN only, or group III (n = 4)-PH modeling before and after a sham procedure. Radiofrequency (RF) PADN was performed in the PA trunk and at the proximal parts of the right and left PAs. PA wall lesions were characterized at the autopsy study using histological and the immunohistochemical examination.
RESULTS
In groups I and II, no statistically significant changes in the mean pulmonary arterial pressure nor systemic blood pressure were found after PADN (-0.8 ± 3.4 vs 4.3 ± 8.6 mmHg, P = 0.47; and 6.0 ± 15.9 vs -8.3 ± 7.5 mmHg, P = 0.1; correspondingly). There was a trend towards a lower diastolic pulmonary arterial pressure after PADN in group I when compared with group III during repeat PH induction (34.4 ± 2.9 vs 38.0 ± 0.8; P = 0.06). Despite the presence of severe PA wall damage at the RF application sites, S100 expression was preserved in the majority of PA specimens. The presence of high-grade PA lesions was associated with HR acceleration after PADN (ρ = 0.68, p = 0.03). No significant correlation was found between the grade of PA lesion severity and PA pressure after PADN with or without PH induction.
CONCLUSIONS
Extended PADN does not affect PH induction using TXA2. Significant PA adventitia damage is associated with HR acceleration after PADN. Possible delayed effects of PADN on perivascular nerves and pulmonary hemodynamics require further research in chronic experiments.
Topics: Animals; Blood Pressure; Catheter Ablation; Denervation; Disease Models, Animal; Hemodynamics; Hypertension, Pulmonary; Male; Pulmonary Artery; Swine
PubMed: 34922518
DOI: 10.1186/s12890-021-01786-y -
Seminars in Thoracic and Cardiovascular... 2021
Topics: Carotid Stenosis; Humans; Pulmonary Artery
PubMed: 33171238
DOI: 10.1053/j.semtcvs.2020.10.010 -
General Thoracic and Cardiovascular... Jan 2023The right B downwards-shifting malformation is rare. This malformation often leads to the following complications: abnormal pulmonary arteries that accompany the...
The right B downwards-shifting malformation is rare. This malformation often leads to the following complications: abnormal pulmonary arteries that accompany the downward-displaced B, and complete fusion of the upper and middle lobes into one lobe, with no horizonal fissure. When performing pulmonary anatomical resection in the right upper or middle lobes in patients with this malformation, careful preoperative planning and surgical technique are required, with which the surgeon should be familiar. Herein, we present the anatomical features necessary for anatomical resection of the right B downwards-shifting malformation based on our technical experiences with anatomic segmentectomy and lobectomy techniques.
Topics: Humans; Pneumonectomy; Lung; Lung Neoplasms; Pulmonary Artery
PubMed: 36301486
DOI: 10.1007/s11748-022-01884-6 -
Asian Journal of Surgery Aug 2023
Topics: Humans; Pulmonary Artery; Aneurysm
PubMed: 36878779
DOI: 10.1016/j.asjsur.2023.02.083 -
Asian Cardiovascular & Thoracic Annals Mar 2022Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal...
Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal ductus is absent, the large right ventricular stroke volume dilates the pulmonary trunk leading to pulmonary regurgitation. A proximal extension of the embryonic insult to the entire left sixth arch causes absence of the left pulmonary artery, a common association of absent pulmonary valve syndrome. On the contrary, absence of right pulmonary artery is not reported in absent pulmonary valve syndrome. A rare combination of tetralogy, absent pulmonary valve syndrome and isolation of a hypoplastic right pulmonary artery offered challenges to diagnosis and management.
Topics: Humans; Pulmonary Artery; Pulmonary Atresia; Pulmonary Valve; Tetralogy of Fallot; Treatment Outcome
PubMed: 33789442
DOI: 10.1177/02184923211006309 -
Journal of the College of Physicians... Dec 2022To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary...
OBJECTIVE
To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary artery (mPA) diameter, calculated by computed tomography (CT).
STUDY DESIGN
A descriptive cross-sectional study.
PLACE AND DURATION OF STUDY
Department of Radiology, Balikesir University School of Medicine, Turkey, from February to December 2020.
METHODOLOGY
After excluding the cases with suspected COVID-19 from the cases sent to the Radiology Department for chest CT exams with the mPA included in the cross-sections, the volunteers were evaluated with PW-DUS. The study group consisted of 66 cases. Two radiologists measured the velocity values of the A, S, and D waves in the recorded PW Doppler spectra. HVIs (A/S, A/S+D, A/A+S+D) were calculated. The mPA diameter was calculated in the axial plane from the pulmonary trunk, 1cm proximally to the bifurcation manually on the workstation. The correlation between the HIVs and mPA diameter was evaluated. Interoperator reliability was also analysed.
RESULTS
Thirty-nine males (59%) and 27 (41%) females were included in the study group. The mean HVI values were 0.50 ±0.20, 0.28 ±0.12, and 0.21 ±0.07 for A/S, A/A+S, and A/A+S+D, respectively. The mean mPA diameter was 24.0 ±3.3 mm. Correlation analysis determined that the HVIs were positively correlated with mPA diameter (r=0.730-0.765-0.751, p<0.001). Inter-observer correlation coefficients were found to be compatible between two radiologists.
CONCLUSION
A significant and strong correlation was found between HVIs and mPA diameter. The mPA diameter that reflects the pulmonary artery systolic pressure (PAP) increased as the HVIs increased. Therefore, PW-DUS may be helpful to evaluate PAP as a quantitative method that is cost-effective, easily accessible and radiation-free.
KEY WORDS
Hepatic veins, Pulmonary artery, Multidetector computed tomography, Pulmonary hypertension, Pulsed doppler ultrasonography.
Topics: Humans; Hepatic Veins; Pulmonary Artery; Cross-Sectional Studies; Reproducibility of Results; COVID-19
PubMed: 36474369
DOI: 10.29271/jcpsp.2022.12.1529 -
Cardiology in the Young Sep 2023Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this... (Review)
Review
Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this is multifactorial and related to the anterior shift of the pulmonary trunk during the LeCompte manoeuvre, the complex suture line required to fill the gaps after harvesting the coronary arteries, and the need for patch implantation to maintain a tensionless anastomosis.We reviewed all patients with transposition of the great arteries operated on at our institute between 1991 and 2020 to establish the frequency of pulmonary stenosis during post-operative follow-up, reinterventions, and reoperations related to pulmonary stenosis and its potential risk factors.During the analysed period, we performed 848 arterial switch operations for simple and complex cases of transposition of the great arteries. The overall early mortality was 6.96%, and the late mortality was 2.53%. Among all study groups, 243 (28.66%) patients developed mild pulmonary stenosis, 43 patients (5.07%) developed moderate, and 45 patients (5.31%) developed severe pulmonary stenosis. During follow-up, 21 patients required interventions related to pulmonary stenosis. Pulmonary reconstruction with patches, aortic arch anomalies, and ventricular septal defects associated with transposition of the great arteries were significant risk factors. Nine patients required reoperation because of pulmonary artery stenosis with patch reconstruction of the pulmonary artery, aortic arch anomalies, and aortic cross-clamping time, increasing the risk of reoperation.Pulmonary stenosis in patients with transposition of the great arteries after the arterial switch operation is a common complication. If significant, it occurs early after surgery and is the most frequent reason for post-operative interventions and reoperations.
Topics: Humans; Arterial Switch Operation; Transposition of Great Vessels; Pulmonary Valve Stenosis; Pulmonary Artery; Prognosis; Reoperation; Postoperative Complications; Follow-Up Studies; Treatment Outcome
PubMed: 36040409
DOI: 10.1017/S1047951122002670 -
Journal of Medical Case Reports Apr 2021Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac...
BACKGROUND
Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity.
CASE PRESENTATION
A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 37 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation.
CONCLUSION
There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.
Topics: Adult; Cesarean Section; Female; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Pregnancy; Pulmonary Artery; Pulmonary Atresia
PubMed: 33812372
DOI: 10.1186/s13256-021-02750-4 -
General Thoracic and Cardiovascular... Aug 2020A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the...
A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the bilateral pulmonary branch (maximum diameter 6.4 cm) of the artery. Echocardiography revealed moderate pulmonary valve (PV) regurgitation with right ventricle dilatation. Surgery was indicated because of the pulmonary aneurysm and dyspnea on exertion due to moderate PV regurgitation. Intra-operatively, two cusps were found to be normal in shape, whereas a third left-facing cusp was thick and resembled a small ridge. Therefore, we created one neo-cusp with autologous pericardium using a custom-made template and sutured it along a new, predetermined annulus. We then replaced the pulmonary aneurysm with a T-shaped artificial graft. Postoperative echocardiography showed satisfactory movement of the neo-cusp without pulmonary regurgitation and reduced right ventricular size.
Topics: Aneurysm; Echocardiography; Heart Defects, Congenital; Heart Ventricles; Humans; Male; Middle Aged; Pericardium; Pulmonary Artery; Pulmonary Valve; Pulmonary Valve Insufficiency; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32040820
DOI: 10.1007/s11748-020-01315-4