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Objective To investigate the therapeutic effect of the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations.Methods Retrospective analysis of 6 Fontan surgical patients, 4 males and 2 females, who received surgical treatment in the cardiothoracic surgery of Shanghai Children's Medical Center from May 2016 to August 2018;Age(5.7 ±2.9) years;(19.8 ±5.5) kg weight.All 6 patients were treated with primary pulmonary artery banding operation and secondary bilateral Glenn operation(BDG) and re-PAB.Before Fontan surgery, cardiac catheterization was performed in the department of cardiology to close the antegrade pulmonary blood flow .Results These six patients received interventional therapy in the department of cardiology.The mean pulmonary artery pressure(Pp) before occlusion was(17.0 ±0.8) mmHg (1 mmHg=0.133 kPa), the ventricular diastolic pressure(VEDP) was (11.2 ±0.9) mmHg, and the mean pulmonary artery pressure after occlusion was effectively decreased to(14.2 ±0.7) mmHg and VEDP to(9.7 ±0.7) mmHg.Fontan surgery was performed 6 to 12 months after the occlusion.No death was found after the operation, and all the clinical indicators were normal after the operation.Follow-up was conducted for 2-24 months, and the cardiac function and the function of each organ recov-ered well.Conclusion For some patients with high risk Fontan before operation , this method can safely and effectively reduce the average pulmonary artery pressure and reduce the ventricular and pulmonary vascular load , which is of positive help for the successful Fontan operation.
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AIM: To explore the regulatory effect of adrenomedullin (ADM) on pulmonary oxidative stress in the rats with pulmonary hypertension induced by high blood flow.METHODS: Healthy male SD rats (n=22) were randomly divided into control group, shunt group and shunt with ADM group.Abdominal aorta and inferior vena cava shunting was produced in the rats in shunt group and shunt with ADM group.After 8 weeks, ADM (1.5 μg·kg-1·h-1) was administered into the rats in shunt with ADM group subcutaneously by mini-osmotic pump for 2 weeks.Mean pulmonary artery pressure (mPAP) was evaluated by a right cardiac catheterization procedure.The ratio of right ventricular mass to left ventricular plus interventricular septal mass [RV/(LV+SP)] and relative medial thickness (RMT) in pulmonary muscularized arteries were calculated.The content of malonaldehyde (MDA), total antioxidative capacity (T-AOC), and activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in lung tissues were detected by colorimetry.The expression of NADPH oxidase 4 (NOX4) in the lung tissue was analyzed by Western blot.RESULTS: Compared with control group, the mPAP, RV/(LV+SP) and RMT in pulmonary muscularized arteries in shunt group were all significantly increased.The content of MDA and the expression of NOX4 in the lung tissues were significantly increased.The T-AOC, and activity of SOD and GSH-Px in the lung tissues were significantly decreased.However, mPAP, RV/(LV+SP) and RMT in pulmonary muscularized arteries in shunt with ADM group were significantly decreased as compared with shunt group.Meanwhile, ADM decreased the content of MDA and the expression of NOX4 in the lung tissues, but increased the T-AOC, and activity of SOD and GSH-Px in the lung tissue of shunt rats.CONCLUSION: ADM inhibits oxidative stress response in the development of pulmonary hypertension and pulmonary vascular structural remodeling induced by high pulmonary blood flow in the rats by down-regulating the NOX4 expression and strengthening the anti-oxidation response.
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We report a rare complication of massive aneurysm of the proximal ligated end of the main pulmonary artery which occurred in the setting of a patient with a functionally univentricular heart and increased pulmonary blood flow undergoing superior cavopulmonary connection. Awareness of this possibility may guide others to electively transect the pulmonary artery in such a clinical setting
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Objective To investigate the effects of calcium - dependent and calcium - independent in myosin light chain(MLC)dephosphorylation on pulmonary hemodynamics and right ventricular remodeling,and to observe whether there is a superimposition effect while intervention is conducted in two ways at the same time. Methods Ac-cording to random number table,50 rats were divided into 5 groups:sham operation group,model group,3 mg/(kg·d) ML - 7[MLC kinase(MLCK)inhibitor]treating group(M group),20 mg/(kg·d)Fasudil(Rho kinase inhibitor) treating group(F group)and 3 mg/(kg·d)ML - 7 plus 20 mg/(kg·d)Fasudil treating group(M + F group). The shunt between the abdominal aorta and inferior vena cava was used to establish rat models of pulmonary hypertension in-duced by high pulmonary flow in group of C and the experimental groups. The sham operation group was given a sham operation. MLCK and Rho kinase inhibitor were administrated intraperitoneally to rats with the shunt. After 8 weeks of shunting,mean right ventricular pressure(MRVP),mean pulmonary arterial pressure(MPAP),right ventricular hyper-trophy index(RVHI)and width of inferior venacava were evaluated by the right cardiac catheterization procedure. Results Compared with the sham operation group,MRVP,MPAP,and RVHI were obviously elevated in the model group [(2. 65 ±0. 57)kPa vs(4. 19 ±0. 67)kPa;(2. 42 ± 0. 48)kPa vs(4. 04 ± 0. 61)kPa,F = 295. 368,263. 912,all P ﹤0. 01;(0. 21 ±0. 01)g/ g vs(0. 41 ±0. 03)g/ g,F =247. 024,P ﹤0. 01]. Compared with model group,the MRVP,MPAP and RVHI in M group and F group were decreased significantly[(3. 51 ± 0. 47)kPa vs(4. 19 ± 0. 67)kPa;(3. 68 ± 0. 55)kPa vs(4. 19 ±0. 67)kPa,all P ﹤0. 01;M group:(0. 29 ±0. 02)g/ g,model group:(0. 41 ± 0. 03)g/ g,F group (0. 30 ±0. 03)g/ g,F =247. 024,P ﹤0. 05]. But the MRVP,MPAP and RVHI in M group and F group were higher than those of rats in the sham operation group. The MRVP,MPAP and RVHI of M + F group were elevated much obviously compared with those of the M or F group(P ﹤0. 05). Conclusions The calcium - dependent and calcium - independent in MLC dephosphorylation can respectively restrain the development of pulmonary hypertension and right ventricular re-modeling,and the obvious additive effect can be observed when the 2 drugs are used jointly.
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Objective To study the pulmonary interstitial changes in pulmonary hypertension induced by high pulmonary blood flow.Methods Sixty-five male or female Sprague-Dawley rats (180-230 g) were used and randomly divided into 3 groups:normal group (n =20) ; sham group (n =20),only exposing the abdominal aorta and inferior vena cava about 10-20 minutes;model group(n =25),rats in this group were subjected to an abdominal aorta-inferior vena cava shunt to create animal models of high pulmonary.After operation,all the rats were reared under the same conditions for 11 weeks.Then,the systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) of every rat were determined by means of homemade right heart catheterization.After that,the right ventricle (RV) was separated from the left ventricle (LV) and septum (S),then weighed.And right ventricular hypertrophy index (RVHI) was measured by the ratio of RV to LV + S [RV/(LV + S)].In addition,the morphological changes of pulmonary interstitial of rats were observed under optical microscope by means of hematoxylin-eosin (HE) staining.In the end,single pulmonary artery smooth muscle cell (PASMC) was isolated through acute enzyme separation.Then membrane capacitance (Cm) was recorded through in the method of patch clamp technique.Results 1.Compared with sham group and normal group,the sPAP,mPAP and RVHI of model group increased significantly(F =17.293,16.259,12.878,all P ＜ 0.01).2.In contrast to sham group and normal group,arterial wall area/vessel area(W/V) and arterial wall thickness/vessel external diameter(T/D) in model group increased significantly(F =85.717,22.795,all P ＜0.01).3.The membrane capacitance of model group was bigger than that of sham group and normal group(F =8.704,P ＜ 0.01).4.mPAP was positively correlated with W/V,T/D and Cm (r =0.669,0.662,0.663,all P ＜ 0.01).Conclusions Shunts from abdominal aorta-inferior vena cava in SD rats caused high pulmonary blood flow-induced pulmonary hypertension,and these rats appeared with pulmonary smooth muscle cells hypertrophy,pulmonary vascular wall thickening and inflammatory cells infiltration.
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[ ABSTRACT] AIM:To explore the regulatory effect of intermedin ( IMD) on pulmonary collagen synthesis and ac-cumulation in rats with pulmonary hypertension induced by high pulmonary blood flow.METHODS: Healthy male SD rats (n=20) were randomly divided into control group (n=7), shunt group (n=7) and shunt with IMD group (n=6).The shunting of abdominal aorta and inferior vena cava was produced in rats of shunt group and shunt with IMD group.After 8 weeks, IMD was administered into the rats of shunt with IMD group subcutaneously by mini-osmotic pump for 2 weeks.Mean pulmonary artery pressure (mPAP), relative medial thickness (RMT) of pulmonary arteries, contents of hydroxyproline, collagen type I and III, bone morphogenetic protein-2 (BMP-2), and the mRNA expression of procollagen I and III in lung tissues were measured and compared.RESULTS:Compared with control group, mPAP and RMT of medium and small pul-monary arteries in the rats of shunt group were significantly increased.Meanwhile, the lung hydroxyproline, collagens I and III and BMP-2 contents, and the mRNA expression of lung procollagen I and III were all significantly increased compared with control group.However, IMD significantly decreased mPAP, alleviated the changes of pulmonary vascular micro-struc-ture, decreased the collagen accumulation and pulmonary tissue homogenate BMP-2 contents, and inhibited the mRNA ex-pression of procollagen I and III in the lung tissue of shunting rats.CONCLUSION:IMD plays a protective role in the de-velopment of pulmonary hypertension and pulmonary vascular structural remodeling induced by high blood flow by inhibiting pulmonary collagen synthesis and accumulation, possibly in association with the BMP-2 pathway.
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Objective To study the effect of chloride channel blocker(niflumic acid,NFA) on pulmonary hypertension induced by high pulmonary blood flow in rats.Methods Fifty male or female Sprague-Dawley rats were randomly divided into 5 groups:normal group,sham group,model group,drug 1 group,and drug 2 group,with 10 rats in each group.After subjected to an abdominal aorta-inferior vena cava shunt,all the rats were reared under the same condition for 11 weeks.Then,mean pulmonary artery pressure(mPAP) and right ventricular hypertrophy index(RVHI) of each rat were measured.In addition,arterial wall area/vessel area (W/V) and arterial wall thickness/vessel external diameter(T/D) of each rat were also measured.Results 1.The mPAP of model group [(25.79 ± 4.03) mmHg,1 mmHg =0.133 kPa] was significantly higher than those of normal group [(16.48 ± 1.70) mmHg],sham group [(17.03 ± 2.01) mmHg],drug 1 group [(21.78 ± 2.77) mmHg] and drug 2 group [(20.31 ± 2.15) mmHg] (F =18.983,P ＜0.01).Although the mPAP of drug 1 group was a little higher than drug 2 group,there was no significant difference (P ＞ 0.05).Compared with normal group and sham group,the mPAP of drug 1 group and drug 2 group increased(P ＜0.01,respectively).2.The W/V and T/D of model group were significantly higher than those of normal group,sham group,drug 1 group and drug 2 group (F =26.135,15.527,all P ＜ 0.001).The W/V and T/D of two drug groups showed no significant difference,but they were higher than those of normal group and sham group (P ＜ 0.01,respectively).Conclusions Chloride channel blocker NFA partly decrease mPAP of pulmonary hypertension indnced by high pulmonary blood flow in rats,and inhibit proliferation of vascular smooth muscle cells.These results suggest that NFA had part of therapeutic effect to pulmonary hypertension induced by high pulmonary blood flow.
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Objective To study the influence of hydrogen sulfide (H2 S)on the mitochondrial function of pulmonary artery smooth muscle cells of the rats with high pulmonary blood flow pulmonary hypertension, and to clarify the function and its mechanism in the occurrence of high pulmonary blood flow pulmonary hypertension.Methods A total of 27 rats were randomly divided sham operation group,operation group,and operation+sodium hydrosulfide (NaHS)group (n=9).The pulmonary hypertension rat model was built by left lung resection.After fed for 35 d, the mean pulmonary artery pressure (mPAP),ratio of right ventricle/body weight (RV/BW),and ratio of right ventricle/(left ventricle+septum)[RV/(LV + S)]of the rats in three groups were measured.The plasma H2 S levels and the CSE activities in pulmonary artery tissue of the rats were detected;the activities of total mitochondrial ATP enzyme,superoxide dismutase (SOD),glutathione peroxidase (GSH-Px)and malondialdehyde (MDA)levels were determined;the ultrastructure of pulmonary artery smooth muscle mitochondria was observed through transmission electron microscope.Results Compared with sham operation group,the plasma H2 S level and the CSE activity in pulmonary artery tissue of the rats in operation group were decreased(P<0.01);the mitochondrial membrane of pulmonary tissue was swelling, and the mitochondrial activity was decreased (P<0.01);the mitochondrial ATP enzyme,SOD and GSH-Px activities were significantly decreased,and the MDA level was significantly increased (P<0.01).Compared with operation group,the H2S level in plasma and the activity of CSE in pulmonary tissue of the rats in operation + NaHS group were increased (P<0.01 );the mitochondrial membrane swelling was reduced, and the vitality was restored;the ATP enzyme, GSH-Px, and SOD level in pulmonary tissue were significantly increased (P<0.01),and the MDA level was significantly reduced (P<0.01).Conclusion H2 S can enhance the activities of mitochondrial ATP enzyme,GSH-Px,and SOD,and decrease the mitochondrial lipid peroxidation level,thus it plays a protective effect on rat pulmonary artery smooth muscle.
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Objective The bidirectional cavopulmonary shunt (BCPS) is a major step in the staged palliation of functionally univentricular heart defects.Whether to preserve of additional pulmonary blood flow (APBF) has been a highly controversial issue.The purpose is to mathematical model and set out to determine the significa advantages and disadvantages of bidirectional cavopulmonary shunt with additional pulmonary blood flow:a theoretical analysis nce of APBF and the appropriate APBF ratio.Methods We used models of the univentricular circulation after the bidirectional cavopulmonary anastomosis with additional pulmonary blood and to computational analyze the impact of APBF on oxygen delivery,APBF flow on the CVP and SaO2.Results The influence of APBF depends on the ratio of superior vena cava flow to inferior vena cava flow ( QSVC/QIVC ).For QSVC/QIVC ＞ 0.3,APBF may be associated with decreased oxygen delivery.For QSVC/QIVC ＜ 0.3,appropriate APBF may be associated with increased oxygen delivery.A linear relationship exists between the increase of APBF and CVP,and the slope was depended on the value of pulmonary vascular resistance.Estimating APBF from CVP measurements may be a feasible method.A nonlinear relationship between the increase of APBF and oxygen saturation,and estimating APBF from SaO2 measurements may result in errors.BCPS and appropriate APBF may optimal the oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who accepted BCPS without APBF,there is a decreasing tendency of oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who suffered pulmonary arterivenous malformation,there is a more obvious decrease in oxygen delivery.ConclusionFor patients under age who has normal pulmonary vascularbed ( that is,QSVC/QVC ＞ 0.3),elimination of additional pulmonary blood flow can improve the oxygen delivery under a given cardiac output.For patients who with hypoplastic pulmonary vascular or in older patients under age,APBF is necessary to improve oxygen delivery.For patients who have to accept BCPS as the final procedure,preserving of APBF is suggested.
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Objective Artificial atrial septum defect combining pulmonary artery banding to create a model of congenital heart defect with decreased pulmonary blood flow to explore the morphological changes of immature pulmonary vascular. Methods Choose twenty piglets with about one to two-month-old, which are exclusively for experiment used. The piglets were randomly divided into three groups: normal control group (group C, n = 6), Small incisions on the right chest, produced a transient reduction in pulmonary blood; low-medium pulmonary artery stenosis groups ( group T1, n = 7 ) : Did artificial room septostomy creation by self-dilators which were delivered into the surface of the right atrium and controlled Systolic trans pulmonary artery banding pressure (Trans-PABP) at pressure of 20 - 30 mmHg; severe pulmonary artery stenosis groups ( group T2, n = 7): T2 were the same surgical procedures with group T1 ,and controlled Trans-PABP ≥ 30 -50 mmHg. Monitored ultrasound after operation , carried out 64-slice computed tomography scanning after one month, to measure the proximal vessel diameter and TransPABP , after two month surgical exploration on the left chest. When the animals were sacrificed, the heart and lung tissue was cut to measure atrial septal defect, pulmonary artery and the banding diameter. By weihgt elastic fiber and van Cieson staining to observe the morphological pathological changes, three groups took lung tissue with right middle lobe lateral segment about 1.0 cm × 0.8 cm × 0.8cm at the end of surgery and 2-months after operation respectively. Results The models were all successfully in the survival animal of the two test groups. One pig died from tracheal intubation accident in the C group, there was one case died due to bowel obstruction in the T1 group, And there were two cases died result from acute right heart failure and chronic heart failure respectively in T2 group. 64-slice CT angiography showed that BD was significantly lower than the AOD in the two test groups, the proximal pulmonary vascular expansion result from stenosis, distal pulmonary vascular scarce. Histopathology showed that the pulmonary artery inside diameter of T1 and T2 was significantly higher than group C(P ＜0. 05,P ＜ 0.01), and the NAPSC of two experimental groups were significantly lower than group C 2-month after operation( P ＜0.01).Conclusion This type of Piglet model is closer to clinical pathological and physiological ,64-slice spiral CT combined with lung histopathology observed for the evaluation of pulmonary vascular hypoplasia is a reliable method. Tunica media of pulmonary arterioles hypoplasia with the number reducing, with pulmonary artery banding increased,the degree of pulmonary arterioles hypoplasia gradually increased.
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Acute viral bronchiolitis (AVB) is an obstructive lung disease which frequently develops in infants and the most common functional involvement is a V/Q ratio change caused by small airway obstruction. We report a case showing the redistribution of pulmonary blood flow by multiple perfusion scan defects in an infant with AVB. A 15 month-old male infant visited ER due to respiratory difficulty. He manifested decreased lung sound in the left lung field, hyperinflation of the left lung on chest x-ray, and metabolic acidosis in blood gas analysis. A perfusion scan showed multiple perfusion defects of both lungs without the evidence of pulmonary embolism on a following cardiac CT and echocardiography. Human Rhinovirus PCR in a nasopharyngeal aspirate was positive. With supportive care, the symptom was resolved in 4 days. AVB can show multiple perfusion defects by the redistribution of pulmonary blood flow of which the direction is opposite to the usual distribution of pulmonary blood flow in children.
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Child , Humans , Infant , Male , Acidosis , Airway Obstruction , Blood Gas Analysis , Bronchiolitis, Viral , Echocardiography , Lung , Lung Diseases, Obstructive , Perfusion , Polymerase Chain Reaction , Pulmonary Embolism , Respiratory Sounds , Rhinovirus , ThoraxABSTRACT
Objective To comprehend the action mechanism of simvastatin in pulmonary hypertension(PH)when it induced by high pulmonary blood flow.Methods Abdominal aorta-inferior vena cava shunting was made in rats to establish animal model of PH induced by high pulmonary blood flow,simvastatin with dose of 2 mg/(kg?d)was used to interfere for 11 weeks.And then,pulmonary arterial pressure,apoptosis rate and proliferation rate of pulmonary vascular smooth muscle cell were determined.Results were compared with other groups.Results Simvastatin could cut down the pulmonary arterial pressure well,pulmonary arterial pressures of simvastatin group rats were lower than those of spliting groups obviously(Pa
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Objective To explore impact of high pulmonary blood flow on the content and metabolism of collagen in rats.Methods Thirty-two male SD rats were randomly divided into shunt group and control group.Rats in shunt group were subjected to an abdominal aorta-inferior vena cava shunt to create an animal model of high pulmonary blood flow.In control group,rats experienced the same expe-rimental processes except the shunting procedure.After 4 and 11 weeks of experiment,these changes of pulmonaryartery collagen Ⅰ,collagen Ⅲ,matrix metalloproteinase(MMP-13)and tissue inhibitor of metalloproteinase(TIMP-1) protein expression of rat were investigated by immunohistochemistry.Results After 4 weeks and 11 weeks of shunt,the collagen Ⅰ,collagen Ⅲ,MMP-13 and TIMP-1 of pulmonary artery in rats of shunt group increased significantly compared with those of control group,respectively(all P
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Objective To explore possible impact of endogenous hydrogen sulfide(H2S) on connective tissue growth factor(CTGF) expression in rat pulmonary artery with high pulmonary blood flow.Methods Thirty-two male SD rats,weighing 120～140 g,were randomly divided into 4 groups:shunt group,shunt+PPG group,sham group and sham+PPG group.After 4 weeks of experiment,Rat lung tissue H2S content was determined by a modified sulfide electrode method.Plasma ET-1 concentration was detected by radioimmunoactivity,and lung tissue ET-1 mRNA expression of rat was determined by quantitative competitive reverse transcriptional polymerase chain reaction(RT-PCR).Pulmonary artery connective tissue growth factor(CTGF) protein expression of rats was investigated by immunohistochemistry.Results After 4 weeks of experiment,lung tissue H2S content plasma ET-1,lung tissue ET-1 mRNA and CTGF expression increased significantly in rats of shunt group as compared with that of sham group(P
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BACKGROUND: The hemodynamic superiority of total cavopulmonary anastomosis (TCPA) over atriopulmonary connection as a modification of Fontan-type operation, began to be acknowledged with more applications to clinical cases. The need of adequate resolutions for the investigation and improvement of residual hemodynamic derangements including abnormal distribution of the pulmonary blood flow, is emerging. METHODS: We studied 20 patients (M:F=12:8, age:67.9+/-41.5 months) who have had the TCPA and were followed-up by cardiac catheterization, angiography and lung perfusion scan 24.5+/-15.7 months after the operation. Pulmonary arterial growth and hemodynamic influences including the pulmonary blood flow distribution were investigated to verify the appropriateness of the conventional TCPA method and to aid in the determination of the consequences and prognosis of the operation. RESULTS: The mean pulmonary arterial pressure before and after the operation was 15.1+/-3.2 mmHg and 13.9+/-4.8 mmHg respectively without significant difference and there was no significant postoperative changes in the cross-sectional area index of pulmonary artery in regard to the variability of body surface area. The pulmonary blood flow was distributed with a greater amount in the ipsilateral side of IVC flow entrance (IVCipsi) than the contralateral side (IVCcontra), with an ipsilateral to contralateral perfusion ratio (i/cPR) of 1.24+/-0.42. Comparing the subgroups by the type of superior vena caval inflow, unilateral superior cavopulmonary anastomosis (SCPA) group showed significantly higher i/cPR (1.47+/-0.33) than the bilateral SCPA group (1.07+/-0.21). Comparing the subgroups by the type of IVC inflow, the i/cPR of the intraatrial tunnel group was higher than the hemiazygous continuation group, but there was no statistical significance. CONCLUSION: TCPA does not influence the growth of pulmonary artery, and the type of cavopulmonary anastomosis and the bilaterality of superior vena cava may have major influences on the distribution of the pulmonary blood flow. The details of surgical methods should be evaluated case by case in respect to the associated anomalies in order to achieve adequate postoperative pulmonary blood flow distribution.
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Humans , Angiography , Arterial Pressure , Body Surface Area , Cardiac Catheterization , Cardiac Catheters , Fontan Procedure , Heart Bypass, Right , Hemodynamics , Lung , Perfusion , Prognosis , Pulmonary Artery , Pulmonary Circulation , Vena Cava, SuperiorABSTRACT
Previously, we observed that hypoxic pulmonary vasoconstriction (HPV) can be reduced by endurance exercise training. This study determined whether nitric oxide (NO) plays a role in inhibition of the HPV after endurance exercise training in isolated rat lung perfused with physiological saline solution containing meclofenamate. Sprague-Dawley rats were used, and were divided into two groups: a control (Cont) group and an endurance exercise-trained (ET) group. Endurance exercise training was carried every day on a small-animal motorized treadmill. The training protocol was 30 to 40 min/day and the rats ran at a speed of 15 to 30 m/min for 2 weeks. It appeared that HPV could be reduced by short-term endurance exercise training. The NO-forming enzyme inhibitor, N<SUP>G</SUP>-nitro-L-arginine methyl ester (1.5×10<SUP>-8</SUP>M, L-NAME), administered to the ET group increased the HPV compared in that of the Cont group. These findings indicate that endothelial NO synthesis may contribute to the inhibition of HPV in ET rats. Our data suggest that endurance exercise training promotes endothelium dependent-pulmonary vasodilation through the stimulation of NO released during HPV.
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It was developed that a new method for measuring the ratio of pulmonary blood flow tosystemic biood flow by two-dimensional Doppler echocardiography.Qp and Qs blood flow were consid-ered to be propotional to the mitral and tricuspid Doppler flow velocity time integral multipled respectively by mitral or tricuspid valve ring diameters(MVID or TVID),I.e.MVID/TVID was equal to Qp/Qs.With the method,we calculated the Qp/Qs ratio close to 1:1(0.939+/-0.083)in 18 normal Per-sons,0-656+/-0.167 in 15 patients with Tetralogy of Fallot.Qp/Qs in TOF corrected negativly With hemoglobin.Our results demonstrated that conventional Doppler mdthod to calculate the Qp/Os ratio can be simplified.
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Objetivo - Avaliar o resultado pós-operatório imediato de crianças portadoras de cardiopatias congênitas com hipofluxo pulmonar, submetidas à derivaçäo sistêmico-pulmonar. Casuística e Métodos - Sessenta e quatro pacientes, 30 (46,8%) do sexo masculino, com idades entre 1 dia e 17 anos, divididos em: grupo I, 13 (20,3%) pacientes submetidos à operaçäo de Blalock-Taussig (B-T) clássica; grupo II, 46 (71,8%) pacientes submetidos à B-T modificada, sendo usados 2 tipos de enxertos, polytetrafluoroetylene (PTFE) em 34 casos e veia umbilical em 12; grupo III, em 5 (7,8%) pacientes submetidos à derivaçäo central com emprego de 3 tipos de enxertos, PTFE em 3, veia umbilical em 1 e artéria mamária bovina em 1. Os procedimentos associados foram ligadura do canal arterial persistente em 2 casos, ligadura de artérias brônquicas em 3, valvotomia pulmonar em 3, ampliaçäo de via de saída do ventrículo direito em 3 e apliaçäo de estenose de artéria pulmonar em outros 2 casos. Resultados - No grupo I houve 4 (30,7%) casos com obstruçäo da derivaçäo, tendo sido 2 reoperados, com mortalidade de 30,7%. No grupo II houve 4 (8,6%) casos com obstruçäo e 2 reoperaçöes com mortalidade de 15,2% (7 casos) e no grupo III houve 1 (20%) de obstruçäo e mortalidade de 80% (4 casos). A mortalidade relacionada exclusivamente à derivaçäo foi de 15,3%, 8,6% e 40% respectivamente. Conclusäo - A operaçäo de B-T modificada, realizada com maior freqüência, apresentou menor índice de obstruçäo e menor mortalidade, sendo recomendada como primeira escolha
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pulmonary Artery/surgery , Subclavian Artery/surgery , Pulmonary Circulation , Heart Defects, Congenital/surgery , Prognosis , Anastomosis, Surgical/methodsABSTRACT
This study was performed to compare the amount of blood flow from left and right side heart using Doppler echocardiography and Fick method. The pulmonary blood flow (Qp), aortic blood flow (Qs) and Qp/Qs ratio were noninvasively evaluated by two dimensional Doppler echocardiography in 10 patients with ventricular septal defect in children, aged 2 years to 15 years (mean+/-SD=7.1+/-4.9 years). Cardiac catheterization was performed within 2 days after examination of Doppler echocardiography in all patients. Systemic and pulmonary blood flow was calculated by using Fick principle, based on measured oxygen consumption and measured blood oxygen saturation. The Doppler frequency shift was analyzed by computer system combined with Meridian Echocardiography System. Comparison of Qp, Qs and Qp/Qs ratio obtained by invasive methods and by two-dimensional pulsed wave Doppler echocardiography showed a correlation of 0.679 in Qp, 0.710 in Qs and 0.639 in Qp/Qs ratio (p<0.05).
Subject(s)
Child , Humans , Cardiac Catheterization , Cardiac Catheters , Computer Systems , Echocardiography , Echocardiography, Doppler , Heart , Heart Septal Defects, Ventricular , Oxygen , Oxygen ConsumptionABSTRACT
Aim The study was designed to explore the possible impact of sodium hydrosulfide NaHS on the content and metabolism of collagen in rats with pulmonary hypertension induced by high pulmonary blood flow. Methods Thirty-two male SD rats, weighing 140~160 g, were randomly divided into 4 groups, shunt group (n=8), shunt+NaHS group (n=8), sham group (n=8) and sham+NaHS group (n=8). Rats in shunt group and shunt+NaHS group were subjected to an abdominal aorta-inferior vena cava shunt to create an animal model of high pulmonary flow. In the sham group and sham+NaHS group, rats experienced the same experimental processes except the shunting procedure. After 11 weeks of experiment, systolic pulmonary artery pressure (SPAP) of rats was detected using a right cardiac catheterization procedure. Lung tissue hydrogen sulfide(H2S) content of rats was determined by a modified sulfide electrode method. Pulmonary artery collagen Ⅰ,collagen Ⅲ,MMP-13 and TIMP-1 protein expression of rats was investigated by immunohistochemistry.Results After 11 weeks of experiment, SPAP increased significantly, whereas lung tissue hydrogen sulfide(H2S) content decreased significantly in rats of shunt group as compared with those of sham group (P