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OBJECTIVE:To investigate the effect of preoperative use of high-dose simvastatin on the pulmonary artery pres-sure in congenital heart disease with left-to-right shunt. METHODS:86 patients with left-to-right shunt congenital heart disease who were planned to implement interventional occlusion therapy were randomly divided into control group(43 cases)and observa-tion group(43 cases). Patients in both groups were given digitalis,diuretics,anticoagulants and other basic treatments;On this basis, control group received Sildenafil citrate tablet,25 mg,3 times a day,orally given 1 h before a meal;observation group received Simvastatin tablet 80 mg,once every evening,orally. The treatment course for both groups was 7 d. Mean pulmonary hypertension (mPAP),N terminal prohormone brain natriuretic peptide (NT-proBNP),arterial oxygen saturation (SaO2),arterial oxygen ten-sion(PaO2),pulmonary blood circulation ratio(Qq/Qs),pulmonary pressure variation(Rp/Rs),pulmonary vascular resistance in-dex(PVRi)before and after treatment in 2 groups were observed,and related indicators of liver functions [alanine aminotransfer-ase (ALT),aspartate aminotransferase(AST)] and myocardial enzymes [lactate dehydrogenase (LDH),creatine kinase MB(CK-MB)] were detected. The incidence of adverse reactions were deteted. RESULTS:Before treatment,there were no significant differ-ences in mPAP,NT-proBNP,SaO2,PaO2,Qq/Qs,Rp/Rs,PVRi,ALT,AST,LDH and CKMB levels in 2 groups(P>0.05). Af-ter treatment,mPAP,NT-proBNP,Rp/Rs and PVRi levels were significantly lower than before,SaO2,PaO2,and Qq/Qs levels were significantly higher than before and Qq/Qs level in observation group was higher than these in control group.The difference was statistically significant(P<0.05). There was 1 patient showed severe liver injury in observation group and exited the test;the other 85 patients showed no obvious adverse reactions,with successful surgery and good prognosis. CONCLUSIONS:The preoper-ative use of high-dose simvastatin shows obvious effect on controlling mean pulmonary hypertension,reducing mPAP,NT-proB-NP,Rp/Rs and PVRi levels and increasing SaO2,PaO2,and Qq/Qs levels before operation,with good safety.
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Objective To investigate the changes in bone age, and the correlation between the changes in structure and function of cardiovascular and bone age index in children with left to right shunt congenital heart disease (CHD) such as atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods One hundred and thirty children diagnosed CHD had been enrolled, including 52 cases of ASD, 46 cases of VSD and 32 cases of PDA. The cardiac structure and function indicators had been detected by ultrasonic. The anteroposterior iflm of left hand and wrist had been taken. The bone age had been assessed according to“China children bone age score”atlas, and the bone age index (BAI) had been calculated. The differences of bone age among each group had been compared. The linear correlation of the cardiac structure and function indicators with BAI had been analyzed. Results The BAI was statistically different among ASD, VSD and PDA groups (P<0.05). The BAI of PDA group was higher than those of ASD and VSD groups (all P<0.05). The BAI was also statistically different among the groups with different pulmonary artery pressures (P=0.000). The BAI was higher in small defect size group than that in large defect size group (P=0.002). The defect size was negatively correlated with BAI in both ASD and VSD groups (r=-0.48, -0.54, all P<0.05), The pulmonary artery systolic pressure and pulmonary-to-systemic blood lfow ratio (QP/QS) were negatively correlated with BAI in ASD, VSD and PDA groups (r=-0.64--0.38,all P<0.05). Conclusion The bone age and BAI of children with left to right shunt CHD are signiifcantly lower than those of healthy children of the same age . The extent of bone age delay is related with PASP, defect size and shunt volume in children with left to right shunt CHD.
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Objective To investigate the characteristics of different electrophysiology of Ca2+-activated Cl-channels (ClCa) in pulmonary arterial smooth muscle cells (PASMCs) between pulmonary arterial hypertension (PAH) rats induced by left-to-right shunt and normotensive rats,and to study its possible role in the progress of PAH induced by high pulmanry blood flow.Methods Forty SD rats were randomly divided into 3 groups:control group (n =10),sham group (n =10),PAH model group (n =20).After molding,the rats were raised in the same condition for 11 weeks.Right ventricular systolic pressure (RVSP) of each rat was measured by right cardiac catheterization procedure.Right ventricular hypertrophy index (RVHI) was calculated.Single PASMC was obtained by acute enzyme separation method and the conventional whole-cell patch clamp technique was used to record the resting membrane potential (Em),ClCa and current density.The Ⅰ-Ⅴ curve between each group were compared.Results Compared with control group and sham group,the Ⅰ-Ⅴ curve about Itail of PAH model group was significantly shift downward; the difference between control group and sham group was not significant.There were positive correlations between Em and RVSP,RVHI (all P ＜ 0.01),and negative correlations between Itail and RVSP,RVHI and Em(all P ＜ 0.01).Conclusions During the formation process of left-to-right shunt induced PAH,with the step up of pulmonary arterial pressure,the Em of PASMCs stepping up.The absolute value of current density of inward ClCa currents was increased,and its Ⅰ-Ⅴ curve was shift downward.These suggest that the change of ClCa currents may play a role in the PAH induced by left-to-right shunting.
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Interrupted aortic arch (IAA) is a rare congenital cardiovascular anomaly in which there is no direct continuity between the aortic arch and the descending aorta. A patent ductus arteriosus (PDA) usually feeds the descending aorta. But, as ductus constricts, IAA is lethal in nearly 100% of the cases, if untreated. The cause of death is a combination of greatly increased left to right shunt with increased pulmonary blood flow, which results in heart failure, pulmonary edema, and sequelae of the reduced perfusion of all structures distal to the interruption. During the noncardiac surgery in such patients, adequate managements with prostaglandin infusion, careful manipulation of the pulmonary-systemic blood flow ratio, inotropic support, and aggressive treatment of acidosis should be provided to ensure optimal outcomes of subsequent surgical reconstruction. We present the anesthetic experience of abdominal surgery in a neonate with a type A IAA combined with PDA and ventricular septal defect.
Subject(s)
Humans , Infant, Newborn , Acidosis , Anesthesia , Aorta, Thoracic , Cause of Death , Dietary Sucrose , Ductus Arteriosus, Patent , Heart Failure , Heart Septal Defects, Ventricular , Perfusion , Pulmonary EdemaABSTRACT
PURPOSE: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. MATERIALS AND METHODS: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. RESULTS: The mean Qp/Qs was 1.83+/10.50 by radionuclide, and 1.74+/10.51 by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.52, 0.74, 0.96, 1.57, and 1.50, respectively. CONCLUSION: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.
Subject(s)
Humans , Angiocardiography , Catheterization , Catheters , Ductus Arteriosus, Patent , Heart , Heart Septal Defects, Atrial , Heart Septal Defects, Ventricular , Mitral Valve InsufficiencyABSTRACT
Objective To establish a rat model of pulmonary hypertension induced by left-to-right shunt and explore the influence of high pulmonary blood flow on pulmonary vascular collagen remodeling.Methods Abdominal aorta and inferior vena cava shunting was produced in rats. Pulmonary artery meanpressure (PAMP) of each rat was measured by using a right cardiac catheterization.Pulmonary artery collagen Ⅰ and Ⅲ were detected using immunohistochemisty.Results After 11 weeks of shunting the Qp/Qs was 3.3∶1.0,indicating a large shunt. Pulmonary artery mean pressure was increased as compared with controls[(23.0?0.9) mm Hg vs (15.7? 1.1) mm Hg,P
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Os autores descrevem dois casos de hipertensão arterial pulmonar secundária a defeito do septo atrial. Em seguida, apresentam uma revisão da literatura discutindo os aspectos mais importantes para o diagnóstico e para a terapêutica desta condição.
The authors describe two cases of secondary pulmonary hypertension due to atrial septal sefect. Following they present a review of literature discussing important aspects for the diagnosis and for the therapeutic of this condition.
Subject(s)
Humans , Male , Female , Adult , Heart Septal Defects, Atrial/diagnosis , Heart Septal Defects, Atrial/therapy , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapyABSTRACT
The hemodynamic findings related to the histologic changes in the small pulmonary arteries in congenital heart disease were analyzed with a left-to-right shunt. A lung biopsy was performed during the repair because of pulmonary arterial (PA) hypertension (mean PA pressure > or = 15 mmHg) in 38 patients. There were 13 patients whose age ranged from 2 years to 25 years old. A preoperative cardiac catheterization was performed to locate the site of the defect and to determine the preoperative hemodynamic findings. Among them, 29 patients had pulmonary vascular resistance (PVR) > 2.5 unit/m2. The lung biopsy specimens were investigated microscopically for the Heath- Edward grade, morphometric analysis of medial wall thickness (MWT) and the rate of the decrease in the pulmonary arteriolar concentration (PAC) obtained by the alvoelo-arterial ratio divided by patients' age. All patients were in the Heath-Edward grade I to III (29 patients in grade I). This grade correlated with the MWT, but did not correlate with a decrease in the PAC. The MWT and the rate of the decrease in the PAC did not accompany each other, but either one had the tendency dominate the pattern in individual patients. The MWT had a close correlation with the mean PA pressure and PVR, and an even closer correlation in patients with a high PVR and those older than 2 years of age. The rate of the decreased in the PAC showed a weak correlation with the shunt volume in patients over 2 years of age or with a large shunt. In the high flow group (PVR 2.0, n=14) the MWT was significantly thinner and the rate of the decrease in the PAC was significantly higher than the high resistance group (PVR > 2.5 unit/m2, Qp/Qs2 < 2.0, n=13). The rate of the decrease in the PAC correlated with the patients' age, but the MWT did not. The lung biopsy results in patients who had both left-to-right shunts and pulmonary hypertension showed that the rate of the decrease in the PAC was weakly related to the shunt volume and the MWT was related to the PA pressure and PVR. Either an increased MWT or the rate of the decrease in the PAC tended to dominate. These phenomena were prominent in patients older than 2 in whom a wide range of individual variations were noted in the morphometric pattern. The medial hypertrophy and the rate of the decrease in the PAC may be induced by different stimuli or that medial hypertrophy may play a role in preventing PAC decrease.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Heart Defects, Congenital/pathology , Hemodynamics , Pulmonary Artery/pathologyABSTRACT
We performed this study to assess the correlation of residual pulmonary hypertension in the immediate postoperative period with that in the late follow-up period, to assess the histologic changes of pulmonary arteries (PA) at the time of repair for patients with congenital heart disease consisting of left-to-right shunt, and to clarify the role of lung biopsy in determining the operability and reversibility of pulmonary vascular changes. Lung biopsy was performed during repair in 38 patients, with a wide range of age, who had congenital left to right shunt and pulmonary hypertension. All were Heath-Edward grade III or less. Morphometric study included measurement of medial wall thickness (MWT) and decrease rate of pulmonary arterial concentration (PAC). Mean PA pressure in the immediate postoperative period was measured in all 38 patients. Follow-up cardiac catheterization was performed in 15 patients (average 3.8 years after repair). At operation, 5 patients of this late follow-up group were under 2 years of age and the other 10 were 2 or more. During catheterization, pulmonary hemodynamic reaction was observed both under room air inhalation and after inhalation of hypoxic gas FiO2 0.15. Mean PA pressure and pulmonary vascular resistance (PVR) in the immediate postoperative period had a significant correlation with PA pressure and PVR values before the operation, but not with morphometry, Heath-Edward grade, or with pulmonary hemodynamics in late follow-up. During the late follow-up study, 5 of the 15 patients had pulmonary hypertension (defined as mean PA pressure > or = 15 mmHg) under room air inhalation, and PA hypertension was induced in 4 additional patients after hypoxic gas inhalation. There was no incidence of PA pressure or PVR values registering above the preoperative level. The degree of PA hypertension showed a correlation with the rate of PAC decrease and also with patients' age-at-operation. Multiple regression analysis showed that both the rate of PAC decrease and the age-at-operation contributed significantly to the degree of PA hypertension. Some of the patients over age 2 had a decreased rate of PAC above the regression line, which none of the patients under age 2 experienced. In patients with Heath-Edward grade III or less, residual pulmonary hypertension in the immediate postoperative period was not correlated with histology, but in late follow-up, it was with PAC and the age-at-operation. Therefore, a decrease of PAC is assumed to be a totally or partially irreversible pulmonary vascular change depending on the patient's age-at-operation, while medial hypertrophy is thought to be a reversible pulmonary vascular change. Lung biopsy could play an important role in determining the reversibility of pulmonary vascular obstruction, particularly in patients older than 2 years. Ed- re highlights above: such hyphenation is optional, but if used then it should be applied consistently throughout the paper. As 3 of the 4 entries in the abstract use it, I have maintained it consistently below.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Biopsy , Follow-Up Studies , Heart Defects, Congenital/pathology , Hemodynamics , Pulmonary Artery/pathologyABSTRACT
AIM: To examine the alteration of pathologic structure and gaseous molecules in rats with pulmonary hypertension induced by high pulmonary blood flow.METHODS: Aortocaval shunting was produced for 11 weeks in rats, and pulmonary hemodynamics was evaluated.Pulmonary vascular micro- and ultra- structure was also examined.Meanwhile,the concentration of plasma nitric oxide (NO) and carbon monoxide (CO) was measured by spectrophotometry.The expression of endothelial nitric oxide synthase (eNOS) and heme oxygenase-1 (HO-1) in pulmonary arteries was detected by immunohistochemistry.RESULTS: After 11- week aortocaval shunting,pulmonary artery mean pressure was significantly increased.Muscularization of small pulmonary vessels and relative medial thickness and area of pulmonary arteries were obviously increased in shunting rats compared with controls.Ultrastructure of intrapulmonary arteries changed obviously in shunting rats.Meanwhile,plasma NO concentration was increased and eNOS expression in pulmonary artery endothelial cells was significantly augmented in rats of shunting group.Plasma carbon monoxide level and HO-1 expression in puomonary artery smooth muscle cells,however,were not altered in shunting rats.CONCLUSIONS: Pulmonary vascular structural remodeling is the important pathologic basis of pulmonary hypertension induced by a left-to-right shunt,and NO other than CO might play an important regulating role in the development of high pulmonary blood flow-induced pulmonary hypertension.
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BACKGROUND: A left to right shunt through an iatrogenic atrial septal defect(ASD) is known to occur after percutaneous mitral valvuloplasty(PMV), however, its hemodynamic significance as well as methods for the quantitation and follow-up evaluation have not been well established. SUBJECTS AND METHOD: In order to compare the feasibilities of noninvasive diagnostic methods for the detection and quantitation of the left-to-right shunt after PMV. 35 patients(age 37+/-10 years) undertook either radionuclide angiography or transesophageal echocardiography or both within a week after PMV. Qp/Qs was calculated by Fick's oxygen method during cardiac catheterization and by indicator dilution method during radionuclide angiography. The left-to-right shunt was also quantified with transesophageal echocardiography(TEE) by calculating shunt flow rate(Q=2 pir2Vr) using isovelocity surface area. RESULT: TEE was the most sensitive to detect ASD(16 among 27 patients, 59%) compared to either RI angiography(5 among 27 patients, 18%, Qp/Qs>1.5) or cardiac catheterization(4 among 35 patients, 11%, oxygen step-up>7%). Calculated shunt flow rate by TEE showed significant linear correlation to the Qp/Qs by cardiac catheterization(r=0.73, p<0.001). Also there was a significant correlation between Qp/Qs by radionuclide angiography and by cardiac catheterization(r=0.49, p<0.01). CONCLUSION: Both radionuclide angiography and TEE appear useful for the detection and quantitation of the left to right shunt after PMV. Since TEE seems to be not only more sensitive to detect the presence of the ASD than either radionuclide angiography or cardiac catheterization but useful to quantify the left-to-right shunt, it appears to be useful method for the follow-up evaluation after PMV.