Objective To observe the influence of edaravone perfusion via the pulmonary artery on postoperative lung tissue and lung function during pulmonary ischemia in deep hypothermic circulatory arrest （DHCA）， and explore its possible mechanism. Methods A total of 24 healthy New Zealand white big-ear rabbits were randomly divided into three groups： （1） control group： DHCA model under cardiopulmonary bypass （CPB） was established； （2）low potassium dextran （LPD）group： LPD solution perfusion via the pulmonary artery after the establishment of DHCA； （3）edaravone group：LPD solution containing edaravone （5 mg/kg） perfusion via the pulmonary artery after the establishment of DHCA. Oxygenation index and lung compliance were observed at the time of baseline condition， recovery of ventilation， 1 hour and 2 hours after recovery of ventilation， and postoperative lung function of the three groups were compared. Malondialdehyde （MDA） and superoxide dismutase （SOD） in pulmonary venous blood were measured. All the rabbits were sacrificed after the operation. HE staining and immunohistochemistry were performed on the lung tissues to investigate lung structure changes and inflammatory reaction. Transmission electron microscopy was used to compare ultrastructural changes of lung.Results There were no statistical difference in oxygenation index， lung compliance， MDA and SOD among the 3 groups under the baseline condition （P＞0.05）. After recovery of ventilation， oxygenation index and lung compliance deteriorated to varying degrees in all 3 groups. Oxygenation index and lung compliance of the control group and LPD group at the time of recovery of ventilation， 1 hour and 2 hours after recovery of ventilation were significantly lower than those of edaravone group （oxygenation index：recovery of ventilation and in control group and edaravone group: 198.25±11.02 mm Hg vs. 244.87±13.05 mm Hg；lung compliance：one hour after recovery ventilation in control group and edaravone group：45.88±1.64 ml/cm H2O vs. 59.75±2.38 ml/cm H2O；P＜0.05）. After CPB removal， MDA levels were increased to varying degrees in all 3 groups. MDA levels of the control group and LPD group at the time of CPB removal， 1 hour and 2 hours after CPB removal were significantly higher than those of edaravone group （P＜0.05）. After CPB removal， SOD levels were decreased to varying degrees in all 3 groups. SOD levels of the control group and LPD group at the time of CPB removal， 1 hour and 2 hours after CPB removal were significantly lower than those of edaravone group （P＜0.05）. HE staining showed clear lung structure， less red blood cell leakage， less inflammatory cell infiltration， and less alveolar fluid accumulation in the edaravone group. Immunohistochemistry showed that integral light density of interleukin 6 （IL-6）in edaravone group was significantly lower than those of the LPD group and control group （14.44±1.75 vs. 20.18±2.22， P＜0.05）. Transmission electron microscopy showed integral basement membrane structure， clear blood gas barrier structure， significantly larger number of type II epithelial cells， abundant but not swollen mitochondria and lamellar bodies in the cytoplasm in the edaravone group， which were destroyed in varying degrees in the LPD group and control group. Conclusion Pulmonary artery perfusion of protective solution in low temperature can significantly reduce lung injury induced by DHCA and CPB. Protective solution containing edaravone in low temperature can better decrease lung injury and protect oxygenation.
Objective To investigate the security and feasibility of silk ligating for pulmonary artery in video-assisted thoracoscopic lobectomy, and to summarize the clinical skills. Methods We retrospectively analyzed the clinical data of 68 patients underwent the video-assisted thoracoscopic lobectomy from April 2013 to March 2015. There were 49 males and 19 females with the mean age of 59.6±10.3 years, ranging from 38 to 76 years. We divided the patients into an ECR60W cut-up group (31 patients) and a silk ligation group (37 patients). There were 22 males and 9 females patients with the average age of 59.3±9.9 years with ECR60W. There were 27 males and 10 females patients with the average age of 59.9±10.5 years with silk ligation. We observed the effect of hemostasis, and analyzed the amount of bleeding loss during operation, postoperative suction drainage and the cost of operation material between the two groups. Results There were 4 patients out of 68 converted to the open lobectomy, and all of them used ECR60W. The application of silk ligation for pulmo-nary artery could effectively control bleeding loss and avoid massive amount of bleeding due to the vascular tear in opera-tions. Furthermore, the application can reduce the rate of severe complications such as massive bleeding resulting from postoperative silk ligation slippage. There was a statistical difference between the two groups on the cost of operation mate-rials (P < 0.01). Conclusions Silk ligation for pulmonary artery in video-assisted thoracoscopic lobectomy is simple and prac-tical to apply. Compared with the ECR60W, it can significantly reduce the cost of operation material. It's worth to popularize in clinic.
Objective To evaluate the clinical value of computer tomography angiography( CTA) in the diagnosis of anomalous pulmonary artery. Methods Clinical data of 9 patients with anomalous pulmonary artery diagnosed by CTA were retrospectively analyzed, and CTA results were compared with those of echocardiographic examination. Results CTA clearly demonstrated the origin sites and topography of anomalous pulmonary arteries in all 9 patients. One patients presented with left pulmonary artery sling, and 8 patients presented with anomalous right pulmonary artery which originated fromthe proximal ascending aorta. Among them1 patient was with isolated anomalous origin of right pulmonary, and the others were complicated with patent ductus artery( 5 cases) , ventricular septal defect ( 3 cases) , and aortopulmonary septal defect ( 1 case) , etc. Conclusions CTA is highly valuable in the diagnosis of anomalous origin of pulmonary artery and associated abnormities by clearly developing the pathologic anatomic features and complicated cardiovascular malformations
Abstract: Objective To observe the physical characteristics of decellularized porcine pulmonary valved conduits crosslinked by carbodiimide (EDC). Methods [WTBZ]Twenty porcine pulmonary valved arteries were mobilized on relative asepsis condition. They were cut longitudinally into three samples at the junction position of pulmonary valve (every sample was comprised of a part of the pulmonary conduit wall and the corresponding valve). The samples were randomly divided into three groups by lotdrawing method. Group A was the control group which was made up of the fresh porcine arterial valved conduit samples without any other treatments. Group B was comprised of porcine pulmonary samples decellularized by trypsindetergent digestion. Group Cincluded the decellularized porcine pulmonary samples crosslinked by EDC. We observed the water content, thickness, tensile strength, and shrinkage temperature of all the samples, based on which the physical characeteristics of these samples were analyzed. Results [WTBZ]Complete cellfree-pulmonary conduit matrix was achieved by trypsindetergent digestion. Compared with group A, in group B, the water content of pulmonary wall was significantly higher (P=0.000), while the water content of pulmonary valve was not significantly different; the thickness of pulmonary wall and valve (P=0.000，0.000) and tensile strength of pulmonary wall and valve (Plt;0.01） was significantly lower, while shrinkage temperature was not significantly different. Compared with group B, in group C, the water content of pulmonary wall was significantly lower (P=0.000), while the water content of pulmonary valve, and the thickness of pulmonary wall and valve were not significantly different; the tensile strength of pulmonary wall (Plt;0.01) and valve (P=0.000), and the shrinkage temperature of them (P=0.000, 0.000) were significantly higher. Compared with group A, in group C, the water content of pulmonary wall and valve, and the tensile strength of them were not statistically different, while the thickness of pulmonary wall and valve was significantly lower (P=0.000, 0.000), and the shrinkage temperature of them was significantly higher (P=0.000, 0.000). Conclusion [WTBZ]EDC crosslinking method is available for treating decellularized porcine pulmonary valved conduits in order to enhance its tensile strength, and decrease water content of pulmonary wall.
Objective To improve the knowledge of pulmonary artery sarcoma ( PAS) and early diagnosis.Methods The clinical data of 8 patients with PAS confirmed by biopsy from April 2001 to April 2012 in Beijing Anzhen Hospital were retrospectively analyzed. Results There were 5 males and 3 females, with mean age of 46. 75 ±11. 47 years [ range: 32-67 years] . The main clinical manifestations were chest tightness, shortness of breath, intermittent syncope, heart palpitations at exertion, etc. Laboratory examinations showed the patients with PAS have no obvious hypoxemia and most of them have normal D-dimer level. Echocardiography revealed pulmonary hypertension, right ventricular enlargement, and echo of massive lumps in main pulmonary truck. Lower limb veins were normal in color doppler ultrasonography. Chest X-ray revealed prominent pulmonary artery segment, full segment of the right pulmonary artery, an increased hilum and pleural effusion. CT pulmonary angiography showed expansion of pulmonary artery, large filling defect in main pulmonary truck and left or right pulmonary artery, combined with pericardial effusion, pleural effusion. Lung ventilation/perfusion imaging did not match, showing radioactive sparse and defects in multiple lung segments and subsegments, involved 3 to 13 lung segments. Pulmonary angiography showed filling defects in the main pulmonary artery, left or right pulmonary artery. 8 patients were confirmed pathologically after operation. Pathological results showed leiomyosarcoma differentiation in 3 cases, undifferentiated sarcoma in2 cases, and undefined pathological type in 3 cases. All 8 patients were misdiagnosed as pulmonary embolism before surgery. The average days of misdiagnosis were 85. 6 ±21. 5 days. 7 cases were given simple surgical resection, one case underwent surgical resection combined with radiotherapy and chemotherapy. 7 cases were relieved and discharged, and one case died. Conclusion PAS is a rare disease clinically and is easily misdiagnosed as pulmonary embolism. Clinicians should enhance the recognition in order to diagnose early and treat comprehensively.
Abstract： Objective To evaluate clinical outcomes of pulmonary artery banding for morphologic left ventricular training in corrected transposition of the great arteries.?Methods?A total of 89 patients with corrected transposition of the great arteries underwent surgical repair in Shanghai Children’s Medical Center from January 2007 to December 2011 year. Among them, 11 patients underwent pulmonary artery banding, whose clinical records were retrospectively analyzed. Except that one patient was 12 years, all other patients were 3 to 42 （16.40±11.67） months old and had a body weight of 6 to 32 （11.70±7.20）kg. All the patients were diagnosed by echocardiogram and angiocardiogram.?Results?There was no postoperative death after pulmonary artery banding in 11 patients. The pulmonary arterial pressure/systemic blood pressure ratio （Pp/Ps） was 0.3 to 0.6 （0.44±0.09） preoperatively and 0.6 to 0.8 （0.70±0.04） postoperatively with statistical difference （P＜0.01）. Tricuspid regurgitation was mild in 2 （18.2%） patients, moderate in 5 （45.4%）, severe in 4 （36.4%）preoperatively，and none in 2（18.2%）patients, mild in 7 （63.6%），and mild to moderate in 2 （18.2%）postoperatively. Five patients underwent staged double-switch operation after pulmonary artery banding at 15.20±8.31 months, and 1 patient died. The other 6 patients were followed up for 18.83±3.43 months, and echocardiogram showed tricuspid regurgitation as trivial in 2 （33.3%）, mild in 3 （50.0%）, and moderate in 1 （16.7%）patient.?Conclusions?In patients with corrected transposition of the great arteries, pulmonary artery banding is helpful to reduce tricuspid regurgitation, and morphologic left ventricle can be trained for staged double-switch operation with good clinical outcomes. It is important to follow up these patients regularly to evaluate their morphologic left ventricular function and tricuspid regurgitation after pulmonary artery banding.
Objective To confirm the changes of pulmonary artery pressure, neo pulmonary artery stenosis and reoperation in children with unilateral absence of pulmonary artery (UAPA) undergoing pulmonary artery reconstruction. Methods The clinical data of the infants with UAPA undergoing pulmonary artery reconstruction in our hospital from February 19, 2019 to April 15, 2021 were analyzed. Changes in pulmonary artery pressure, neo pulmonary artery stenosis and reoperation were followed up. Results Finally 5 patients were collected, including 4 males and 1 female. The operation age ranged from 13 days to 2.7 years. Cardiac contrast-enhanced CT scans were performed in all children, and 2 patients underwent pulmonary vein wedge angiography to confirm the diagnosis and preoperative evaluation. Preoperative transthoracic echocardiography and intraoperative direct pulmonary arterial pressure measurement indicated that all 5 children had pulmonary hypertension, with a mean pulmonary arterial pressure of 31.3±16.0 mm Hg. Pulmonary arterial pressure decreased immediately after pulmonary artery reconstruction to 16.8±4.2 mm Hg. The mean follow-up time was 18.9±4.7 months. All 5 patients survived during the follow-up period, and 1 patient had neo pulmonary artery stenosis or even occlusion and was re-operated. Conclusion Pulmonary artery reconstruction can effectively alleviate the pulmonary hypertension in children with UAPA. The patency of the neo pulmonary artery should be closely followed up after surgery, and re-pulmonary angioplasty should be performed if necessary.
ObjectiveTo explore the clinical significance of quantitative CT measurement of pulmonary vascular indexes in chronic obstructive pulmonary disease (COPD). MethodsFifty-three stable COPD patients who were diagnosed in our hospital between May 2013 and February 2015 were recruited in the study. The HRCT results were analyzed, and the pulmonary vascular indexes were measured including the main pulmonary artery diameter (mPAD), axial diagonal mPAD, sagittal mPAD, right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD) and etc. The % CSA<5 (the percent of total cross-sectional area of the vascular with cross-sectional area less than 5 mm2 to total area of the lung) was calculated with Image J 1.48. The % LAA[volume percentage of low attenuation areas (<-950 HU)] representing degree of emphysema was calculated with GE ADW 4.5. Lung function test and questionnaires including CAT, mMRC, SGRQ and frequency of acute exacerbation of COPD (AECOPD) were completed and collected. ResultsIn COPD patients, the mPAD,axial diagonal mPAD, sagittal mPAD, RPAD and LPAD were positively correlated with % LAA respectively (r=0.36, 0.33, 0.43, 0.45, 0.33) and % CSA<5 was negatively correlated with % LAA (r=-0.37). mPAD was positively correlated with CAT, SGRQ and frequency of AECOPD respectively (r=0.52, 0.29, 0.35), and negatively correlated with FEV1% pred (r=-0.30).% CSA<5 was negatively correlated with CAT, SGRQ and frequency of AECOPD, respectively (r=-0.29,-0.30,-0.29), and positively correlated with FEV1% pred (r=0.28). The multivariate linear regression analysis revealed a linear relationship of mPAD with body mass index,% LAA and CAT. There was also linear relationships between axial diagonal mPAD, sagittal mPAD, RPAD and % LAA, CAT, respectively, and linear relationships between % CSA<5 and FEV1% pred,% LAA. The P value were all less than 0.05. ConclusionQuantitative CT measurement of cross-sectional area of small pulmonary vessels and pulmonary artery diameter are associated with clinical indexes in COPD patients, which will provide a new appraoche for the disease assessment of COPD patients.
ObjectiveTo investigate the feasibility, safety and accuracy of inserting a left atrial piezometer tube and pulmonary artery flotation catheter (PAFC)via the internal jugular vein (IJV)for postoperative monitoring of adult patients with pulmonary arterial hypertension (PAH)after open cardiac surgery. MethodsA prospective study was conducted in 100 patients aged over 18 years who underwent open cardiac surgery in Wuhan Asia Heart Hospital from 2010 to 2012. There were 43 male and 57 female patients with their age of 46-65 (47±16)years. All the patients were divided into 2 groups, including 50 patients with severe PAH who underwent heart valve replacement (HVR)in group A, and 50 patients with mild to moderate PAH who underwent HVR in group B. All the patients received insertion of ARROW 5 Fr three-cavity catheter by piercing the atrial septum via IJV for continuous monitoring of left atrial pressure (LAP), and insertion of ARROW 8 Fr high-flow sheath for PAFC implantation via IJV in the same side. LAP and pulmonary artery wedge pressure (PAWP)were continuously monitored after the patients entering the intensive care unit (ICU). The corelation and accuracy of LAP and PAWP were observed in the 2 groups. ResultsAll the patients successfully received continuous LAP and PAWP monitoring without serious catheter-related complications. There was no statistical difference in operation time or extracorporeal circulation time between group A and B (P > 0.05). There was statistical difference in postoperative mechanical ventilation time and length of ICU stay between the 2 groups (P < 0.05). Mean pulmonary artery pressure (PAPmean), mean LAP (LAPmean), mean PAWP (PAWPmean), and mean difference between PAWP and LAP (PAWP-LAPmean)of group A were significantly higher than those of group B (P < 0.01). PAWP was well correlated with LAP in both groups, and the correlation in group A was significantly milder than that in group B (P < 0.01). ConclusionIt is safe and feasible for LAP and PAFC monitoring via IJV after cardiac surgery. PAWP can not accurately reflect left ventricular preload, and LAP is more accurate to monitor left ventricular preload for patients with severe PAH.
ObjectiveTo improve the knowledge of clinical features,image and pathology of Behcet's disease with the pulmonary artery aneurysm. MethodsOne typical female patient aged 40 years with recurrent pulmonary artery aneurysm caused by Behcet's disease was analyzed including clinical data,image and pathological features.The Pubmed (1967.1 to 2013.10) and Wanfang database (1982.1 to 2013.10) were searched with "Behcet's disease","pulmonary artery aneurysm" as search terms. ResultsRecurrent hemoptysis was major clinical manifestation of pulmonary artery aneurysm caused by Behcet's disease.Features of image including hilar enlargement,pulmonary artery aneurysm and primary thrombus.During the first hospitalization,the patient was diagnosed as pulmonary artery aneurysm.Then pulmonary lobectomy was performed and pathology examination revealed artery aneurysm and primary thrombus.During the second hospitalization,she was diagnosed as pulmonary thromboembolism and it was considered as failure of treatment of anticoagulant therapy.During the third hospitalization,she was diagnosed as pulmonary artery aneurysm of Behcet's disease,and recurrent hemoptysis was fully ameliorated by the combination treatment of glucocorticoid and immunodepressant. ConclusionPulmonary artery aneurysm is the typical feature of pulmonary vascular lesions of Behcet's disease,and recurrent hemoptysis is major clinical manifestation.CT angiography can identify location of pulmonary artery aneurysm.The key drugs of therapy are imunosuppressive drugs in combination with steroids.