Ipsilateral Pulmonary Artery Research Articles

Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung‐to‐head ratio in fetuses with congenital diaphragmatic hernia

To describe the association between the intrapulmonary circulation and the degree of lung growth in fetuses with congenital diaphragmatic hernia (CDH). Thirty-six fetuses with isolated left CDH at 22-29 weeks of gestation were studied. Four groups were defined according to lung-to-head ratio (LHR), expressed as the ratio of observed to expected LHR for gestational age (O/E LHR). Pulsatility index (PI), peak systolic velocity (PSV), peak early-diastolic reversed flow (PEDRF), end-diastolic velocity (EDV), acceleration time (AT), time averaged velocity (TAV) and the ratio AT to ejection time (AT/ET) were measured in all fetuses in the proximal arterial branch of both lungs. For analysis, Doppler values were converted to Z-scores. It was possible to record all Doppler parameters from the contralateral lung of all CDH fetuses, and from the ipsilateral lung in 28 (77.7%). PEDRF significantly increased in relation to the decrease in O/E LHR in both lungs (contralateral: r = - 0.65, P = 0.01; ipsilateral: r = - 0.43, P = 0.02). PI increased significantly with the reduction in O/E LHR but only on the side contralateral to the hernia (r = - 0.55, P = 0.02). In the ipsilateral pulmonary artery, PI values showed a significant overall increase but no differences were observed among the O/E LHR groups. PSV, EDV and TAV were reduced in both lungs with respect to normal values, but no association was found with the O/E LHR. No changes in AT or AT/ET were observed in either lung. PEDRF is quick and easy to calculate, and showed the strongest and most consistent correlation with O/E LHR. The association between PEDRF and LHR might be an additional parameter that could help to establish prognosis in fetuses with CDH.

Effects of Blood Flow and/or Ventilation Restriction on Radiofrequency Coagulation Size in the Lung: An Experimental Study in Swine

The purpose of this study was to investigate how the restriction of blood flow and/or ventilation affects the radiofrequency (RF) ablation coagulation size in lung parenchyma. Thirty-one RF ablations were done in 16 normal lungs of 8 living swine with 2-cm LeVeen needles. Eight RF ablations were performed as a control (group G1), eight with balloon occlusion of the ipsilateral mainstem bronchus (G2), eight with occlusion of the ipsilateral pulmonary artery (G3), and seven with occlusion of both the ipsilateral bronchus and pulmonary artery (G4). Coagulation diameters and volumes of each ablation zone were compared on computed tomography (CT) and gross specimen examinations. Twenty-six coagulation zones were suitable for evaluation: eight in G1, five in G2, seven in G3, and six in G4 groups. In G1, the mean coagulation diameter was 21.5 +/- 3.5 mm on CT and 19.5 +/- 1.78 mm on gross specimen examination. In G2, the mean diameters were 26.5 +/- 5.1 mm and 23.0 +/- 2.7 mm on CT and gross specimen examination, respectively. In G3, the mean diameters were 29.4 +/- 2.2 mm and 27.4 +/- 2.9 mm on CT and gross specimen examination, respectively, and in G4, they were 32.6 +/- 3.33 mm and 28.8 +/- 2.6 mm, respectively. The mean coagulation volumes were 3.39 +/- l.52 cm(3) on CT and 3.01 +/- 0.94 cm(3) on gross examinations in G1, 6.56 +/- 2.47 cm(3) and 5.22 +/- 0.85 cm(3) in G2, 10.93 +/- 2.17 cm(3) and 9.97 +/- 2.91 cm(3) in G3, and 13.81 +/- 3.03 cm(3) and 11.06 +/- 3.27 cm(3) in G4, respectively. The mean coagulation diameters on gross examination and mean coagulation volumes on CT and gross examination with G3 and G4 were significantly larger than those in G1 (p < 0.0001, p < 0.0001, p < 0.0001, respectively) or in G2 (p < 0.05, p < 0.005, p < 0.005, respectively). Pulmonary collapse occurred in one lung in G2 and pulmonary artery thrombus in two lungs of G3 and two lungs of G4. The coagulation size of RF ablation of the lung parenchyma is increased by ventilation and particularly by pulmonary artery blood flow restriction. The value of these restrictions for potential clinical use needs to be explored in experimentally induced lung tumors.

Advances in Neonatal Cardiac Surgery

After completing this article, readers should be able to: 1. Describe the developments that have allowed advances in neonatal cardiac surgery. 2. Describe the diagnostic approach to hypoplastic left heart syndrome (HLHS). 3. Delineate the preoperative management of the neonate who has HLHS. 4. Describe the original Norwood procedure and subsequent modifications. 5. Delineate the optimal therapy in the postoperative period for neonates who have a single ventricle. Advances in the surgical and medical management of children who have congenital heart disease (CHD) have led to a dramatic improvement in overall survival and reduced the long-term sequelae of open-heart surgery. With improved survival and decreased morbidity over the past 2 decades, the early complete repair of complex congenital heart problems in preterm and low-birthweight neonates has gained wider acceptance. Cardiologists and cardiothoracic surgeons now consider and perform complete neonatal repair more frequently than palliative surgery in this patient population. The treatment of hypoplastic left heart syndrome (HLHS) best illustrates the evolution of management strategies to improve survival and long-term outcome. A recent modification of the Norwood operation that involves a right ventricle-to-pulmonary artery conduit has led to much improved early postoperative stability and, in many centers, improved survival to a stage II superior cavopulmonary connection. A multidisciplinary team approach is required to provide the necessary care for this complex patient population. In 1938, Robert Gross at Children’s Hospital in Boston successfully ligated a patent ductus arteriosus, and this procedure—performed against the wishes of surgeon-in-chief William Ladd—opened the era of surgery for CHD. (1) Gross and Hufnagel performed detailed animal experiments to develop a technique for treatment of coarctation of the aorta that involves excision and end-to-end anastomosis. (2) Clarence Craaford of Stockholm, Sweden, had visited Gross to observe his experimental work, and in October 1944, Craaford and Nylin were the first to repair aortic …

Ductus-associated proximal pulmonary artery stenosis in patients with right heart obstruction

Proximal pulmonary artery stenosis is a common acquired lesion in infants treated for congenital heart disease. We hypothesized that a large number of stenoses develop at the site of ductal insertion in patients with right ventricular outflow tract obstruction (RVOTO) and that these patients are at risk for developing hypoplasia of the ipsilateral pulmonary artery. The surgical and cardiac catheterization databases at our institution during the years 1988–2000 were searched for all patients under 1 year of age carrying a diagnosis of pulmonary atresia with intact ventricular septum (PA), tetralogy of Fallot (TOF) or pulmonary stenosis (PS), yielding 700 patients (62 PA, 373 TOF, 265 PS). The cardiac catheterization database was also searched for all patients with any diagnosis under 1 year of age found at catheterization to have proximal pulmonary artery stenosis. Proximal pulmonary artery stenosis associated with the ductal insertion site was diagnosed at catheterization in 33 infants (18 with PA, 5 with TOF, 6 with PS, 4 other diagnoses). This represents 29% of patients with PA, 1% with TOF and 2% with PS. Among patients with RVOTO and ductal insertion site-associated stenosis, there was a high prevalence (59%) of associated distal pulmonary arterial hypoplasia, defined as diameter of the stenosed vessel at first distal branch ≤ 80% the diameter of the contralateral vessel. Symptomatology failed to identify this lesion; therefore, a high index of suspicion is necessary if proximal pulmonary artery stenosis is to be detected early in these patients.

Isolated Unilateral Absence of Right Proximal Pulmonary Artery: Surgical Repair and Follow-Up

The isolated unilateral absence of a proximal pulmonary artery is a rare congenital lesion with a diverse clinical presentation. If the connecting ductus arteriosus closes after birth, the ipsilateral pulmonary artery will lose its source of blood supply, resulting in hypoplasia or obliteration of intrapulmonary vessels. Despite a seemingly benign early clinical course, a significant number of untreated patients will develop pulmonary hypertension, hemoptysis, and recurrent respiratory infections. Early detection and surgical repair provides restoration of physiologic pulmonary circulation, regression of pulmonary hypertension, and the potential for normal distal pulmonary vascular development.

Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia

Objective: We hypothesized that fetal branch pulmonary artery (PA) diameters indirectly reflect lung mass and are associated with postnatal outcome in cases of isolated congenital diaphragmatic hernia (CDH). Study Design: We retrospectively reviewed echocardiograms of fetuses with CDH, measuring branch PA diameters and other echocardiographic parameters. Antenatal parameters were correlated with postmortem lung weights in 5 fetuses after pregnancy termination. Fetal echocardiographic measures were correlated with outcome variables in 29 live-born infants with CDH to identify antenatal indices associated with postnatal death and respiratory morbidity. Results: Antenatal branch PA size correlated with postmortem lung weights from 5 terminated fetuses (r = 0.87). In 26 cases of left CDH in which the fetus continued to term, the ipsilateral branch PA diameter was significantly smaller than the contralateral branch PA diameter at presentation (P <.001). In these fetuses, a larger contralateral PA diameter was associated with worse postnatal survival (P =.049). Among survivors with left CDH, the main PA z score and the discrepancy between right and left PA diameters correlated positively with duration of supplemental oxygen requirement (P =.019 and P =.022, respectively) and ventilation (P =.036 and P =.012, respectively). Serial antenatal studies in 8 of 10 cases revealed progressive ipsilateral PA hypoplasia. Conclusion: Antenatal branch PA size correlates with postmortem lung weight. A larger contralateral PA, and significant branch PA discrepancy and larger main PA diameter, best correlate with postnatal death and respiratory morbidity, respectively. Progressive ipsilateral PA hypoplasia suggests progressive in utero lung hypoplasia in cases of CDH. (Am J Obstet Gynecol 2002;186:1085-90.)

Hemoptisis recurrente por anastomosis sistemicopulmonar de la arteria frénica inferior derecha. Tratamiento mediante embolización percutánea

Systemic-pulmonary-artery anastomoses resulting in a left-to-right shunt, regardless of the etiology, the anastomosis resulting shunt produces increased oxygen saturation in the ipsilateral pulmonary artery. They are radiologically seen sporadically in patients with hemoptisis, being main causes: traumatic, inflammatory or congenital, many times keeps etiology unknown. We present the case of a 33 year-old male with recurrent hemoptisis without etiology defined; his chest x-ray was reported as normal. The study was completed with broncoscopy, HRCT and selective arteriography, allowed diagnosis of shunt diafragmatic lower right artery with pulmonary artery. Finally our patient was treated by percutaneous transcatheter embolization.

Congenital unilateral pulmonary vein atresia: radiologic findings in three adult patients.

The purpose of our study is to describe the radiologic findings of adult patients presenting with congenital unilateral pulmonary vein atresia. Chest radiography in affected patients typically reveals a small hemithorax and ipsilateral pulmonary artery as well as ipsilateral septal thickening. CT shows, in addition, ground-glass attenuation, the absence of a pulmonary vein connection to the left atrium, and abundant mediastinal venous collateral vessels. MR imaging is helpful in further characterizing the vascular abnormalities. Angiography may help to confirm the diagnosis.

Anomalies of the Pulmonary Arteries and Veins

Congenital absence of one pulmonary artery is rare and may remain unrecognized until adulthood. Malignant neoplasm in the affected lung has only been noted twice in the English literature, and neither report provided any follow-up data. We report the occurrence of adenocarcinoma in the lung of a young woman with congenital absence of the ipsilateral pulmonary artery. Surgical resection of the malignant lesion was performed, and no recurrence has been detected for 10 years. A high index of suspicion is required to recognize congenital abnormalities of the pulmonary vasculature, especially in adults. Therefore, we reviewed the literature concerning the various congenital abnormalities of the pulmonary arteries and veins. Because of the infrequent nature of these congenital lesions, most reports provide only limited clinical data. No longitudinal natural history studies are available. As such, therapeutic recommendations are based on small series and case reports for most of these conditions.

Cirurgia de Glenn bidirecional: importância da manutenção de fluxo "pulsátil" na artéria pulmonar

Com o objetivo de avaliar a importância clinica da presenca de fluxo na arteria pulmonar de pacientes submetidos a cirurgia de Glenn bidirecional, 36 casos consecutivos operados no periodo de outubro de 1990 a julho de 1994 foram revistos. As criancas, com idade variando de 11 meses a 14 anos (media, 4,4 ± 3,4 anos), eram portadoras das seguintes lesoes: atresia tricuspide (18), ventriculo unico (16), atresia mitral (1) e atresia pulmonar sem comunicacao interventricular (1). Dezenove (52,8%) pacientes haviam sido submetidos a 22 procedimentos cirurgicos previos, sendo que 2 fizeram duas e outro, tres anastomoses sistemico-pulmonar. Circulacao extracorporea foi utilizada em todos os casos, sendo com hipotermia leve em 11 e com hipotermia profunda e parada cardiocirculatoria total nos demais. A tecnica cirurgica basica foi a anastomose termino-lateral da veia cava superior a arteria pulmonar ipsilateral. Nos casos com fluxo anterogrado, o tronco pulmonar foi ligado somente quando a pressao media ao nivel da anastomose era superior a 15 mmHg, sendo que em 2 casos recentes com pressao acima de 20 mmHg, optouse por cerclar o tronco pulmonar, ajustando-se, assim, os niveis pressoricos. Ocorreram 3 obitos imediatos; a sobrevida hospitalar foi de 91,7%. Uma crianca, que evoluiu no pos-operatorio com baixa saturacao arterial sistemica, foi submetida apos 7 dias a anastomose sistemico-pulmonar com protese vascular de 3 mm. Vinte e oito pacientes foram acompanhados por um periodo de tempo que variou de 3,1 meses a 4,1 anos (media 1,8 ± 1,2 anos) e foram divididos em 2 grupos: A-18 criancas com fluxo pulmonar dependente exclusivamente do Glenn; B -10 criancas com outra fonte de circulacao pulmonar promovendo fluxo pulsatil ao nivel da anastomose. No Grupo A a saturacao arterial sistemica tem variado de 68% a 85% (media, 77,6 ± 5,5%) e no Grupo B de 80% a 90% com media de 86,0 ± 3,8% (p<0,001). Os pacientes do Grupo B encontram-se em classe funcional I e II, enquanto que 2 criancas do Grupo A estao em classe III e outras 2 estavam em classe IV (p=0,05), sendo que uma foi a obito e a outra foi submetida a cirurgia de Fontan modificada, com bom resultado. Nao foram observadas complicacoes relacionadas ao Glenn em nenhum dos dois grupos. Assim, a presenca de fluxo na arteria pulmonar melhora a saturacao arterial sistemica e a tolerância aos exercicios em criancas submetidas a cirurgia de Glenn bidirecional, sem efeitos adversos na circulacao pulmonar e no fluxo sanguineo da veia cava superior.

Causes of congenital unilateral pulmonary hypoplasia: a study of 33 cases

A review of the roentgenograms and clinical records of 33 children with primary congenital underdevelopment of one lung showed that 9 patients had simple pulmonary hypoplasia, 8 had anomalous venous return to the right atrium or the inferior vena cava (scimitar syndrome), 7 had an absence of the ipsilateral pulmonary artery, 7 had an accessory diaphragm, and 2 had a pulmonary sequestration adjacent to a small diaphragmatic hernia.

Temporary Unilateral Pulmonary Artery Occlusion: A Method for Controlling Swan-Ganz Catheter–Induced Hemoptysis

A patient undergoing mitral and aortic valve replacement suffered catheter-induced pulmonary artery trauma and massive hemoptysis during weaning from cardiopulmonary bypass. Hemorrhage ceased when the ipsi-lateral pulmonary artery was occluded. Forty-eight hours later the temporary band was removed, and the patient did well without further bleeding.

Tetralogy of Fallot. Development of hypoplastic pulmonary arteries after palliation.

Thirty-one patients with tetralogy of Fallot were studied angiographically before and after palliation with Blalock-Taussig operation (n = 9), Brock operation (n = 12), or enlargement of the right ventricular outflow tract with extracorporeal circulation (ECC) (n = 10). The relative diameter of the pulmonary vascular ring (PVR), pulmonary trunk (PT), and right and left pulmonary arteries (RPA, LPA) were measured before and 24.8 +/- 20.9 months after palliation. Using correlation analysis, the magnitude of growth of the pulmonary artery system was inversely related to its initial size. Mean pressure in the pulmonary artery after palliation as well as the period between date of surgery and recatheterization did not correlate significantly with growth. After Blalock-Taussig operation, the ipsilateral pulmonary artery predominantly increased in size without significant growth of PVR and PT. Brock operation and enlargement of the right ventricular outflow tract with ECC, improving the flow in the pulmonary vascular system centrally, induced a significant, symmetrical growth of the pulmonary vascular system and, therefore, are our methods of choice for palliation in patients with tetralogy of Fallow combined with hypoplastic pulmonary arteries.

Unilateral Lung Lavage

The authors attempted to favorably manipulate the distribution of pulmonary blood flow during unilateral atelectasis and during unilateral lung lavage by nonocclusive inflation of an ipsilateral pulmonary artery catheter balloon (PAB). Six mongrel dogs were anesthetized, intubated with a double-lumen endotracheal tube, and following a thoracotomy, pulmonary artery and left lung blood flows (Qt and QLL/Qt, respectively) were measured electromagnetically; right lung blood flows (QRL/Qt) were derived by difference. A PAB was positioned in the right main pulmonary artery. The experimental sequence consisted of seven steps: 1) both lungs ventilated; 2) ventilation of the left lung (LL vent), right lung (RL) atelectatic, PAB deflated; 3) LL vent, RL atelectatic, PAB inflated; 4) LL vent, RL lavaged, PAB deflated; 5) LL vent, RL lavaged, PAB inflated; 6) LL vent, RL drained, PAB deflated; and 7) LL vent, RL drained, PAB inflated. At each step the shunt fraction (Qs/Qt) was determined. Inflation of the PAB during LL vent and RL atelectatic (step 3) caused QRL/Qt and Qs/Qt to decrease and QLL/Qt and PaO2 to increase significantly (compared to step 2). There were no significant differences in QRL/Qt, QLL/Qt, Qs/Qt, and PaO2 during RL lavage with the PAB deflated (step 4) compared to RL lavage with the PAB inflated (step 5). Inflation of the PAB during RL drainage (step 7) caused QRL/Qt to decreased and QLL/Qt to increase significantly compared to their values during periods of RL drainage with the PAB deflated (step 6). This resulted in a significant increase in PaO2 and decrease in Qs/Qt. These results demonstrate that the distribution of pulmonary blood flow in dogs can be favorably manipulated by nonocclusive ipsilateral PAB inflation and support a trial of use in selected patients during one-lung anesthesia and ventilation.

Misplacement of Central Venous Pressure Catheters and Unilateral Pulmonary Edema

Two instances of misplacement of a central venous pressure monitoring catheter into a pulmonary artery are presented. In one case, reported in detail, unilateral pulmonary edema developed during administration of 0.5N saline for the treatment of diabetic acidosis via the misplaced catheter, and it reverted following repositioning of the catheter in the superior vena caca. Experiments were carried out in dogs to explore possible causes of this phenomenon. The results of these experiments suggest that the release of vasoactive substances, stimulation of neural reflexes, or both are the pathophysiological mechanisms responsible for the development of the pulmonary edema.

Angiographic demonstration of the absence of an atrial septal defect in the presence of partial anomalous pulmonary venous connection.

Twenty-two patients with partial anomalous pulmonary venous connection (PAPVC) were studied. In 8 patients, the absence of an associated atrial septal defect was established by a roentgenographic method not previously described.If an anomalous pulmonary vein (APV) is identified or suspected by main pulmonary arteriography, selective injection of the ipsilateral pulmonary artery will more clearly demonstrate it, while selective injection of the pulmonary artery contralateral to the APV will establish whether or not an associated ASD is present.

A Study on the Mechanism of the Pulmonary Hypertension and Associated Systemic Hypotension induced by Miliary Pulmonary Embolization

In order to throw light upon the controversial mechanism of pulmonary hypertension associated with hypertensive shock due to acute pulmonary embolism, the following experiments were carried out. Strictly unilateral pulmonary embolization with Lycopodium spores was attempted in the dog, and the results were compared with those obtained by unilateral balloon occlusion of the ipsilateral pulmonary artery as the control. In addition, reccurrent embolizations with Lycopodium spores were also performed to observe a critical point at which lethal systemic hypotension would occur. Method s A suspension of Lycopodium spores in saline was prepared so as to be a mixture of 50 mg/ml. The adult mongrel dog was anesthetized with pentobarbital soda (an initial dose of 25 mg/kg) and heparinized. 1. A balloon tip catheter with an end hole was placed in the proximal left pulmonary artery. Effects of balloon occlusion of the left pulmonary artery on the pulmonary artery pressure was compared with that of strictly ipsilateral Lycopodium embolization, in the same animal. In order to evaluate the degree of obstruction of the blood flow, end-tidal CO2 concentration from the left lung was continuously monitored employing a bronchospirometric tube. The systemic and pulmonary artery pressures were consistently recorded. To confirm that Lycopodium spores had not overflowed into the contralateral lung, a smear preparates obtained by means of incising of the right lung lobes were microscopically checked very carefully, in postmortem examination. 2. An initial dose of 100 to 200 mg of Lycopodium spores was injected into the right atrium, then a dose of 25 to 100 mg was added every 5 to 15 minutes in the same manner. In this series, the changes in the pulmonary and systemic artery pressures and the respiratory rate were observed. Results When strictly left pulmonary artery embolization was accomplished, the elevation in the pulmonary artery pressure never exceeded that observed in the control balloon occlusion of the ipsilateral pulmonary artery. In this group, the elevation in the pulmonary artery pressure by superimposed balloon occlusion after embolization was as same in the degree as by the control occlusion. No or negligible overflowing of Lycopodium spores into the right pulmonary artery was confirmed by the postmortem examination (10 experiments).

Opacification of an atelectatic lung segment during selective angiocardiography.

The demonstration of the vasculature in an atelectatic lung segment in man via selective angiocardiography comprises a unique experience, no example having previously been recorded in the literature. The blood supply to an atelectatic lung segment in animals has been demonstrated experimentally. In 1912, Bruns (1) described the circulation in atelectatic lungs in rabbits. He showed that the normal rabbit lung contains more blood than the atelectatic lung and receives more blood per unit of time. He also reported that, in spite of collapse of an entire lung, the oxygen saturation of the arterial blood was not lowered and the carbon dioxide content not increased. He stated that there was no blood flow in the capillaries in an atelectatic lung (following artificial pneumothorax). Bruns' measurements of blood flow were made by direct cannulization. Gilroy, Wilson, and Marchand (2), in 1951, reported that collapse of a pulmonary lobe or an entire lung does not necessarily cause systemic arterial anoxia. In 8 patients with collapse of a lung or the lobe of a lung, Gilroy and his co-workers demonstrated the systemic arterial oxygen saturation to be normal. Studies of the blood oxygen saturation at various sites in the main pulmonary arteries and veins during operation for the removal of a collapsed and functionless lung or lobe suggested that no pulmonary arterial blood was traversing the lung and that there was a retrograde flow of blood from the bronchial to the pulmonary arteries. Björk (3) studied the blood flow to atelectatic lung segments in dogs with the aid of angiography. He reported in 1953 that in acute atelectasis of one lung the ipsilateral pulmonary artery maintained its caliber and the capillary bed remained open, as indicated by the filling of the pulmonary arteries and veins with contrast medium bilaterally. Björk concluded that acute atelectasis present for one hour does not significantly decrease the blood flow through the atelectatic segment. After the atelectasis had persisted for one and one-half months, practically no opacified blood could be seen passing through the collapsed segment. Bulgarelli (4) reported in 1955 that, in a case of atelectasis of the left lower lobe, an intravenous angiocardiogram showed hypercirculation in the opposite lung, with dilatation of the opposite pulmonary artery and visualization of numerous small, usually undetected vessels. He described hypovascularity of the atelectatic lung. These findings do not coincide with our observations. Case Report R. M., a 6-year-old white boy, was admitted to Montefiore Hospital for the first time on April 20, 1956, from the Cardiac Clinic. The child had been born at full term, weighing 6 pounds and 4 ounces at birth. Delivery was uncomplicated and development normal.

Blood Content in a Lung on Occlusion of the Ipsilateral Pulmonary Artery

Blood Content in a Lung on Occlusion of the Ipsilateral Pulmonary Artery

Chapter IV: Blood Content in a Lung on Occlusion of the Ipsilateral Pulmonary Artery

Chapter IV: Blood Content in a Lung on Occlusion of the Ipsilateral Pulmonary Artery