Pulmonary Artery Research Articles

Evaluation of Three-Vessel View Intervessel Distance Measurements in Fetuses Without Congenital Cardiac Defects.

We aimed to compare the intervessel distances on standard 3-vessel views during fetal echocardiography across nonanomalous fetuses between 18 and 23 weeks' gestation. The intervessel measurements included the distances between the main pulmonary artery (PA) and ascending aorta (Ao) (PA-Ao), between Ao and superior vena cava (SVC) (Ao-SVC), and between PA and SVC (PA-SVC). Throughout a 2-year period, 95 low-risk pregnancies as controls were included. Two evaluators measured intervessel distances from archived images. Scatter plots that included gestational age, femur length (FL), biparietal diameter (BPD), and intervessel distance measurements for nonanomalous fetuses were formed. Inter- and intraobserver reliabilities were assessed by intraclass correlations (ICC). In normal fetuses, PA-Ao and Ao-SVC distance values did not significantly change (p = 0.62 and p = 0.09, respectively), although PA-SVC distance measurements increased (p = 0.0001) with increasing gestational weeks. Interobserver and intraobserver agreement for PA-Ao distance were moderate (ICC, 0.63) and high positive (ICC, 0.79); for Ao-SVC distance, it was low positive (ICC, 0.47) and moderate (ICC, 0.59); for PA-SVC distance, it was high positive (ICC, 0.76) and high positive (ICC, 0.89), respectively. Reference intervals for intervessel distances PA-Ao, Ao-SVC, and PA-SVC in the three-vessel view at 18-23 weeks of gestation were established.

Volume challenge in women with congenital heart disease during reproductive age and pregnancy outcomes.

Thanks to medical improvements in the care for patients with congenital heart disease (CHD), women with CHD reach reproductive age. Pregnancy is not without risk due to the cardiovascular changes that occur. University Hospitals Leuven use a standardised protocol, including a catheterisation and volume challenge, to assess these women before pregnancy. This protocol has never been evaluated. The primary aim was to evaluate this volume challenge protocol. The second objective was to investigate whether hemodynamic data obtained during cardiac catheterisation were associated with maternal and/or neonatal outcome. A single-centre, retrospective study was conducted. Primarily, changes in catheterisation measurements were evaluated. Second, correlation statistics investigated associations between catheterisation data and outcome. Twenty-five women, with nine different CHDs were eligible for inclusion and underwent a catheterisation with volume challenge. Significant changes in pre- and post-volume challenge measurements were observed in the mean averaged systemic venous pressure (ASVP) (p < 0.001), diastolic and mean pulmonary artery pressures (p < 0.001), and the pulmonary capillary wedge pressure (p < 0.001). A negative correlation was observed between the pre-test ASVP and the neonatal gestational age at delivery (p = 0.002). Another negative correlation was found between the post-test cardiac index (CI) and gestational age at delivery (p = 0.049) and birthweight (p = 0.018). The results suggest that higher ASVP is associated with lower gestational age at delivery. Remarkably, higher CI was related with lower gestational age and birthweight. However, our data do not support that a systematic volume challenge in women with CHD can be considered as a reliable prediction test.

Biologically engineered valved conduits for right ventricular outflow tract repair evaluated for 52 weeks in growing lambs.

Replacement heart valves that grow with children remain an unmet need. We previously reported valves fabricated from tubes of fibroblast-derived collagenous matrix increased in size while functioning with low systolic gradients and less than moderate regurgitation over 52 weeks in most cases, when implanted as interpositional grafts in the pulmonary artery of lambs. Here, we evaluated valved conduits fabricated by including an inflow segment to the tri-tube valve allowing for myocardial anastomosis as done in a typical right ventricular outflow tract (RVOT) surgical repair, in the same growing lamb model. In this pilot study, 19 mm valved conduits fabricated from resorbable suture were implanted into Dorset lambs (n = 3), sutured to the pulmonary annulus and distal pulmonary artery with resorbable suture after dissection of the pulmonary valve leaflets and resection of an arterial segment. Valve function and dimensions were measured with longitudinal transthoracic echocardiography. All animals exhibited an increase in valve diameter (18.2 ± 1.8 mm at 1 week to 25.1 ± 2.4 mm at 52 weeks) and leaflet free-edge length (21.1 ± 2.4 mm at 1 week to 26.2 ± 3.9 mm at 52 weeks) while functioning with at most mild regurgitation over 52 weeks. The inflow segment of the conduit grew somatically based on its unchanged thickness and increased diameter (38%) and collagen content (128%). In all three explanted conduits, the leaflets contained interstitial cells, new collagen and elastin primarily around the base, a developing endothelium on the surfaces, and they remained thin and pliable without macroscopic calcification. There was interdigitating integration of the conduit with the myocardium at the pulmonary annulus. Further, a stent was successfully placed in a valved conduit at term to evaluate feasibility of a prospective clinical intervention. This valved conduit grows in lambs based on this pilot study and thus has clinical potential for RVOT reconstruction and long-term valve growth in children.

Fontan Surgical Planning: Numerical Simulations Reveal Efficient Geometries Predicting Post-Surgical Outcomes.

Computational fluid dynamics has the potential to assist cardiovascular surgeons in making more accurate decisions, allowing the prediction of post-surgical outcomes, provided that pre-surgical conditions are well established. However, the application of current techniques, which are based on volume methods, is still limited to a few specialized centers. Lack of knowledge, coupled with the need for advanced computational resources, can serve as obstacles to implementation. Objective: This study aimed to develop a replicable surgical planning procedure for a simplified and clinically feasible total cavopulmonary geometry. The finite volume method was used to simulate different configurations of cavopulmonary anastomosis under continuous and pulsatile flow and thus gain a better understanding of blood behavior, energy efficiency, and shear stress in the studied regions. Two geometries were found to be efficient in distributing blood flow in a physiological manner, with adequate shear stress and energy loss. In addition to the correct placement of the anastomosis, the results underscored the need for attention regarding potential stenoses in pulmonary arteries to obtain adequate geometries. The developed method proved to be effective for early visualization of post-surgical results, particularly in complex clinical cases. Furthermore, the method contributes to a comprehensive understanding of hemodynamics in the studied area, improving the accuracy of cardiovascular surgical planning.

International liver transplantation society practice guideline update on portopulmonary hypertension.

Portopulmonary hypertension (POPH), pulmonary artery hypertension (PAH) that develops in the setting of portal hypertension, has long been of significant interest to the pulmonary, cardiology and hepatology communities. Optimal management of POPH has been challenging to define due to lack of evidence from clinical trials regarding PAH therapies and uncertainty regarding the role of liver transplantation (LT). Initially, the high risk of intraoperative and early post-transplant death in predominantly untreated patients with POPH tempered consideration of LT. More recently, the observation that POPH can improve, and sometimes even resolve, following LT, has led to reconsideration of the role of LT in selected patients. The first International Liver Transplantation Society (ILTS) POPH and hepatopulmonary syndrome practice guideline was a multidisciplinary consensus of expert opinions based on available evidence. Since that publication, hemodynamic definitions, management approaches and POPH Model for End Stage Liver Disease exception criteria have evolved and there have been new randomized controlled trials in POPH as well as studies regarding long-term outcomes. In order to ensure the guidelines remained current and reflected recent evidence, the original writing committee of the 2016 guidelines, leaders of the ILTS Cardiovascular Special Interest Group and colleagues active in POPH research were invited to participate in the writing committee. In this document, approved for publication by the ILTS executive council, we provide an update to the prior guidelines with expert recommendations to guide and advance POPH management. Recommendations in these guidelines are based on expert opinion and available evidence and were agreed upon by consensus.

A Systematic Review of Surgical Strategies for Managing Major Thoracic Vessels in Thoracic Oncology.

The management of locally advanced thoracic malignancies, particularly those involving critical vascular structures, presents substantial surgical challenges. Surgery remains a cornerstone of treatment for these conditions, yet the involvement of the superior vena cava (SVC), pulmonary artery (PA), aorta, and thoracic outlet vessels complicates the process. The literature search was performed from January 1990 to January 2025 in PubMed, Embase, and Cochrane according to PRISMA guidelines. Through the process of evidence acquisition, 78 types of research were identified: 27 focusing on SVC, and 25 focusing on PA, 15 focusing on the aorta, and 11 focusing on thoracic outlet vessels. The findings indicated that surgical management of the SVC and PA, although feasible, carries significant risks. The perioperative mortality for SVC surgeries ranged from 0 to 17%, with morbidity varying between 0 and 50%. For PA surgeries, the perioperative mortality ranged from 0 to 17.2% and morbidity ranged from 0 to 62%. Extended resections, including partial and total aortic resections, offered long-term survival rates of 25% to 40% for carefully selected patients. Vascular reconstructions, such as subclavian artery resection followed by bypass, demonstrated a 70% success rate with a 35% 5-year survival rate. Vascular reconstructive techniques significantly extend surgical resection options, offering lung-sparing procedures for patients with bulky mediastinal masses and avoiding pneumonectomy in functionally challenging cases. Although advancements such as aortic endografting and cardiopulmonary bypass have improved outcomes, challenges such as hemorrhage, vascular injury, and neurologic deficits persist.

Infectious pulmonary artery pseudoaneurysms in 3 children and literatures review

Objective: To summarize the clinical characteristics and prognosis of infectious pulmonary artery pseudoaneurysm (IPAP) in pediatric patients. Methods: This case series study summarizes the clinical data of 3 children diagnosed with IPAP at the Children's Hospital of Chongqing Medical University from January 2015 to December 2024.A comprehensive literature review was conducted by searching Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China VIP Database and Chinese Medical Journals Full Text Database) and the PubMed database through December 2024, using the keywords"infect""pseudoaneurysm""pulmonary artery". The clinical characteristics and prognosis of IPAP were synthesized by combining the reviewed literature. Results: The 3 cases included a 2-month-old male infant, a 6-year-3-month-old male child, and a 12-year-old female child, all of whom presented with fever and various respiratory symptoms. Case 1 was complicated by a retro-orbital abscess, Case 2 had a history of chronic granulomatous disease and psoriasis, and Case 3 was diagnosed with patent ductus arteriosus. Enhanced CT imaging in all 3 cases revealed multiple IPAP, with 2 cases associated with pulmonary infection foci and 1 case linked to infective endocarditis. Accompanying complications included pleural effusion in all 3 cases, necrotizing pneumonia in 2 cases, and pulmonary embolism in 1 case. Of the 3 cases, 2 cases showed improvement after anti-infective treatment, while 1 case resulted in death. A total of 9 English-language studies were identified, while no suitable Chinese-language studies were found. Including these 3 cases, a total of 12 pediatric IPAP cases were analyzed. The predominant clinical manifestations included fever in 10 cases, cough in 6 cases and hemoptysis in 5 cases. The most frequently identified pathogen was methicillin-resistant Staphylococcus aureus (MRSA) found in 3 cases. Additionally, 6 cases were complicated by extra-pulmonary infections, 4 cases had a history of congenital heart disease and surgical intervention, 1 case underwent rectovestibular fistula repair and 4 cases exhibited immune dysfunction. Imaging characteristics revealed that 9 of the 12 cases were associated with pulmonary infection foci, while 1 case was related to infective endocarditis, and 2 cases had insufficient imaging data for accurate classification. A total of 7 cases presented with a single IPAP, predominantly located in the right lower lobe in 3 cases, while the remaining 5 cases had multiple IPAP. IPAP was complicated by pleural effusion in 8 cases, by necrotizing pneumonia in 8 cases (1 of which was suspected), and by lung abscess and pulmonary embolism in 3 cases each. Among the 12 cases, 5 cases received anti-infective therapy without lobectomy or embolization, of which 3 cases improved, 1 case showed no response, and 1 case died. Additionally, 6 cases underwent endovascular embolization, with 4 cases showing improvement and 2 cases resulting in death. Only 1 case underwent lobectomy and was discharged in stable condition. Conclusions: IPAP in children manifests with a broad spectrum of clinical signs, frequently accompanied by extra-pulmonary infections and immune dysfunction. Enhanced CT plays a crucial role in the diagnosis of IPAP. The prognosis of IPAP is closely linked to the treatment approach, and timely diagnosis along with personalized treatment are essential for improving survival rates.

Ventriculo-arterial coupling in pulmonary regurgitation following transannular patch repair of pulmonary stenosis

Pulmonary regurgitation is a common consequence following the repair of tetralogy of Fallot and can lead to heart failure. Early detection of right ventricular dysfunction remains challenging, and current clinical markers have limited predictive value to identify which patients are at risk for heart failure and require interventions. This study aimed to investigate the potential of ventriculo-arterial coupling as a marker of early right ventricular dysfunction in a porcine model of chronic pulmonary regurgitation following transannular patch repair of neonatal pulmonary stenosis. Neonatal swine were subjected to pulmonary artery banding for 1 month to induce RV pressure overload, followed by transannular patch repair (rTAP, n=10) to create chronic pulmonary regurgitation, and were compared to Sham animals (n=6). Longitudinal hemodynamic assessments, including pressure-volume analysis and cardiac magnetic resonance imaging, were performed. VAC was defined as the ratio of end-systolic elastance to effective arterial elastance. Over the follow-up period of 4 months, VAC was preserved in the rTAP group. Effective arterial elastance was significantly lower in rTAP animals (P=0.001), while end-systolic elastance remained unchanged. Lower end-diastolic pulmonary artery pressures and increased early systolic ejection were observed in rTAP, correlating with higher VAC. Ventriculo-arterial coupling remains preserved in chronic pulmonary regurgitation due to decreased afterload, making it unsuitable as an early marker for right ventricular dysfunction. Low afterload, a consequence of diastolic emptying of the pulmonary artery into the right ventricle, may pseudo-normalize systolic function. Alternative markers e.g. focusing on diastolic function and atrio-ventricular interactions should be investigated.

Bilateral tumoral pulmonary emboli complicating right atrial myxoma.

A 48-year-old female underwent emergency surgery for an undetermined mass in the right atrium associated with bilateral pulmonary artery emboli. Under deep hypothermic circulatory arrest, a large gelatinous mass was excised from the right atrium, and large embolic lumps were removed from both main pulmonary arteries. Histopathological testing of excised specimens confirmed the diagnosis of a vascularized myxoma. At 6 months of follow-up, repeated transthoracic echocardiography has not shown any signs of local recurrence or elevated pulmonary artery pressure. The potential for right atrial myxoma as a source of pulmonary embolization should be borne in mind, as this potentially fatal yet curable condition demands emergency surgical intervention.

Neonatal Transcatheter Closure of a Large Pulmonary Arteriovenous Fistula with a KONAR-MF™ VSD Occluder.

Pulmonary arteriovenous fistulas (PAVFs) are rare congenital anomalies characterized by abnormal vascular connections that bypass the capillary bed, causing hypoxemia, cyanosis, and systemic embolic risks. Early diagnosis and intervention are critical to prevent complications, particularly in neonates with severe right-to-left shunts. This report describes the first documented case of neonatal transcatheter closure of a large PAVF using a KONAR-MF™ VSD Occluder (MFO). A 1-day-old neonate with a prenatally diagnosed PAVF presented with oxygen saturation of 82%. Angiographic and echocardiographic assessments confirmed the presence of a large PAVF between the right pulmonary artery and right inferior pulmonary vein. The fistula was successfully closed using an 8 × 6mm MFO device, with no complications. Post-procedure, oxygen saturation improved to 100%, and follow-up at 5months demonstrated sustained closure. This report highlights the safety and versatility of the MFO occluder in complex cardiac cases, offering a minimally invasive alternative to surgical intervention.

Clinical characteristics and therapeutic experience with rivaroxaban in children with Mycoplasma pneumoniae pneumonia associated with pulmonary thromboembolism

Objective: To evaluate the efficacy and safety of rivaroxaban and investigate the clinical features of Mycoplasma pneumoniae pneumonia (MPP) associated with pulmonary thromboembolism (PTE) in children. Methods: A case series study was conducted on 36 children, diagnosed with MPP associated with PTE and hospitalized in our institution from January 2020 to June 2024 of Department of Pediatric Respiratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University. Clinical data and follow-up information were collected to analyze their clinical characteristics, outcomes, and adverse events to rivaroxaban. Comparison of coagulation indices before and after treatment with rivaroxaban using the Mann-Whitney rank sum test. Results: Among the 36 children, there were 27 males and 9 females, and the age of onset was (7.8±2.8) years. PTE was diagnosed (17±6) days after the onset of MPP. Thirty-four cases (94%) were classified as low-risk PTE, and 13 cases (36%) had thromboembolism of multiple anatomic sites. All patients presented with cough and fever, manifesting as shortness of breath in 33 cases (92%), chest pain in 12 case (33%), hemoptysis in 6 case (17%) and dyspnea in 5 cases (14%). All Pulmonary artery involvement was demonstrated by CT pulmonary angiography in all 36 children. The D-dimer level was 5.1 (4.2, 12.2) mg/L. D-dimer levels were 5.1 (4.2, 12.2) mg/L, of which 29 cases (81%) were ≥4.0 mg/L. The total duration of anticoagulation 3.1 (2.5, 4.2) months. All children received rivaroxaban for 2.7 (2.2, 3.8) months. Of the 36 children, 35 cases were followed up after 3 months of anticoagulant therapy, and 30 cases (83%) showed pulmonary artery thrombus absorption. Finally, follow-up outcome data were available for 34 cases, of which 33 showed complete resolution of thrombus in the affected areas, and 1 showed partial resolution. There were no cases of death, thrombus recurrence or progression, major bleeding events occurred or chronic thromboembolic pulmonary hypertension. Adverse events included hemoptysis in 2 cases and elevated liver enzymes in 4 cases. After the treatment of rivaroxaban, the levels of D-dimer were decreased compared with those before the treatment of PTE (0.3 (0.2, 0.5) vs. 5.1 (4.2, 12.2) mg/L, Z=-7.12, P<0.05), and the levels of prothrombin time levels were significantly longer compared with those before the treatment of PTE (3.6 (12.4, 14.9) vs. 13.0 (11.8, 13.6) s, Z=2.34, P<0.05). Conclusions: During the course of MPP, the emergence of clinical symptoms such as short of breath, chest pain, hemoptysis, dyspnea or along with elevated D-dimer levels, should raise suspicion for the occurrence of PTE. Rivaroxaban has shown good efficacy and a favorable safety profile.

Type 1 truncus arteriosus with main pulmonary artery arising at the origin of left subclavian artery: case report from Northern Nigeria

Type 1 truncus arteriosus with main pulmonary artery arising at the origin of left subclavian artery: case report from Northern Nigeria

Novel pulmonary abdominal normothermic regional perfusion circuit for simultaneous in-donor evaluation and preservation of lungs and abdominal organs in donation after circulatory death.

To overcome limitations of traditional ex vivo lung perfusion (EVLP) for controlled donation after circulatory death (cDCD) lungs, this study aimed to evaluate a novel pulmonary abdominal normothermic regional perfusion (PANRP) technique, which we uniquely designed, for in situ assessment of lungs from cDCD donors. We modified the abdominal normothermic regional perfusion circuit for simultaneous lung and abdominal organ assessment using independent extracorporeal membrane oxygenation components. Blood was oxygenated via a membrane oxygenator and returned to the body, with pulmonary flow adjusted to maintain pressure < 25mmHg. Femoral cannulation was performed, and the lungs were ventilated with standard settings. Organ function was assessed over 2h using PaO2/FiO2, AST, ALT, BUN, and Cr measurements to monitor perfusion and oxygen delivery. PANRP maintained stable lung function, with P/F ratios above 300, and preserved abdominal organ parameters, including stable AST, ALT, BUN, and Cr levels. Adequate urine output was observed, indicating normal renal function. Pulmonary artery pressure remained < 20mmHg, and pulmonary vascular resistance was kept at 400 dyn・s/cm5, showing no signs of lung dysfunction or injury throughout the circuit. PANRP offers a promising alternative to traditional EVLP for cDCD lung evaluation, allowing in situ assessment of multiple organs simultaneously. This approach may overcome logistical and economic challenges associated with ex vivo techniques, enabling a more efficient evaluation process. Further studies are warranted to confirm its clinical applicability and impact on long-term outcomes.

Left atrial to coronary sinus shunting in more advanced heart failure with preserved ejection fraction.

Inter-atrial shunt device therapy has shown mixed results in clinical trials, with clinical 'non-responders' typically showing features of more advanced heart failure. We aimed to analyse the haemodynamic and clinical response of a novel left atrial to coronary sinus (LA-CS) shunt device in patients with higher natriuretic peptide (NP) levels, a marker of disease severity. An analysis population (n=95) of patients from the ALT-FLOW early feasibility study with left ventricular ejection fraction >40% and 1-year follow up was analysed. The cohort was divided into low and high subgroups based on NP levels [b-type natriuretic peptide (BNP) and n-terminal pro BNP (NT-proBNP)]. The mean BNP and NT-proBNP levels for low versus high subgroups were 64.2±34.3 versus 261±103 and 322±269 versus 2050±1070pg/mL, respectively. Patients in the high NP subgroup had evidence of more advanced disease including worse haemodynamic profiles, lower estimated glomerular filtration rate, and higher percentages of atrial fibrillation. The high NP subgroup experienced significant improvements in KCCQ-OSS and NYHA functional class (P<0.0001 and P<0.001, respectively) and to a similar magnitude compared with the low NP subgroup. Compared with pre-implant baseline, workload adjusted pulmonary artery wedge pressure at peak exercise declined in the high NP subgroup (PCWL, 164.1 vs. 96.0mmHg/W/kg at 6months, P<0.003) as well as the low NP subgroup (115.9 vs. 65.9mmHg/W/keg at 6months, P<0.001). Importantly, in both NP subgroups, there was preservation of cardiac index through 6months as well as right ventricular structure (right ventricular diastolic dimension) and function (tricuspid annular systolic plane excursion) through 1year. The quality-of-life, haemodynamic, and functional class improvements along with stable right heart function seen in ALT-FLOW study of LA-CS shunt remain consistent in the subgroup with highest NP levels. This suggests that shunting location could influence outcomes in symptomatic heart failure patients.

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) in an Infant.

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) in an Infant.

Relationship of pulmonary artery size and venovenous collaterals during staged single ventricle reconstruction and their impact on outcomes after fontan procedure.

This study aimed to evaluate the relationship between pulmonary artery size and venovenous collaterals during staged single ventricle reconstruction. Patients who underwent staged Fontan palliation between 2003 and 2023 were reviewed. The relationship between the pulmonary artery index and the development of venovenous collaterals was determined. Furthermore, the impact of pulmonary artery index and venovenous collaterals on in-hospital morbidities after the Fontan procedure was evaluated. A total of 377 patients were included. Median age at bidirectional cavopulmonary shunt and total cavopulmonary connection were 4.2 (3.3-6.2) months and 2.1 (1.7-2.6) years, respectively. Venovenous collaterals were observed in 51 (13.5%) of the patients. Patients who developed venovenous collaterals showed higher pulmonary artery pressure (p = 0.024), higher transpulmonary gradient (p = 0.042), lower pulmonary artery index (p = 0.016), and lower right pulmonary artery index (p = 0.011) at the time of bidirectional cavopulmonary shunt, compared to those without. However, the pulmonary artery index was similar in patients with and without venovenous collaterals at the time of total cavopulmonary connection. Higher transpulmonary gradient (p = 0.007) and lower pulmonary artery symmetry index (p = 0.032) at bidirectional cavopulmonary shunt were identified as independent risks for developing venovenous collaterals. The existence of venovenous collaterals did not influence the postoperative course after total cavopulmonary connection. Notably, pulmonary artery symmetry index at bidirectional cavopulmonary shunt was identified as an independent risk for prolonged pleural effusion (p = 0.018) and for chylothorax (p = 0.021). A small and unbalanced pulmonary artery at bidirectional cavopulmonary shunt is associated with the postoperative development of venovenous collaterals.

Correlation between T-lymphocyte subsets and hemodynamics in patients with congenital heart disease-associated pulmonary arterial hypertension.

This study aims to explore the correlation between T-lymphocyte subsets and hemodynamics in patients with congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH). Thirty patients with CHD-PAH from Cardiovascular Hospital Affiliated to Shanxi Medical University were included and divided into cardiac function class I to II (low-risk group) and cardiac function class III to IV (high-risk group) according to the World Health Organization functional class. T-lymphocyte subsets levels and hemodynamic parameters related to right heart function were compared between the 2 groups, and correlation analysis of T-lymphocyte subsets levels and hemodynamic parameters related to right heart function was also performed. Color Doppler ultrasonography was used to measure the hemodynamic parameters of the patients, and flow cytometer was used for the detection of T-lymphocyte subsets. The percentage of regulatory T-cells in the high-risk group (3.62 ± 0.72) was lower than that in the low-risk group (4.10 ± 0.48) (P = .039). Compared with the low-risk group, the Th17/Treg and Th2/Treg levels in the high-risk group were significantly increased, and the difference was statistically significant (P < .05). Right ventricular anteroposterior is negatively correlated with regulatory T cell percentage count with a correlation coefficient of -0.373 (P = .042), and positively correlated with Th2/Treg with a correlation coefficient of 0.392 (P = .032). Tricuspid annular plane systolic excursion and tricuspid annular velocity of motion are positively correlated with the percentage count of T-lymphocytes, with correlation coefficients of 0.397 (P = .03) and 0.413 (P = .023), respectively. Pulmonary artery systolic pressure demonstrated a significant positive association with absolute count of T-lymphocytes (R = 0.387, P = .034), helper T cells (R = 0.426, P = .019), suppressor T cells (R = 0.466, P = .009), Th2 cells (R = 0.453, P = .012), Th17 (IL-17) cells (R = 0.408, P = .025). Tricuspid regurgitation velocity is positively correlated with absolute counts of Ts cells (R = 0.426, P = .019) and Th2 (R = 0.361, P = .05) cells. The inferior vena cava collapsibility index is positively correlated with the absolute count of Th1 cells (R = 0.388, P = .034). Our study confirmed that changes in T-lymphocyte subsets were associated with hemodynamic changes in patients, suggesting that T-lymphocyte subsets may be involved in the development of CHD-PAH, and that immunomodulatory therapy may become a new direction for the treatment of CHD-PAH in the future.

Lactate infusion improves cardiac function in a porcine model of ischemic cardiogenic shock

BackgroundCardiogenic shock (CS) is associated with high mortality and medical therapies have failed to improve survival. Treatment with lactate is associated with improved cardiac function which may benefit this condition. Comprehensive hemodynamic assessment of lactate administration in CS is lacking, and the mechanisms underlying the cardiovascular effects of lactate in CS have not yet been elucidated. In this study we aimed to study the cardiovascular and cardiometabolic effects of treatment with lactate in experimental ischemic CS.MethodsIn a randomized, blinded design, 20 female pigs (60 kg) were studied. Left main coronary artery microsphere injections were used to cause CS, defined as a 30% reduction in CO or mixed venous saturation (SvO2). Subjects were randomized to receive either intravenous exogenous lactate or euvolemic, equimolar saline (control) for 180 min. Positive inotropic control with dobutamine was administered on top of ongoing treatment after 180 min. Extensive hemodynamic measurements were obtained from pulmonary artery and left ventricular (LV) pressure–volume catheterization. Furthermore, endomyocardial biopsies were analyzed for mitochondrial function and arterial, renal vein, and coronary sinus blood samples were collected. The primary endpoint was change in CO during 180 min of treatment.ResultsArterial lactate levels increased from 2.4 ± 1.1 to 7.7 ± 1.1 mmol/L (P < 0.001) during lactate infusion. CO increased by 0.7 L/min (P < 0.001) compared with control, due to increased stroke volume (P = 0.003). Notably, heart rate and mean arterial pressure did not differ significantly between treatments. End-systolic elastance (load independent contractility) was enhanced during lactate infusion (P = 0.048), together with LV ejection fraction (P = 0.009) and dP/dt(max) (P = 0.041). Arterial elastance (afterload) did not differ significantly (P = 0.12). This resulted in improved ventriculo-arterial coupling efficiency (P = 0.012). Cardiac mechanical efficiency (P = 0.003), diuresis (P = 0.016), and SvO2 (P = 0.018) were increased during lactate infusion. Myocardial mitochondrial complex I respiration was enhanced during lactate infusion compared with control (P = 0.04). Concomitant administration of dobutamine on top of lactate resulted in further hemodynamic improvements compared with control.ConclusionsLactate infusion improved cardiac function and myocardial mitochondrial respiration in a porcine model of CS. The hemodynamic effects included increased CO mediated through stroke volume increase. These favorable cardiovascular effects may benefit patients with CS.

Differences in Pulmonary Artery Stiffness Measured by CMR in Preterm-Born Young Adults With and Without Bronchopulmonary Dysplasia.

Very preterm-born infants are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. Nowadays, the majority of these infants reach adulthood. Very preterm-born young adults are at risk for developing pulmonary arterial (PA) hypertension later in life. An early sign of PA hypertension is increased PA stiffness. This study aims to use cardiovascular magnetic resonance to compare PA stiffness using PA relative area change (RAC) and pulse wave velocity (PWV) to identify early signs for PA hypertension in young adults born very premature, with and without BPD. Twenty preterm-born young adults with and 20 without BPD underwent cardiovascular magnetic resonance and were compared with 20 at-term-born young adults. RAC was calculated as the percentage change between the maximal and minimal areas of the PA. PWV was calculated using a method that simultaneously compares flow and area increase in the pulmonary artery during early systole. In 57 of 60 patients, PWV and RAC measurements could be performed. Preterm-born young adults with BPD showed increased PWV compared with preterm-born young adults without BPD (median [25th-75th percentile] 2.07 m/s [1.45-3.05] versus 1.61 m/s [1.18-1.85]; P=0.04) and at-term-born young adults (1.35 m/s [1.08-2.23]; P=0.04). RAC was decreased in both preterm-born young adults with (62% [56-82]; P<0.01) and without BPD (78% [67-93]; P<0.01), compared with at-term-born young adults (101% [87-122]). Preterm-born young adults with BPD show increased PA stiffness as measured by PWV compared with preterm-born young adults without BPD and at-term-born young adults; RAC was decreased in both preterm-born groups compared with at-term controls. This noninvasive method of measuring PA stiffness might be a valuable tool to identify individuals at risk for early signs of PA hypertension in this population.

Understanding Early Fontan Failure in Vietnam: Incidence and Clinical Predictors.

BackgroundWe aimed to determine the incidence of early Fontan failure (EFF) in a contemporary series of patients from Vietnam and identify risk factors for EFF.MethodsA total of 145 consecutive patients underwent the Fontan procedure at E hospital in Vietnam from August 2012 through December 2019. We analyzed predictive factors for EFF based on clinical evaluation, literature review, and our institutional database. The primary outcome assessed was EFF.ResultsThe incidence of EFF was 9.66%. In a univariate analysis of preoperative data, the anatomic diagnosis of unbalanced atrioventricular (AV) septal defect, situs inversus, AV valve regurgitation, large aortopulmonary circulation on Doppler echocardiogram, elevated pulmonary artery pressure (PAP), and elevated pulmonary vascular resistance (PVR) were significantly associated with EFF. Four intraoperative risk factors influencing EFF included pulmonary artery reconstruction, AV valve repair, bleeding, and elevated PAP. Postoperative edema was also significantly associated with EFF. A total of 22 potential independent variables were put into a model with multivariate logistic regression analysis. A final reduced model following utilizing a stepwise backward selection strategy indicated preoperative elevated PAP (odds ratio [OR]: 1.84, 95% CI: 1.12-3.00, P = .016), AV valve repair at Fontan (OR: 65.85, 95%CI: 1.95-2228.14, P = .020), and postoperative elevated PAP (OR: 1.66, 95%CI: 1.19-2.33, P = .004) were independent predictors for EFF.ConclusionEarly Fontan failure was relatively high in our case series and was associated with a significant mortality rate. Patients with single ventricle physiology having preoperative elevated PAP, intraoperative AV valve repair, and postoperative elevated PAP were identified as independent risk factors to predict EFF. Particularly, in the context of a developing country with limited health care resources, a comprehensive management strategy that targets the variable predictors for EFF should be incorporated with previously known risk factors to avoid EFF.