Evaluation of the Microcirculation in Chronic Thromboembolic Pulmonary Hypertension Patients: The Impact of Pulmonary Arterial Remodeling on Postoperative and Follow-Up Pulmonary Arterial Pressure and Vascular Resistance

被引：24

作者：

Jujo, Takayuki ^{[1
,2
]}

Sakao, Seiichiro ^{[1
]}

Ishibashi-Ueda, Hatsue ^{[3
]}

Ishida, Keiichi ^{[4
]}

Naito, Akira ^{[1
]}

Sugiura, Toshihiko ^{[1
]}

Shigeta, Ayako ^{[1
,2
]}

Tanabe, Nobuhiro ^{[1
,2
]}

Masuda, Masahisa ^{[5
]}

Tatsumi, Koichiro ^{[1
]}

机构：

[1] Chiba Univ, Grad Sch Med, Dept Respirol B2, Chuo Ku, Chiba 2608670, Japan

[2] Chiba Univ, Grad Sch Med, Dept Adv Med Pulm Hypertens, Chuo Ku, Chiba 2608670, Japan

[3] Natl Cerebral & Cardiovasc Ctr, Dept Pathol, Suita, Osaka 5658565, Japan

[4] Chiba Univ, Grad Sch Med, Dept Cardiovasc Surg, Chuo Ku, Chiba 2608670, Japan

[5] Natl Hosp Org, Chiba Med Ctr, Dept Cardiovasc Surg, Chuo Ku, Chiba 2608606, Japan

来源：

PLOS ONE | 2015年 / 10卷 / 08期

基金：

日本学术振兴会;

关键词：

MICROVASCULAR DISEASE; THROMBOENDARTERECTOMY; ENDARTERECTOMY; CROSSTALK; PATHOLOGY; PERFUSION; LESIONS;

D O I：

10.1371/journal.pone.0133167

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is generally recognized to be caused by persistent organized thrombi that occlude the pulmonary arteries. The aim of this study was to investigate the characteristics of small vessel remodeling and its impact on the hemodynamics in CTEPH patients. Methods and Results Hemodynamic data were obtained from right heart catheterization in 17 CTEPH patients before pulmonary endarterectomy (PEA). Lung tissue specimens were obtained at the time of PEA. Pathological observations and evaluation of quantitative changes in pulmonary muscular arteries and veins were performed using light microscopy on 423 slides in 17 patients. The relationship between the results and the hemodynamics of CTEPH was investigated. Pulmonary arteriopathy and venopathy were recognized in most cases, although no plexiform lesions and no capillary-hemangiomatosis-like lesions were detected in any of the specimens. The severity of pulmonary arteriopathy was correlated with pulmonary vascular resistance (PVR) in the postoperative and follow-up periods. The PVR and mean pulmonary arterial pressure were significantly higher in the high-obstruction group than in the low-obstruction group. The findings in pulmonary venopathy were similar to the findings seen in pulmonary veno-occlusive disease in some cases, although severe venopathy was only observed in a portion of the pulmonary veins. There was a significant correlation between the extent of pulmonary arteriopathy and venopathy, although an effect of pulmonary venopathy to hemodynamics, including pulmonary arterial wedged pressure (PAWP), could not be identified. Conclusion The vascular remodeling of the pulmonary muscular arteries was closely associated with the hemodynamics of CTEPH. Severe pulmonary arteriopathy might be related to residual pulmonary hypertension after PEA. Those altered pulmonary arteries might be a new target for the persistent PH after the operation.

引用

页数：17

共 36 条

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