Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary Arterial Hypertension and Congenital Heart Disease
- 57 Downloads
The purpose of this study was to evaluate the pathological changes of the pulmonary arterioles in patients ≥ 2 years of age who first underwent a pulmonary artery banding (PAB) procedure, followed by bidirectional Glenn or Fontan according to their specific conditions. This was a prospective study of 15 children diagnosed and treated with PAB at the Department of Cardiothoracic Surgery of Anzhen Hospital between January 2009 and December 2012. The percentage of media area (%MS) of pulmonary arteriole, the percentage of media thickness (%MT), and pulmonary arterial density (APSC) were calculated from lung tissue sections. Pulmonary artery pressure decreased significantly after PAB surgery (P < 0.01). Postoperative mean pulmonary artery pressure declined significantly (P < 0.01), the cardiothoracic ratio was reduced (P < 0.05), and percutaneous oxygen saturation (inhaled air) decreased to 80–85% (P < 0.01). %MT (from 35.1 ± 5.6% to 26.9 ± 4.3%, P < 0.01), %MS (from 51.4 ± 6.7% to 32.2 ± 7.4%, P < 0.01), and APSC (from 108.3 ± 38.5 to 83.6 ± 19.6, P < 0.01) were decreased significantly after PAB. Five patients underwent the bidirectional Glenn procedure and four underwent Fontan. In conclusion, the results suggest that PAB can reduce pulmonary artery pressure and that pulmonary arterial lesions can be reversed after PAB.
KeywordsPulmonary artery banding Pulmonary artery Pathological alteration Pulmonary arterial hypertension Congenital heart disease
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no competing interests.
Research Involving Human Participants
The study was approved by the ethics committee of Anzhen Hospital. Written informed consent was obtained from the legal guardians.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki eclaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Wagenvoort CA, Wagenvoort N, Draulans-Noe Y (1984) Reversibility of plexogenic pulmonary arteriopathy following banding of the pulmonary artery. J Thorac Cardiovasc Surg 87(6):876–886Google Scholar
- 7.Sharma R (2012) Pulmonary artery banding: rationale and possible indications in the current era. Ann Pediatr Cardiol 5(1):40–43Google Scholar
- 8.Ishii Y, Inamura N, Kayatani F, Iwai S, Kawata H, Arakawa H, Kishimoto H (2014) Evaluation of bilateral pulmonary artery banding for initial palliation in single-ventricle neonates and infants: risk factors for mortality before the bidirectional Glenn procedure. Interact Cardiovasc Thorac Surg 19(5):807–811. https://doi.org/10.1093/icvts/ivu240 CrossRefGoogle Scholar
- 9.Kameny RJ, Colglazier E, Nawaytou H, Moore P, Reddy VM, Teitel D, Fineman JR (2017) Pushing the envelope: a treat and repair strategy for patients with advanced pulmonary hypertension associated with congenital heart disease. Pulm Circ 7(3):747–751. https://doi.org/10.1177/2045893217726086 CrossRefGoogle Scholar
- 10.Masaki N, Saiki Y, Endo M, Maeda K, Adachi O, Akiyama M, Kawamoto S, Saiki Y (2018) Evidence of pulmonary vascular reverse remodeling after pulmonary artery banding performed in early infancy in patients with congenital heart defects. Circ J 82(3):684–690. https://doi.org/10.1253/circj.CJ-17-0379 CrossRefGoogle Scholar
- 13.Galie N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, Olschewski H, Peacock A, Pietra G, Rubin LJ, Simonneau G, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie M, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, McGregor K, Morais J, Oto A, Smiseth OA, Barbera JA, Gibbs S, Hoeper M, Humbert M, Naeije R, Pepke-Zaba J, Task F (2004) Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The task force on diagnosis and treatment of pulmonary arterial hypertension of the European Society of Cardiology. Eur Heart J 25(24):2243–2278. https://doi.org/10.1016/j.ehj.2004.09.014 CrossRefGoogle Scholar
- 14.Bando K, Turrentine MW, Sharp TG, Sekine Y, Aufiero TX, Sun K, Sekine E, Brown JW (1996) Pulmonary hypertension after operations for congenital heart disease: analysis of risk factors and management. J Thorac Cardiovasc Surg 112(6):1600–1607. https://doi.org/10.1016/S0022-5223(96)70019-3 (discussion 1607–1609) CrossRefGoogle Scholar
- 17.Ikonomidis JS, Hilton EJ, Payne K, Harrell A, Finklea L, Clark L, Reeves S, Stroud RE, Leonardi A, Crawford FA Jr, Spinale FG (2007) Selective endothelin-A receptor inhibition after cardiac surgery: a safety and feasibility study. Ann Thorac Surg 83(6):2153–2160. https://doi.org/10.1016/j.athoracsur.2007.02.087 (discussion 2161) CrossRefGoogle Scholar
- 19.Botney MD, Kaiser LR, Cooper JD, Mecham RP, Parghi D, Roby J, Parks WC (1992) Extracellular matrix protein gene expression in atherosclerotic hypertensive pulmonary arteries. Am J Pathol 140(2):357–364Google Scholar
- 23.Yamaki S (2000) Lung biopsy diagnosis of pulmonary vascular disease. Medical Review, TokyoGoogle Scholar
- 30.Galie N, Beghetti M, Gatzoulis MA, Granton J, Berger RM, Lauer A, Chiossi E, Landzberg M (2006) Bosentan RandomizedTrial of Endothelin Antagonist Therapy I Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study. Circulation 114(1):48–54. https://doi.org/10.1161/CIRCULATIONAHA.106.630715 CrossRefGoogle Scholar
- 32.Lunze K, Gilbert N, Mebus S, Miera O, Fehske W, Uhlemann F, Muhler EG, Ewert P, Lange PE, Berger F, Schulze-Neick I (2006) First experience with an oral combination therapy using bosentan and sildenafil for pulmonary arterial hypertension. Eur J Clin Investig 36(Suppl 3):32–38. https://doi.org/10.1111/j.1365-2362.2006.01692.x CrossRefGoogle Scholar