Pulmonary blood flow distribution after the total cavopulmonary connection for complex cardiac anomalies

1999 ◽  
Vol 14 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Masao Tayama ◽  
Nobuaki Hirata ◽  
Tohru Matsushita ◽  
Tetsuya Sano ◽  
Norihide Fukushima ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Total Cavopulmonary Connection ◽  
Blood Flow Distribution ◽  
Cardiac Anomalies ◽  
Cavopulmonary Connection

Mechanisms of improvement in pulmonary gas exchange during isovolemic hemodilution

1999 ◽  
Vol 87 (1) ◽  
pp. 132-141 ◽  
Author(s):  
Steven Deem ◽  
Richard G. Hedges ◽  
Steven McKinney ◽  
Nayak L. Polissar ◽  
Michael K. Alberts ◽  
...  
Keyword(s):  
Blood Flow ◽  
Fractal Dimension ◽  
Gas Exchange ◽  
Spatial Correlation ◽  
Pulmonary Blood Flow ◽  
Minute Ventilation ◽  
Flow Distribution ◽  
Pulmonary Gas Exchange ◽  
Normal Lung ◽  
Blood Flow Distribution

Severe anemia is associated with remarkable stability of pulmonary gas exchange (S. Deem, M. K. Alberts, M. J. Bishop, A. Bidani, and E. R. Swenson. J. Appl. Physiol. 83: 240–246, 1997), although the factors that contribute to this stability have not been studied in detail. In the present study, 10 Flemish Giant rabbits were anesthetized, paralyzed, and mechanically ventilated at a fixed minute ventilation. Serial hemodilution was performed in five rabbits by simultaneous withdrawal of blood and infusion of an equal volume of 6% hetastarch; five rabbits were followed over a comparable time. Ventilation-perfusion (V˙a/Q˙) relationships were studied by using the multiple inert-gas-elimination technique, and pulmonary blood flow distribution was assessed by using fluorescent microspheres. Expired nitric oxide (NO) was measured by chemiluminescence. Hemodilution resulted in a linear fall in hematocrit over time, from 30 ± 1.6 to 11 ± 1%. Anemia was associated with an increase in arterial [Formula: see text] in comparison with controls ( P < 0.01 between groups). The improvement in O2 exchange was associated with reducedV˙a/Q˙heterogeneity, a reduction in the fractal dimension of pulmonary blood flow ( P = 0.04), and a relative increase in the spatial correlation of pulmonary blood flow ( P = 0.04). Expired NO increased with anemia, whereas it remained stable in control animals ( P < 0.0001 between groups). Anemia results in improved gas exchange in the normal lung as a result of an improvement in overallV˙a/Q˙matching. In turn, this may be a result of favorable changes in pulmonary blood flow distribution, as assessed by the fractal dimension and spatial correlation of blood flow and as a result of increased NO availability.

scholarly journals Pulmonary NO synthase inhibition and inspired CO2: effects on V ′/Q ′ and pulmonary blood flow distribution

2000 ◽  
Vol 16 (2) ◽  
pp. 288 ◽  
Author(s):  
T.V. Brogan ◽  
R.G. Hedges ◽  
S. McKinney ◽  
H.T. Robertson ◽  
M.P. Hlastala ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
No Synthase ◽  
Blood Flow Distribution ◽  
Co2 Effects

Pulmonary Blood Flow Distribution during Normal Ambulation

Respiration ◽  
1974 ◽  
Vol 31 (4) ◽  
pp. 289-295
Author(s):  
M. Arborelius, jr. ◽  
V. Lopéz-Majano ◽  
R.C. Reba ◽  
T.K. Natarajan
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Blood Flow Distribution

scholarly journals Headed in the Wrong Direction: Chronic and Acute Derangements in Pulmonary Blood Flow Distribution in a Patient with Severe Pulmonary Vein Stenosis

2019 ◽  
Vol 16 (10) ◽  
pp. 1321-1326 ◽  
Author(s):  
Luisa Morales-Nebreda ◽  
Christopher S. Chung ◽  
Rishi Agrawal ◽  
Anjana V. Yeldandi ◽  
Benjamin D. Singer ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Vein ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Pulmonary Vein Stenosis ◽  
Blood Flow Distribution ◽  
Wrong Direction ◽  
Vein Stenosis

Pulmonary blood flow distribution in standing horses is not dominated by gravity

1996 ◽  
Vol 81 (3) ◽  
pp. 1051-1061 ◽  
Author(s):  
M. P. Hlastala ◽  
S. L. Bernard ◽  
H. H. Erickson ◽  
M. R. Fedde ◽  
E. M. Gaughan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Correlation Coefficients ◽  
Vertical Gradient ◽  
Standing Position ◽  
Central Vein ◽  
Least Squares Regression ◽  
Blood Flow Distribution ◽  
Considerable Heterogeneity

Recent studies using microspheres in dogs, pigs and goats have demonstrated considerable heterogeneity of pulmonary perfusion within isogravitational planes. These studies demonstrate a minimal role of gravity in determining pulmonary blood flow distribution. To test whether a gravitational gradient would be more apparent in an animal with large vertical lung height, we measured perfusion heterogeneity in horses (vertical lung height = approximately 55 cm). Four unanesthetized Thoroughbred geldings (422-500 kg) were studied awake in the standing position with fluorescent microspheres injected into a central vein. Between 1,621 and 2,503 pieces (1.3 cm3 in volume) were obtained from the lungs of each horse with spatial coordinates, and blood flow was determined for each piece. The coefficient of variation of blood flow throughout the lungs ranged between 22 and 57% among the horses. Considerable heterogeneity was seen in each isogravitational plane. The relationship between blood flow and vertical height up the lung was characterized by the slope and correlation coefficient of a least squares regression analysis. The slopes within each horse ranged from -0.052 to +0.021 relative flow units/cm height up the lung, and the correlation coefficients varied from 0.12 to 0.75. A positive slope, indicating that flow increased with vertical distance up the lung (opposite to gravity), was observed in three of the four horses. In addition, blood flow was uniformly low in three of the four horses in the most cranial portions of the lungs. We conclude that in lungs of resting unanesthetized horses, animals with a large lung height, there is no consistent vertical gradient to pulmonary blood flow and there is a considerable degree of perfusion heterogeneity, indicating that gravity alone does not play the major role in determining blood flow distribution.

Hemodilution during Venous Gas Embolization Improves Gas Exchange, without Altering V̇A/Q̇ or Pulmonary Blood Flow Distributions 

1999 ◽  
Vol 91 (6) ◽  
pp. 1861-1861 ◽  
Author(s):  
Steven Deem ◽  
Steven McKinney ◽  
Nayak L. Polissar ◽  
Richard G. Hedges ◽  
Erik R. Swenson
Keyword(s):  
Blood Flow ◽  
Gas Exchange ◽  
Lung Injury ◽  
Partial Pressure ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Arterial Oxygen ◽  
Control Group ◽  
Blood Flow Distribution ◽  
Over Time

Background Isovolemic anemia results in improved gas exchange in rabbits with normal lungs but in relatively poorer gas exchange in rabbits with whole-lung atelectasis. In the current study, the authors characterized the effects of hemodilution on gas exchange in a distinct model of diffuse lung injury: venous gas embolization. Methods Twelve anesthetized rabbits were mechanically ventilated at a fixed rate and volume. Gas embolization was induced by continuous infusion of nitrogen via an internal jugular venous catheter. Serial hemodilution was performed in six rabbits by simultaneous withdrawal of blood and infusion of an equal volume of 6% hetastarch; six rabbits were followed as controls over time. Measurements included hemodynamic parameters and blood gases, ventilation-perfusion (V(A)/Q) distribution (multiple inert gas elimination technique), pulmonary blood flow distribution (fluorescent microspheres), and expired nitric oxide (NO; chemoluminescence). Results Venous gas embolization resulted in a decrease in partial pressure of arterial oxygen (PaO2) and an increase in partial pressure of arterial carbon dioxide (PaCO2), with markedly abnormal overall V(A)/Q distribution and a predominance of high V(A)/Q areas. Pulmonary blood flow distribution was markedly left-skewed, with low-flow areas predominating. Hematocrit decreased from 30+/-1% to 11+/-1% (mean +/- SE) with hemodilution. The alveolar-arterial PO2 (A-aPO2) difference decreased from 375+/-61 mmHg at 30% hematocrit to 218+/-12.8 mmHg at 15% hematocrit, but increased again (301+/-33 mmHg) at 11% hematocrit. In contrast, the A-aPO2 difference increased over time in the control group (P &lt; 0.05 between groups over time). Changes in PaO2 in both groups could be explained in large part by variations in intrapulmonary shunt and mixed venous oxygen saturation (SvO2); however, the improvement in gas exchange with hemodilution was not fully explained by significant changes in V(A)/Q or pulmonary blood flow distributions, as quantitated by the coefficient of variation (CV), fractal dimension, and spatial correlation of blood flow. Expired NO increased with with gas embolization but did not change significantly with time or hemodilution. Conclusions Isovolemic hemodilution results in improved oxygen exchange in rabbits with lung injury induced by gas embolization. The mechanism for this improvement is not clear.

Role of Rho-kinase signaling and endothelial dysfunction in modulating blood flow distribution in pulmonary hypertension

2011 ◽  
Vol 110 (4) ◽  
pp. 901-908 ◽  
Author(s):  
Daryl O. Schwenke ◽  
James T. Pearson ◽  
Takashi Sonobe ◽  
Hatsue Ishibashi-Ueda ◽  
Akito Shimouchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endothelial Dysfunction ◽  
Pulmonary Blood Flow ◽  
Left Lung ◽  
Rho Kinase ◽  
Flow Distribution ◽  
Fundamental Result ◽  
Internal Diameter ◽  
Blood Flow Distribution ◽  
Male Adult

Rho-kinase-mediated vasoconstriction and endothelial dysfunction are considered two primary instigators of pulmonary arterial hypertension (PAH). However, their contribution to the adverse changes in pulmonary blood flow distribution associated with PAH has not been addressed. This study utilizes synchrotron radiation microangiography to assess the specific role, and contribution of, Rho-kinase-mediated vasoconstriction and endothelial dysfunction in PAH. Male adult Sprague-Dawley rats were injected with saline (Cont-rats) or monocrotaline (MCT-rats) 3 wk before microangiography was performed on the left lung. We assessed dynamic changes in vessel internal diameter (ID) in response to 1) the Rho-kinase inhibitor fasudil (10 mg/kg iv); or 2) ACh (3 μg · kg−1 · min−1), sodium nitroprusside (SNP, 5 μg · kg−1 · min−1), and Nω-nitro-l-arginine methyl ester (l-NAME, 50 mg/kg iv). We observed that MCT-rats had fewer vessels of the microcirculation compared with Cont-rats. The fundamental result of this study is that fasudil improved pulmonary blood flow distribution and reduced pulmonary pressure in PAH rats, not only by dilating already-perfused vessels (ID > 100 μm), but also by restoring blood flow to vessels that had previously been constricted closed (ID < 100 μm). Endothelium-dependent vasodilation was impaired in MCT-rats primarily in vessels with an ID < 200 μm. Moreover the vasoconstrictor response to l-NAME was accentuated in MCT-rats, but only in the 200- to 300-μm vessels. These results highlight the importance of Rho-kinase-mediated control and endothelial control of pulmonary vascular tone in PAH. Indeed, an effective therapeutic strategy for treating PAH should target both the smooth muscle Rho-kinase and endothelial pathways.

Possible sources of right-to-left shunting in patients following a total cavopulmonary connection

1998 ◽  
Vol 8 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Gernot Buheitel ◽  
Michael Hofbeck ◽  
Ursula Tenbrink ◽  
Georg Leipold ◽  
Jürgen v.d. Emde ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Veins ◽  
Arterial Oxygen ◽  
Total Cavopulmonary Connection ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Arteriovenous Fistulas ◽  
Cavopulmonary Connection

AbstractDespite a good haemodynamic result, many children have amildly decreased arterial oxygen saturation following a total cavopulmonary connection. Our study was performed to determine possible mechanisms of right-to-left shunting in these patients. We performed elective cardiac catheterization in 19 children at a mean interval of 3.6 years following a total cavopulmonary connection. The intrapulmonary right-to-left shunt, the intracardiac right-to-left shunt and the total right-to-left shunt were calculated under mechanical ventilation with 100% oxygen. The intrapulmonary right-to-left shunt was 10.8±3.5% of the pulmonary blood flow, and the total right-to left shunt accounted for 18.9±5.2% of the systemic blood flow. The intracardiac right-to-left shunt in patients with no relevant venovenous collaterals or leaks in the atrial tunnel was calculated at 6.4±3.0% of the systemic blood flow, while the intracardiac right-to-left shunt in patients with relevant collaterials or leaks accounted for 13.0±5.9% of the systemic blood flow. Since intrapulmonary arteriovenous fistulas were not demonstrated angiographically in any of our patients, the intrapulmonary right-to-left shunt is probably due to low ratios of perfusion to ventilation in some pulmonary segments. The intracafdiac right-to-left shunt was due to leaks across the interatrial baffle, collaterals between stystemic and pulmonary veins, and to the coronary sinus draining to the pulmonary venous atrium.

scholarly journals A novel diagnostic approach for assessing pulmonary blood flow distribution using conventional X-ray angiography

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253565
Author(s):  
Takuya Sakaguchi ◽  
Yuichiro Watanabe ◽  
Masashi Hirose ◽  
Kohta Takei ◽  
Satoshi Yasukochi
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Flow Distribution ◽  
Pulmonary Angiography ◽  
Lung Perfusion ◽  
Blood Flow Distribution ◽  
Perfusion Scintigraphy ◽  
Lung Perfusion Scintigraphy ◽  
X Ray ◽  
The Right

Objective Quantitative assessment of pulmonary blood flow distribution is important when determining the clinical indications for treating pulmonary arterial branch stenosis. Lung perfusion scintigraphy is currently the gold standard for quantitative blood flow measurement. However, it is expensive, cannot provide a real-time assessment, requires additional sedation, and exposes the patient to ionizing radiation. The aim of this study was to investigate the feasibility of a novel technology for measuring pulmonary blood flow distribution in each lung by conventional X-ray pulmonary angiography and to compare its performance to that of lung perfusion scintigraphy. Methods Contrast-enhanced X-ray pulmonary angiography images were acquired at a frame rate of 30 frames per second. The baseline mask image, obtained before contrast agent injection, was subtracted from subsequent, consecutive images. The time-signal intensity curves of two regions of interest, established at each lung field, were obtained on a frame-to-frame basis. The net increase in signal intensity within each region at the torrent period during the second cardiac cycle before contrast agent enhancement over the total lung field was measured, and the right-to-left ratio of the signal intensity was calculated. The right-to-left ratio obtained with this approach was compared to that obtained with scintigraphy. Agreement of the right-to-left ratio between X-ray angiography and lung scintigraphy measurements was assessed using linear fitting with the Pearson correlation coefficient. Result The calculation of the right-to-left ratio of pulmonary blood flow by our kinetic model was feasible for seven children as a pilot study. The right-to-left ratio of pulmonary blood flow distribution calculated from pulmonary angiography was in good agreement with that of lung perfusion scintigraphy, with a Pearson correlation coefficient of 0.91 and a slope of linear fit of 1.2 (p<0.005). Conclusion The novel diagnostic technology using X-ray pulmonary angiography from our kinetic model can feasibly quantify the right-to-left ratio of pulmonary blood flow distribution. This technology may serve as a substitute for lung perfusion scintigraphy, which is quite beneficial for small children susceptible to radiation exposure.

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