Left atrial hypertension causes pleural effusion formation in unanesthetized sheep

We studied the effect of left atrial pressure (LAP) elevation on the formation of pleural effusion in unanesthetized sheep. We prepared the animals by placing catheters in the left atrium, pulmonary artery, femoral artery, and vein. We also placed a balloon catheter in the left atrium. After a recovery period of at least 1 wk, we measured LAP, pulmonary artery pressure (PAP), systemic arterial pressure, systemic venous pressure, cardiac output, plasma protein concentration, and plasma colloid osmotic pressure (pi c). We calculated capillary pressure (Pc) as 0.5(PAP - LAP). We then elevated LAP such that Pc-pi c was between -10 and 19.5 mmHg for 6-24 h. At the end of the experiment, we killed the sheep and measured the volume and protein concentration of the right pleural effusion. We also determined the extravascular fluid to blood free dry weight of the right lung. We found that pleural effusions and pulmonary edema formed when Pc-pi c greater than 5 mmHg. We also found that the pleural effusion volume correlated with the amount of pulmonary edema. Our data show that elevated LAP may cause pleural effusions, but only after pulmonary edema has developed.

Download Full-text

Positive end-expiratory pressure decreases bronchial blood flow in the dog

Journal of Applied Physiology ◽

10.1152/jappl.1984.56.5.1289 ◽

1984 ◽

Vol 56 (5) ◽

pp. 1289-1293 ◽

Cited By ~ 32

Author(s):

E. M. Baile ◽

R. K. Albert ◽

W. Kirk ◽

S. Lakshaminarayan ◽

B. J. Wiggs ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Artery ◽

Left Atrium ◽

Pulmonary Vascular Resistance ◽

Left Atrial ◽

Pulmonary Blood Flow ◽

Venous Pressure ◽

Lower Lobe ◽

Positive End Expiratory Pressure ◽

The Right

Positive end-expiratory pressure (PEEP) increases pulmonary vascular resistance, but its effect on the bronchial circulation is unknown. We have compared two techniques for measuring bronchial blood flow in anesthetized, open-chest, ventilated dogs at varying levels of PEEP. Bronchial blood flow ( Qbr ) to the left lower lobe (LLL) and trachea was measured with radiolabeled microspheres. Total Qbr was partitioned into tracheal, bronchial, and parenchymal fractions. We also measured the bronchopulmonary anastomotic flow ( Qbra ) by attaching cannulas from the lobar pulmonary artery and vein to reservoirs, interrupting the LLL pulmonary blood flow and collecting the flow going into the reservoirs. We measured Qbr and Qbra in 10 animals ventilated with varying levels of PEEP (3, 10, and 15 cmH2O) applied randomly. Pulmonary venous pressure was kept at 0 cmH2O. There was no difference observed between Qbr and Qbra at PEEP 3 and 10 cmH2O, but at PEEP 15 cmH2O, Qbr was greater than Qbra , suggesting that at low left atrial pressures bronchial blood flow drains mainly to the left atrium, whereas at elevated alveolar pressures a larger fraction empties into the right side of the heart. PEEP decreased LLL Qbr and Qbra (P less than 0.01). That fraction of Qbr going to the trachea did not change with PEEP. However, the bronchial and parenchymal fractions decreased.

Download Full-text

Effect of thoracic duct drainage on hydrostatic pulmonary edema and pleural effusion in sheep

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.1.314 ◽

1991 ◽

Vol 71 (1) ◽

pp. 314-316 ◽

Cited By ~ 10

Author(s):

S. J. Allen ◽

R. E. Drake ◽

G. A. Laine ◽

J. C. Gabel

Keyword(s):

Pleural Effusion ◽

Central Venous Pressure ◽

Pulmonary Edema ◽

Thoracic Duct ◽

Left Atrial ◽

Venous Pressure ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Central Venous ◽

Pulmonary Arterial

Positive end-expiratory pressure (PEEP) increases central venous pressure, which in turn impedes return of systemic and pulmonary lymph, thereby favoring formation of pulmonary edema with increased microvascular pressure. In these experiments we examined the effect of thoracic duct drainage on pulmonary edema and hydrothorax associated with PEEP and increased left atrial pressure in unanesthetized sheep. The sheep were connected via a tracheostomy to a ventilator that supplied 20 Torr PEEP. By inflation of a previously inserted intracardiac balloon, left atrial pressure was increased to 35 mmHg for 3 h. Pulmonary arterial, systemic arterial, and central venous pressure as well as thoracic duct lymph flow rate were continuously monitored, and the findings were compared with those in sheep without thoracic duct cannulation (controls). At the end of the experiment we determined the severity of pulmonary edema and the volume of pleural effusion. With PEEP and left atrial balloon insufflation, central venous and pulmonary arterial pressure were increased approximately threefold (P less than 0.05). In sheep with a thoracic duct fistula, pulmonary edema was less (extra-vascular fluid-to-blood-free dry weight ratio 4.8 +/- 1.0 vs. 6.1 +/- 1.0; P less than 0.05), and the volume of pleural effusion was reduced (2.0 +/- 2.9 vs. 11.3 +/- 9.6 ml; P less than 0.05). Our data signify that, in the presence of increased pulmonary microvascular pressure and PEEP, thoracic duct drainage reduces pulmonary edema and hydrothorax.

Download Full-text

Supravalvular Mitral Stenosis in a Cat

Journal of the American Animal Hospital Association ◽

10.5326/0380403 ◽

2002 ◽

Vol 38 (5) ◽

pp. 403-406 ◽

Cited By ~ 14

Author(s):

Deborah M. Fine ◽

Anthony H. Tobias ◽

Kristin A. Jacob

Keyword(s):

Pleural Effusion ◽

Mitral Valve ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Left Atrium ◽

Mitral Stenosis ◽

Left Atrial ◽

Cor Triatriatum ◽

Left Auricle ◽

Cor Triatriatum Sinister

A 3-year-old, 4-kg, castrated male domestic shorthair cat presented with signs of progressive respiratory distress. Thoracic radiographs showed pulmonary edema and pleural effusion. Echocardiography revealed a perforate membrane immediately above the mitral valve that divided the left atrium into proximal and distal chambers. The left auricle was proximal to the dividing membrane and connected to the markedly enlarged proximal left atrial chamber, consistent with the diagnosis of supravalvular mitral stenosis (SMS). Position of the obstructing membrane relative to the left auricle distinguishes SMS from cor triatriatum sinister (CTS). In CTS, the left auricle is distal to the dividing membrane and connects to the distal left atrial chamber.

Download Full-text

Neonatal transcatheter closure of a right pulmonary artery to left atrium fistula

Cardiology in the Young ◽

10.1017/s1047951121000068 ◽

2021 ◽

pp. 1-3

Author(s):

Claire Bertail-Galoin

Keyword(s):

Prenatal Diagnosis ◽

Pulmonary Artery ◽

Left Atrium ◽

Neonatal Period ◽

Transcatheter Closure ◽

Rare Entity ◽

Amplatzer Duct Occluder ◽

Right Pulmonary Artery ◽

The Right ◽

Surgical Treatments

Abstract A fistula between the pulmonary artery and the left atrium is a rare entity and its diagnosis is uncommon in the neonatal period. There are more reported surgical treatments in the literature than with a transcatheter closure. We report the case of a prenatal diagnosis of a large fistula between the right pulmonary artery and the left atrium with successful transcatheter closure with an Amplatzer duct occluder II 6/4 mm.

Download Full-text

A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/8243204 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Negjyp Sopa ◽

Elisabeth Clare Larsen ◽

Anders Nyboe Andersen

Keyword(s):

Pleural Effusion ◽

Ovarian Hyperstimulation Syndrome ◽

Common Finding ◽

Ovarian Hyperstimulation ◽

Pleural Effusions ◽

Luteal Support ◽

Vitro Fertilization ◽

Fluid Production ◽

The Right

We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax.

Download Full-text

Effect of pulmonary artery occlusion and reperfusion on extravascular fluid accumulation

Journal of Applied Physiology ◽

10.1152/jappl.1981.50.1.102 ◽

1981 ◽

Vol 50 (1) ◽

pp. 102-106 ◽

Cited By ~ 18

Author(s):

P. S. Barie ◽

T. S. Hakim ◽

A. B. Malik

Keyword(s):

Pulmonary Artery ◽

Water Content ◽

Left Atrial ◽

Left Lung ◽

Weight Ratio ◽

Dry Weight ◽

Left Pulmonary Artery ◽

Artery Occlusion ◽

Lung Water ◽

The Right

We determined the effect of pulmonary hypoperfusion on extravascular water accumulation in anesthetized dogs by occluding the left pulmonary artery for 3 h and then reperfusing it for 24 h. The lung was reperfused either at normal left atrial pressure (Pla) or during increased Pla induced by a left atrial balloon. In each case the extravascular water content-to-bloodless dry weight ratio (W/D) of the left lung was compared with that of the right lung. The W/D of the left lung of 3.26 +/- 0.49 ml/g was not significantly different from the value of 2.87 +/- 0.37 for the right lung after the reperfusion at normal Pla. However, the W/D of the left lung of 5.10 +/- 0.38 ml/g was greater (P less than 0.05) than the value of 4.42 +/- 0.34 for the right lung after reperfusion at Pla of 25 Torr. This difference could not be prevented by pretreatment with heparin, suggesting that the increase in lung water content was not due to activation of intravascular coagulation secondary to stasis occurring during the occlusion. Because the left lung was more edematous than the right one, even though both lungs had been subjected to the same increase in Pla, the results suggest that a period of pulmonary hypoperfusion causes an increase in the interstitial protein concentration.

Download Full-text

THE HAMMAN-RICH SYNDROME IN CHILDHOOD

PEDIATRICS ◽

10.1542/peds.22.2.279 ◽

1958 ◽

Vol 22 (2) ◽

pp. 279-288

Author(s):

Israel Diamond

Keyword(s):

Pulmonary Artery ◽

Left Atrium ◽

Pulmonary Vein ◽

Clinical Picture ◽

Lung Biopsy ◽

Progressive Dyspnea ◽

Fibrotic Process ◽

Persistent Cough ◽

Right Pulmonary Artery ◽

The Right

The Hamman-Rich syndrome is described in a 4-year-old Negro male. The clinical picture was that of persistent cough and progressive dyspnea beginning at 4 months of age. Diagnosis was made ante mortem by lung biopsy. The fibrotic process and arteriolosclerosis were more marked in the right lung. The disease may have been initiated by a bout of aspiration. There was accompanying stenosis of the right pulmonary artery and vein and occlusion of the lumen of the right pulmonary vein at its entrance to the left atrium. The hilar vascular findings are believed to be secondary to hilar areolar inflammation.

Download Full-text