scholarly journals Pulmonary artery denervation in patients with pulmonary hypertension: present state and clinical experience

2019 ◽  
pp. 162-168
Author(s):  
D. A. Feshchenko ◽  
B. A. Rudenko ◽  
A. S. Shanoyan ◽  
O. M. Drapkina ◽  
A. V. Kontsevaya ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Clinical Experience ◽  
Present State ◽  
Nerve Fibers ◽  
Pulmonary Trunk ◽  
Sympathetic Nerve Fibers ◽  
Secondary Pulmonary Hypertension ◽  
Sympathetic Nervous ◽  
Increased Activity

Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

scholarly journals Pulmonary artery denervation in patients with pulmonary hypertension: present state and clinical experience

2019 ◽  
pp. 162-168
Author(s):  
D. A. Feshchenko ◽  
B. A. Rudenko ◽  
A. S. Shanoyan ◽  
O. M. Drapkina ◽  
A. V. Kontsevaya ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Clinical Experience ◽  
Present State ◽  
Nerve Fibers ◽  
Pulmonary Trunk ◽  
Sympathetic Nerve Fibers ◽  
Secondary Pulmonary Hypertension ◽  
Sympathetic Nervous ◽  
Increased Activity

Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

Afferent sympathetic nerve fibers with mechanoreceptors in the right heart

1975 ◽  
Vol 228 (1) ◽  
pp. 223-230 ◽  
Author(s):  
Y Uchida
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Sympathetic Nerve ◽  
Nerve Fibers ◽  
Right Atrial ◽  
Right Heart ◽  
Unmyelinated Fibers ◽  
Myelinated Fibers ◽  
Sympathetic Nerve Fibers ◽  
The Right

Mechanosensitivity of afferent sympathetic nerve fibers from the right heart and the pulmonary artery has been examined. Action potentials of the afferent fibers that responded to tapping the right heart and the pulmonary artery were derived from upper thoracic communicating rami of both sides of anesthetized dogs. The fibers were composed of myelinated Adelta fibers and unmyelinated fibers. The receptive fields of both groups of fibers were located widely in the right heart and the pulmonary artery. Myelinated fibers ceased to fire quickly whereas unmyelinated fibers continued to fire after withdrawl of a brief mechanical stimulus. In the myelinated group, the pressure threshold was 3-50, 6-58, and 3-10 mmHg for right ventricular, pulmonary and right atrial threshold was 15-58, 22-34, and 4-8 mmHg for right ventricular, pulmonary, and right atrial fibers, respectively. Spontaneous discharge of myelinated fibers was synchronous with each rise and/or fall in intracardiac or pulmonary pressure whereas that of unmyelinated fibers was irregular and independent. A rise in pressure produced by pulmonary embolization or occlusion caused an augumented discharge whereas a fall caused by caval vein occulsion eliminated the discharge. The results indicate the existence of both myelinated and unmyelinated fibers with mechanoreceptors in the right heart and the pulmonary artery.

scholarly journals Segmentation and quantification of pulmonary artery for noninvasive CT assessment of sickle cell secondary pulmonary hypertension

2010 ◽  
Vol 37 (4) ◽  
pp. 1522-1532 ◽  
Author(s):  
Marius George Linguraru ◽  
John A. Pura ◽  
Robert L. Van Uitert ◽  
Nisha Mukherjee ◽  
Ronald M. Summers ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Sickle Cell ◽  
Secondary Pulmonary Hypertension

Stenting for Pulmonary Artery Stenosis Due to a Recurrent Primary Leiomyosarcoma

2003 ◽  
Vol 10 (1) ◽  
pp. 141-146 ◽  
Author(s):  
Stephan Meckel ◽  
Carlos Buitrago-Téllez ◽  
Richard Herrmann ◽  
Augustinus Ludwig Jacob
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Stent Implantation ◽  
Postoperative Radiotherapy ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Trunk ◽  
Pulmonary Artery Stenosis ◽  
Patient Reported ◽  
The Right ◽  
Primary Leiomyosarcoma

Purpose: To report stent implantation for a malignant obstruction within the pulmonary artery (PA) caused by a recurrent leiomyosarcoma in the pulmonary trunk. Case Report: A 62-year-old man with a non-metastatic primary leiomyosarcoma of the right PA underwent pneumectomy of the right lung and postoperative radiotherapy in 1994. Six years later, he presented with symptoms of progressive right ventricular dysfunction. Computed tomography (CT) identified a high-grade stenosis of the left PA due to recurrent tumor within the pulmonary trunk extending into the left PA. Transthoracic ultrasound documented severe pulmonary hypertension with a high pressure gradient across the stenosis. A stent was deployed percutaneously, successfully establishing PA patency. Pressure measurements showed a significantly reduced gradient across the stented area. In follow-up, the patient reported subjective improvement of symptoms; CT scans revealed a fully patent stent. His status remained stable 11 months after stent implantation. Conclusions: PA leiomyosarcoma is a rare and highly malignant tumor. In most cases, surgery can only prolong survival for the short term. Palliative interventional PA stenting performed under local anesthesia can offer improvement in quality of life by reducing excessive pulmonary hypertension.

scholarly journals Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Kardiologiia ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 35-42 ◽  
Author(s):  
N. A. Trofimov ◽  
A. P. Medvedev ◽  
V. Y. Babokin ◽  
I. P. Efimova ◽  
V. A. Kichigin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Pulmonary Trunk ◽  
Long Term Results ◽  
Reverse Remodeling ◽  
High Ph

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

scholarly journals Histological and immunohistochemical study of nerve fibers and ganglia in the periarterial adipose tissue of the pulmonary artery bifurcation in patients with and without pulmonary hypertension

2020 ◽  
Vol 25 (5) ◽  
pp. 498-509
Author(s):  
L. B. Mitrofanova ◽  
A. A. Perminova ◽  
N. S. Goncharova ◽  
E. N. Mikhailov
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Adipose Tissue ◽  
Smooth Muscle ◽  
Pulmonary Artery ◽  
Smooth Muscle Cells ◽  
Dopamine Receptors ◽  
Muscle Cells ◽  
Nerve Fibers ◽  
Receptor Expression

Background. One of the possible methods of reducing pressure in the pulmonary artery (PA) in pulmonary hypertension (PH) is radiofrequency damage of the periarterial nerve fibers. At the same time, the impact of the autonomic nervous system has not been fully determined yet. It is also known that dopamine induces LA vasorelaxation, however, the subtypes of dopamine receptors involved in this mechanism have not yet been identified.Objective. To assess the morphology of nerve fibers and ganglia in the periarterial adipose tissue of the PA bifurcation in patients with and without PH. Design and methods. Tissue samples of the PA bifurcation zone with surrounding fatty tissue were taken from 8 patients with PH and 9 patients without PH (autopsy material): 7 women aged 59 ± 22 years and 10 men 62 ± 15 years. An immunohistochemical reaction was performed with antibodies to S100 protein, tyrosine hydroxylase (TH), M1 muscarinic receptor, D1, D2, D5 dopamine receptors. The number of nerve fibers and ganglia per area of the preparation, their diameter and depth relative to the PA intima were estimated.Results. There were no statistically significant differences in the structure and size of nerve fibers and ganglia in patients with and without PH. In general, the average number of nerve fibers per area of the preparation (4 cm2) was 29,1 ± 15,5; ganglia — 1,1 ± 1,3; the average fiber diameter was 130,6 ± 35,1 pm, ganglia — 532,0 ± 790,7 pm; the average fiber-intima distance was 2141,4 ± 663,3 pm, the ganglion-intima — 1799,0 ± 500,5 pm. The density of fibers around the PA bifurcation was significantly higher (p = 0,04) in patients with chronic heart failure (CHF) II NYHA functional class (FC) (20 ± 10 fibers / 4 cm2) compared to patients with CHF III-IV FC (11 ± 4 fibers / 4 cm2). The expression of M1 and TH was determined on nerve fibers and ganglia, in the endothelium and smooth muscle cells of the PA, in the epithelium of the bronchi. At the same time, unlike M1, the expression of TH was not observed in all nerve cells, and its level ranged from 1 to 4 points. No D2 receptor expression was detected, D1 expression was mild, and D5 was 4 points in all cases in the endothelium and smooth muscle cells of the LA.Conclusions. Morphometric analysis of nerve fibers and ganglia revealed no differences between patients with and without PH. There was a significant decrease in the number of nerve fibers with the progression of heart failure. TH expression on nerve fibers and ganglia was less pronounced and was not observed in all cells as compared with the M1 receptor. Expression of dopamine receptors was detected only in the endothelium and smooth muscle cells of the PA. Further morphological study involving larger sample will allow the substantiation for the validity of the interventional innervation of the PA.

scholarly journals Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Eugénie Soliveres ◽  
Kathleen Mc Entee ◽  
Thierry Couvreur ◽  
Aline Fastrès ◽  
Elodie Roels ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Pulmonary Artery ◽  
Pulmonary Vein ◽  
Computed Tomographic Angiography ◽  
Pulmonary Trunk ◽  
Lower Airway ◽  
Computed Tomographic ◽  
Right Pulmonary Artery

West Highland white terriers (WHWTs) affected with canine idiopathic pulmonary fibrosis (CIPF) are at risk of developing precapillary pulmonary hypertension (PH). In humans, thoracic computed tomography angiography (CTA) is commonly used to diagnose and monitor patients with lower airway diseases. In such patients, CTA helps to identify comorbidities, such as PH, that could negatively impact prognosis. Diameter of the pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), and right ventricle-to-left ventricle ratio (RV/LV) are CTA parameters commonly used to assess the presence of PH. Pulmonary vein-to-right pulmonary artery ratio (PV/PA) is a new echocardiographic parameter that can be used in dogs to diagnose PH. The primary aim of this study was to evaluate the use of various CTA parameters to diagnose PH. An additional aim was to evaluate the correlation of RV/LV measurements between different CTA planes. CTA and echocardiography were prospectively performed on a total of 47 WHWTs; 22 affected with CIPF and 25 presumed healthy control dogs. Dogs were considered to have PH if pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured on 2D-mode echocardiography was less than to 0.7. WHWTs affected with CIPF had higher PT/Ao compared with control patients. In WHWTs affected with CIPF, PT size was larger in dogs with PH (15.4 mm) compared with dogs without PH (13 mm, p = 0.003). A cutoff value of 13.8 mm predicted PH in WHWTs affected with CIPF with a sensitivity of 90% and a specificity of 87% (AUC = 0.93). High correlations were observed between the different CTA planes of RV/LV. Results suggest that diameter of the PT measured by CTA can be used to diagnose PH in WHWTs with CIPF.

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