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PubMed2000

Embolotherapy in the bronchial and pulmonary circulations.

This two-part article first discusses the role of bronchial artery transcatheter embolotherapy in the management of patients with hemoptysis. Following this discussion, the authors review pulmonary arteriovenous malformations, their embolization, follow-up protocols, and outcome criteria as currently practiced at the authors' Vascular Malformation Center.

Angiography↗
PubMed1995

Endovascular stents in the pulmonary circulation. Clinical impact on management and medium-term follow-up.

BACKGROUND: The use of endovascular stents to relieve obstructions in the setting of non-balloon dilatable pulmonary artery stenosis has been encouraging. The benefits in management and the potential for restenosis, however, have not been defined. This study attempts to assess the impact of such implants on clinical outcomes and the pattern of stent incorporation within the vessel wall. METHODS AND RESULTS: Fifty-five balloon-expandable stents were implanted in 42 patients 6.1 +/- 4.7 years of age. Patients were followed prospectively (median, 15 months) and recatheterized 1 year after implantation. Thirty-eight patients had the implants positioned percutaneously (49 implants), while 4 patients (6 implants) had intraoperative implantations. There was a diameter increase in the stenotic area of 109 +/- 79% (P < .0001) and a gradient reduction of 74 +/- 26% (P < .0001). Twelve stents straddled the orifice of side-branch pulmonary arteries and reduced flow to the branch vessel acutely in 7 patients. Twenty-nine patients underwent recatheterization, and various degrees and locations of acquired intraluminal narrowing were observed in all cases, particularly in areas of diameter mismatch between the stented and nonstented vessels. Eleven patients had further dilation with diameter improvement. Of the 38 patients who underwent percutaneous implantation, planned surgery for pulmonary artery stenosis was avoided in 33 and deferred in 4 patients. One patient who was considered inoperable had stent implantation as a palliative procedure. Symptomatic improvement was reported in 27 patients, and 15 patients remained asymptomatic. CONCLUSIONS: Endovascular stents have a role in the treatment of pulmonary artery stenoses and positively affect clinical care. The stenosis relief, however, may be tempered by the development of intraluminal stent obstruction, which may require redilation (15 of 55 stents) and mandates long-term follow-up.

Adolescent↗
PubMed2004

[Expression and variation of angiotensin II type 1 receptor on vascular smooth muscle cells of systemic and pulmonary circulations in experimental ventricular septal defect in pigs].

OBJECTIVE: To investigate the expression of angiotensin II type 1 receptor (AT1R) on the vascular smooth muscle cells (VSMC) of both systemic and pulmonary circulations and their variation caused by intracardiac left to right shunting using an animal model of the ventricular septal defect (VSD). METHODS: Nineteen young pigs were divided into 3 groups: operation (experimental VSD), sham-operation, and normal control. One month after operation, the pigs were catheterized and then put to death. Smooth muscle cells were taken from aorta, pulmonary artery, pulmonary arteriole, mesenteric arteriole and VSMC were isolated. Radioligand binding assay for AT1R was done to measure the Bmax and KD. RESULTS: There were no significant differences in Bmax and KD of AT1R between the sham-operation group and the control. Bmax of the aorta (112.11+/-35.77) fmol/10(6), main pulmonary artery (52.37+/-31.09) fmol/10(6) and mesenteric arteriole (106.98+/-100.48) fmol/10(6) in the operation group were remarkably elevated in comparison with the control (P<0.05). In the operation group, Bmax of the aorta VSMC was higher than that of main pulmonary artery VSMC (P<0.05), and Bmax of the mesenteric arteriole VSMC was higher than that of the small pulmonary arteriole VSMC (P<0.05). CONCLUSION: The findings in AT1R expression in experimental VSD were supportive to the previously proposed hypothesis that ATR expression might be stronger in systemic VSMC than in pulmonary VSMC in young animal, especially in the presence of intracardiac left to right shunt, which may provide a sound rationale for the pharmacological management of VSD infants with angiotensin converting enzyme inhibitor or AT1R antagonist.

Animals↗