Top

Published in:

01-06-2019 | Hypertension | Original Article

Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary Arterial Hypertension and Congenital Heart Disease

Authors: Chenghu Liu, Pei Cheng, Aijun Liu, Bin Li, Yao Yang, Zhiyi Wang, Junwu Su

Published in: Pediatric Cardiology | Issue 5/2019

Abstract

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.

Rodefeld MD, Ruzmetov M, Schamberger MS, Girod DA, Turrentine MW, Brown JW (2005) Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flow. Eur J Cardiothorac Surg 27(6):949–955. https://doi.org/10.1016/j.ejcts.2005.01.066 CrossRefPubMed

Horowitz MD, Culpepper WS 3rd, Williams LC 3rd, Sundgaard-Riise K, Ochsner JL (1989) Pulmonary artery banding: analysis of a 25-year experience. Ann Thorac Surg 48(3):444–450CrossRefPubMed

Epting CL, Wolfe RR, Abman SH, Deutsch GH, Ivy D (2002) Reversal of pulmonary hypertension associated with plexiform lesions in congenital heart disease: a case report. Pediatr Cardiol 23(2):182–185. https://doi.org/10.1007/s00246-001-0044-9 CrossRefPubMed

Wagenvoort CA, Wagenvoort N (1974) Pathology of the Eisenmenger syndrome and primary pulmonary hypertension. Adv Cardiol 11(00):123–130. https://doi.org/10.1159/000395210 CrossRefPubMed

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):876–886PubMed

Kajihara N, Asou T, Takeda Y, Kosaka Y, Onakatomi Y, Nagafuchi H, Yasui S (2010) Pulmonary artery banding for functionally single ventricles: impact of tighter banding in staged Fontan era. Ann Thorac Surg 89(1):174–179. https://doi.org/10.1016/j.athoracsur.2009.09.027 CrossRefPubMed

Sharma R (2012) Pulmonary artery banding: rationale and possible indications in the current era. Ann Pediatr Cardiol 5(1):40–43PubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

11.

Pascall E, Tulloh RM (2018) Pulmonary hypertension in congenital heart disease. Future Cardiol 14(4):343–353. https://doi.org/10.2217/fca-2017-0065 CrossRefPubMedPubMedCentral

12.

Heath D, Edwards JE (1958) The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation 18(4 Part 1):533–547CrossRefPubMed

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 CrossRefPubMed

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) CrossRefPubMed

15.

Dimopoulos K, Peset A, Gatzoulis MA (2008) Evaluating operability in adults with congenital heart disease and the role of pretreatment with targeted pulmonary arterial hypertension therapy. Int J Cardiol 129(2):163–171. https://doi.org/10.1016/j.ijcard.2008.02.004 CrossRefPubMed

16.

Diller GP, Gatzoulis MA (2007) Pulmonary vascular disease in adults with congenital heart disease. Circulation 115(8):1039–1050. https://doi.org/10.1161/CIRCULATIONAHA.105.592386 CrossRefPubMed

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) CrossRefPubMed

18.

Beghetti M, Galie N (2009) Eisenmenger syndrome a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol 53(9):733–740. https://doi.org/10.1016/j.jacc.2008.11.025 CrossRefPubMed

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):357–364PubMedPubMedCentral

20.

Braunlin EA, Moller JH, Patton C, Lucas RV Jr, Lillehei CW, Edwards JE (1986) Predictive value of lung biopsy in ventricular septal defect: long-term follow-up. J Am Coll Cardiol 8(5):1113–1118CrossRefPubMed

21.

Wagenvoort CA (1994) Plexogenic arteriopathy. Thorax 49(Suppl):S39–S45CrossRefPubMedPubMedCentral

22.

Rabinovitch M, Haworth SG, Castaneda AR, Nadas AS, Reid LM (1978) Lung biopsy in congenital heart disease: a morphometric approach to pulmonary vascular disease. Circulation 58(6):1107–1122CrossRefPubMed

23.

Yamaki S (2000) Lung biopsy diagnosis of pulmonary vascular disease. Medical Review, Tokyo

24.

Yamaki S, Kumate M, Yonesaka S, Maeda K, Endo M, Tabayashi K (2004) Lung biopsy diagnosis of operative indication in secundum atrial septal defect with severe pulmonary vascular disease. Chest 126(4):1042–1047. https://doi.org/10.1378/chest.126.4.1042 CrossRefPubMed

25.

Mandegar M, Fung YC, Huang W, Remillard CV, Rubin LJ, Yuan JX (2004) Cellular and molecular mechanisms of pulmonary vascular remodeling: role in the development of pulmonary hypertension. Microvasc Res 68(2):75–103. https://doi.org/10.1016/j.mvr.2004.06.001 CrossRefPubMed

26.

Jain S, Ventura H, deBoisblanc B (2007) Pathophysiology of pulmonary arterial hypertension. Semin Cardiothorac Vasc Anesth 11(2):104–109. https://doi.org/10.1177/1089253207301732 CrossRefPubMed

27.

Mooi WJ, Grunberg K (2006) Histopathology of pulmonary hypertensive diseases. Curr Diagn Pathol 12:429–440CrossRef

28.

Myers PO, Tissot C, Beghetti M (2014) Assessment of operability of patients with pulmonary arterial hypertension associated with congenital heart disease. Circ J 78(1):4–11CrossRefPubMed

29.

Viswanathan S, Kumar RK (2008) Assessment of operability of congenital cardiac shunts with increased pulmonary vascular resistance. Catheter Cardiovasc Interv 71(5):665–670. https://doi.org/10.1002/ccd.21446 CrossRefPubMed

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 CrossRefPubMed

31.

Humbert M, Sitbon O, Simonneau G (2004) Treatment of pulmonary arterial hypertension. N Engl J Med 351(14):1425–1436. https://doi.org/10.1056/NEJMra040291 CrossRefPubMed

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 CrossRef

33.

Chau EM, Fan KY, Chow WH (2007) Effects of chronic sildenafil in patients with Eisenmenger syndrome versus idiopathic pulmonary arterial hypertension. Int J Cardiol 120(3):301–305. https://doi.org/10.1016/j.ijcard.2006.10.018 CrossRefPubMed

34.

Garg N, Sharma MK, Sinha N (2007) Role of oral sildenafil in severe pulmonary arterial hypertension: clinical efficacy and dose response relationship. Int J Cardiol 120(3):306–313. https://doi.org/10.1016/j.ijcard.2006.10.017 CrossRefPubMed

Title: Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary Arterial Hypertension and Congenital Heart Disease
Authors: Chenghu Liu
Pei Cheng
Aijun Liu
Bin Li
Yao Yang
Zhiyi Wang
Junwu Su
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Hypertension
Arterial Hypertension
Arterial Hypertension
Published in: Pediatric Cardiology / Issue 5/2019
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-019-02097-0

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary Arterial Hypertension and Congenital Heart Disease

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2019

Screening Echocardiography and Brain Natriuretic Peptide Levels Predict Late Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia

Routine Detection of Atrial Fibrillation/Flutter Predicts a Worse Outcome in a Cohort of Tetralogy of Fallot Patients During 23 Years of Follow-Up

Preoperative Clinical and Echocardiographic Factors Associated with Surgical Timing and Outcomes in Primary Repair of Common Atrioventricular Canal Defect

Echocardiographic Assessment of Diastolic Function in Children with Incident Systemic Lupus Erythematosus

Nicardipine for the Treatment of Neonatal Hypertension During Extracorporeal Membrane Oxygenation

A Novel Somatic Variant in HEY2 Unveils an Alternative Splicing Isoform Linked to Ventricular Septal Defect

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page