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[PMID]:29332910
[Au] Autor:Kato K; Kato T; Hayano S; Fukasawa Y; Numaguchi A; Hattori T; Saito A; Sato Y; Hayakawa M
[Ad] Endereço:Department of Pediatrics, Nagoya University Graduate School of Medicine.
[Ti] Título:Successful Infant Pneumonectomy with Unilateral Pulmonary Artery Occlusion Test.
[So] Source:Int Heart J;59(1):237-239, 2018 Jan 27.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:The use of unilateral pulmonary artery occlusion (UPAO) test for the preoperative evaluation of pneumonectomy was reported in adult patients. On the contrary, in infants, no strategies have yet been recommended to predict hemodynamics after pneumonectomy, nor has use of the UPAO test been reported. We describe the first case of infant with abnormal pulmonary circulation in whom successful pneumonectomy was performed after preoperative evaluation using UPAO test. Right pneumonectomy was planned for an 8-month-old girl, because of decreased right pulmonary function, high risk of pneumothorax, and impaired left lung expansion due to overexpansion caused by severe left bronchial stenosis and bronchomalacia. However, she had also prolonged pulmonary hypertension and there was difficulty in accurate echocardiographic evaluation of its severity due to concomitant left pulmonary artery stenosis. Furthermore, contrast-enhanced computer tomography suggested a certain degree of right pulmonary venous flow, discordant with the result showing scarce right pulmonary flow in perfusion scintigraphy. Predicting postoperative hemodynamic changes was therefore considered difficult. To evaluate these concerns, we performed cardiac catheterization and UPAO test to simulate postoperative hemodynamics. Pulmonary arteriography showed decreased but significant right pulmonary arterial and venous flows. Measurements including pulmonary artery pressure and cardiac index showed no marked changes after occlusion. Based on UPAO test results, the operation was successfully performed and hemodynamics remained stable postoperatively. The UPAO test may be useful for infants with cardiopulmonary impairment to evaluate the tolerability of pneumonectomy.
[Mh] Termos MeSH primário: Anormalidades Múltiplas
Broncomalácia/cirurgia
Testes de Função Cardíaca/métodos
Pneumonectomia/métodos
Artéria Pulmonar/fisiopatologia
Circulação Pulmonar/fisiologia
Estenose de Artéria Pulmonar/cirurgia
[Mh] Termos MeSH secundário: Angiografia
Broncomalácia/congênito
Broncomalácia/diagnóstico
Feminino
Seres Humanos
Lactente
Artéria Pulmonar/diagnóstico por imagem
Cintilografia
Estenose de Artéria Pulmonar/congênito
Estenose de Artéria Pulmonar/diagnóstico
Resistência Vascular
Função Ventricular Direita/fisiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180116
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-606


  2 / 20056 MEDLINE  
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[PMID]:29195574
[Au] Autor:Yong MS; Yaftian N; Weintraub RG; Brizard CP; d'Udekem Y; Konstantinov IE
[Ad] Endereço:Department of Cardiac Surgery and Cardiology, Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
[Ti] Título:Outcomes of Surgery for Mixed Total Anomalous Pulmonary Venous Drainage in Children.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):338-344, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Total anomalous pulmonary venous drainage (TAPVD) is an uncommon cardiac defect in children. The mixed subset accounts for 5%-10% of the TAPVD and is variable in its anatomy. The outcomes associated with this subset of patients are rarely reported. A retrospective review of all patients with mixed TAPVD undergoing repair at a single institution (1984-2014) was conducted. A descriptive analysis was performed. Twenty-four patients underwent repair for mixed TAPVD (6 univentricular physiology, 18 biventricular physiology). The mixed TAPVD anatomy included 8 patients in group I (2 + 2 veins), 11 patients in group II (3 + 1 veins), and 5 patients in group III (atypical). Preoperative pulmonary venous obstruction occurred in 8 patients (33%). The median age at repair was 2.2 months (range 2 days to 3 years) and median weight was 4.2 kg (range 1.9 to 12.5 kg). Operative mortality was 13% (3 of 24), 33.3% (2 of 6) for patients with univentricular physiology, and 5.6% (1 of 18) for patients with biventricular physiology. There have been no operative deaths in the biventricular group since 1997 (n = 11). Survival at 30-days was 83% ± 15% (95% confidence interval: 27%-97%) and 94% ± 5% (95% confidence interval: 67%-99%) for the univentricular and biventricular groups, respectively. Reoperation for recurrent pulmonary venous obstruction was required in 2 patients (8.3%) where the sutureless technique was used. The average follow-up after surgery was 9.3 ± 6.4 years (5 months to 21 years), and all surviving patients were asymptomatic. Mixed TAPVD can be repaired with good results in children, particularly in those undergoing biventricular repair.
[Mh] Termos MeSH primário: Circulação Pulmonar
Veias Pulmonares/cirurgia
Síndrome de Cimitarra/cirurgia
[Mh] Termos MeSH secundário: Fatores Etários
Pré-Escolar
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Flebografia/métodos
Veias Pulmonares/anormalidades
Veias Pulmonares/diagnóstico por imagem
Veias Pulmonares/fisiopatologia
Pneumopatia Veno-Oclusiva/diagnóstico por imagem
Pneumopatia Veno-Oclusiva/etiologia
Pneumopatia Veno-Oclusiva/cirurgia
Estudos Retrospectivos
Fatores de Risco
Síndrome de Cimitarra/classificação
Síndrome de Cimitarra/diagnóstico por imagem
Síndrome de Cimitarra/fisiopatologia
Resultado do Tratamento
Vitória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:29229150
[Au] Autor:Shah M; Phillips MR; Quintana M; Stupp G; McLean SE
[Ad] Endereço:University of North Carolina, Chapel Hill, North Carolina.
[Ti] Título:Echocardiography allows for analysis of pulmonary arterial flow in mice with congenital diaphragmatic hernia.
[So] Source:J Surg Res;221:35-42, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Congenital diaphragmatic hernia (CDH) is a structural birth defect associated with pulmonary hypoplasia and pulmonary arterial hypertension (PAH). We hypothesize that echocardiography provides a method to assess real-time right ventricle (RV) function, remodeling, and pulmonary artery (PA) flow. MATERIALS AND METHODS: Slit3 wild-type (WT) (n = 6) and knockout (KO) (n = 5) mice were analyzed at 2-3 months of age. Mice were anesthetized using isoflurane. Echocardiography was performed to analyze left and right ventricular wall thickness, internal diameter (ID), and function. Color Doppler was used to analyze flow in the PA and across the tricuspid valve. RESULTS: There was significant RV dilation in the KO mice versus WT, with an average RVID of 1.99 mm versus 1.26 mm, respectively (P = 0.007). Flow in the PA of KO mice was altered compared to WT, with elevated PA velocity time indices, 30.68 mm versus 22.13 mm (P = 0.012), elevated PA peak velocities, 952.61 mm/s versus 628.73 mm/s (P = 0.003), and decreased pulmonary acceleration times, 8.94 ms versus 16.18 ms (P = 0.002), respectively. Pulmonary vascular resistance, calculated by measuring tricuspid regurgitation peak velocity and right ventricular outflow tract velocity time index, was increased in KO versus WT mice, 17.61 mm /s versus 8.91 mm /s (P = 0.003), respectively. CONCLUSIONS: Slit3 KO mice with CDH show evidence of PAH and resultant RV dilation. Using direct cardiac puncture, elevated RV systolic pressures have been demonstrated in KO mice as evidence of PAH. Echocardiography allows direct analysis of the PA and real-time RV function without sacrifice of the mouse. This mode of evaluation allows longitudinal study in mice with PAH and CDH.
[Mh] Termos MeSH primário: Ventrículos do Coração/diagnóstico por imagem
Hérnias Diafragmáticas Congênitas/diagnóstico por imagem
Hipertensão Pulmonar/diagnóstico por imagem
Artéria Pulmonar/diagnóstico por imagem
Circulação Pulmonar
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Ecocardiografia
Feminino
Ventrículos do Coração/fisiopatologia
Hérnias Diafragmáticas Congênitas/fisiopatologia
Masculino
Proteínas de Membrana/genética
Camundongos Knockout
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Membrane Proteins); 0 (Slit3 protein, mouse)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:28938958
[Au] Autor:Adir Y; Guazzi M; Offer A; Temporelli PL; Cannito A; Ghio S
[Ad] Endereço:Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion, Institute of Technology, Haifa, Israel. Electronic address: adir-sh@zahav.net.il.
[Ti] Título:Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities.
[So] Source:Am Heart J;192:120-127, 2017 Oct.
[Is] ISSN:1097-6744
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival. METHODS: We retrospectively reviewed the charts of 168 PH-HFrEF and 86 PH-HFpEF patients. The independent association of PCa and DPG with prognosis was assessed by means of a Cox proportional hazard model. All cause survival was analyzed over an average follow-up period of 50 months. RESULTS: PH-HFpEF patients had a significantly higher DPG than PH-HFrEF patients (6.1±7.1 vs 1.8±4.5 mmHg, adjusted P=.025). PCa was similar in PH-HFpEF and PH-HFrEF. PCa was a significant predictor of survival, according to previously described preset cutoffs (2.15 mL/mmHg in HFrEF and 1.1 mL/mmHg in HFpEF) and based on a continuous scale; whereas DPG had no impact on survival in both patients groups. CONCLUSION: Our findings suggest that for similar levels of PAWP, pulmonary circulation may be stiffer in patients with HFpEF-PH than patients with HFrEF-PH, leading to higher DPGs. Nonetheless, PCa rather than DPG emerged as the stronger predictor of survival in both left-sided PH phenotypes.
[Mh] Termos MeSH primário: Insuficiência Cardíaca/fisiopatologia
Hemodinâmica/fisiologia
Hipertensão Pulmonar/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Cateterismo Cardíaco
Diástole
Ecocardiografia
Feminino
Seguimentos
Insuficiência Cardíaca/complicações
Insuficiência Cardíaca/diagnóstico
Seres Humanos
Hipertensão Pulmonar/complicações
Hipertensão Pulmonar/diagnóstico
Masculino
Meia-Idade
Prognóstico
Circulação Pulmonar
Estudos Retrospectivos
Volume Sistólico
Fatores de Tempo
Resistência Vascular
Função Ventricular Direita
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170924
[St] Status:MEDLINE


  5 / 20056 MEDLINE  
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[PMID]:28898127
[Au] Autor:Im DJ; Hur J; Han KH; Lee HJ; Kim YJ; Kwon W; Choi BW
[Ad] Endereço:1 Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
[Ti] Título:Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT.
[So] Source:AJR Am J Roentgenol;209(5):1015-1022, 2017 Nov.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purposes of this study were to investigate dual-energy CT findings predictive of clinical outcome and to determine the incremental risk stratification benefit of dual-energy CT findings compared with CT ventricular diameter ratio in patients with acute pulmonary embolism. MATERIALS AND METHODS: A retrospective evaluation was conducted of the cases of 172 patients with acute pulmonary embolism who underwent dual-energy CT. Ventricular diameter ratio and relative perfusion defect volume were measured. The primary endpoints were death within 30 days and pulmonary embolism-related death. RESULTS: A ventricular diameter ratio of 1 or greater was associated with increased risk of death within 30 days (hazard ratio, 3.822; p = 0.002) and pulmonary embolism-related death (hazard ratio, 18.051; p < 0.001). Relative perfusion defect volume was also associated with increased risk of death of any cause within 30 days (hazard ratio, 1.044; p = 0.014) and pulmonary embolism-related death (hazard ratio, 1.046; p = 0.017). However, the addition of relative perfusion defect volume to ventricular diameter ratio had no added benefit for prediction of death of any cause within 30 days (concordance statistic, 0.833 vs 0.815; p = 0.187) or pulmonary embolism-related death (concordance statistic, 0.873 vs 0.874; p = 0.866). CONCLUSION: Compared with ventricular diameter ratio alone, lung perfusion defect volume had no statistically significant added benefit for prediction of death of any cause within 30 days or of pulmonary embolism-related death among patients with acute PE.
[Mh] Termos MeSH primário: Angiografia
Embolia Pulmonar/diagnóstico por imagem
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Circulação Pulmonar
Embolia Pulmonar/mortalidade
Embolia Pulmonar/terapia
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.17.17815


  6 / 20056 MEDLINE  
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[PMID]:28823329
[Au] Autor:Mainwaring RD; Hanley FL
[Ad] Endereço:Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California. Electronic address: mainwaring@stanford.edu.
[Ti] Título:Surgical Techniques for Repair of Peripheral Pulmonary Artery Stenosis.
[So] Source:Semin Thorac Cardiovasc Surg;29(2):198-205, 2017 Summer.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Peripheral pulmonary artery stenosis is a rare form of congenital heart disease frequently associated with Williams and Alagille syndromes. Patients with this disease typically have systemic level right ventricular pressures secondary to obstruction at the lobar, segmental, and subsegmental branches. The current management of patients with peripheral pulmonary artery stenosis remains somewhat controversial. We have pioneered an entirely surgical approach to the reconstruction of peripheral pulmonary artery stenosis. This approach initially entailed surgical patch augmentation of all major lobar branches and effectively reduced right ventricular pressures by more than half. This was the first report demonstrating an effective approach to the disease. Over the past 5 years, we have gradually evolved the technique to extend the reconstruction's reach to include segmental and subsegmental branch stenoses. An important technical aspect of this approach entails division of the main pulmonary and separation of the branch pulmonary arteries to access the lower lobe branches. Pulmonary artery homograft patches are used to augment hypoplastic pulmonary artery branches. In addition, we perform a Heineke-Mikulicz type ostioplasty for isolated ostial stenoses. The technical details of the surgical approach to peripheral pulmonary artery stenosis are outlined in this article, and can also be used for other complex peripheral pulmonary artery reconstructions.
[Mh] Termos MeSH primário: Artéria Pulmonar/cirurgia
Procedimentos Cirúrgicos Reconstrutivos
Estenose de Artéria Pulmonar/cirurgia
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Seres Humanos
Complicações Pós-Operatórias/etiologia
Artéria Pulmonar/diagnóstico por imagem
Artéria Pulmonar/fisiopatologia
Circulação Pulmonar
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
Fatores de Risco
Estenose de Artéria Pulmonar/diagnóstico por imagem
Estenose de Artéria Pulmonar/fisiopatologia
Resultado do Tratamento
Grau de Desobstrução Vascular
Procedimentos Cirúrgicos Vasculares/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170822
[St] Status:MEDLINE


  7 / 20056 MEDLINE  
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[PMID]:28733445
[Au] Autor:Sheak JR; Weise-Cross L; deKay RJ; Walker BR; Jernigan NL; Resta TC
[Ad] Endereço:Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
[Ti] Título:Enhanced NO-dependent pulmonary vasodilation limits increased vasoconstrictor sensitivity in neonatal chronic hypoxia.
[So] Source:Am J Physiol Heart Circ Physiol;313(4):H828-H838, 2017 Oct 01.
[Is] ISSN:1522-1539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Augmented vasoconstrictor reactivity is thought to play an important role in the development of chronic hypoxia (CH)-induced neonatal pulmonary hypertension. However, whether this response to CH results from pulmonary endothelial dysfunction and reduced nitric oxide (NO)-mediated vasodilation is not well understood. We hypothesized that neonatal CH enhances basal tone and pulmonary vasoconstrictor sensitivity by limiting NO-dependent pulmonary vasodilation. To test this hypothesis, we assessed the effects of the NO synthase (NOS) inhibitor -nitro-l-arginine (l-NNA) on baseline pulmonary vascular resistance (PVR) and vasoconstrictor sensitivity to the thromboxane mimetic U-46619 in saline perfused lungs (in situ) from 2-wk-old control and CH (12-day exposure, 0.5 atm) Sprague-Dawley rats. Basal tone was defined as that reversed by exogenous NO (spermine NONOate). CH neonates displayed elevated right ventricular systolic pressure (in vivo) and right ventricular hypertrophy, indicative of pulmonary hypertension. Perfused lungs from CH rats demonstrated greater baseline PVR, basal tone, and U-46619-mediated vasoconstriction compared with control rats in the absence of l-NNA. l-NNA markedly increased baseline PVR and reactivity to U-46619 in lungs from CH neonates, further augmenting vasoconstrictor sensitivity compared with control lungs. Exposure to CH also enhanced NO-dependent vasodilation to arginine vasopressin, pulmonary expression of NOS III [endothelial NOS (eNOS)], and eNOS phosphorylation at activation residue Ser However, CH did not alter lung nitrotyrosine levels, a posttranslational modification reflecting [Formula: see text] scavenging of NO. We conclude that, in contrast to our hypothesis, enhanced basal tone and agonist-induced vasoconstriction after neonatal CH is limited by increased NO-dependent pulmonary vasodilation resulting from greater eNOS expression and phosphorylation at activation residue Ser This research is the first to demonstrate enhanced nitric oxide-dependent vasodilation that limits increased vasoconstrictor reactivity in neonatal pulmonary hypertension. These results suggest that augmented vasoconstriction in this setting reflects changes in smooth muscle reactivity rather than a reduction in nitric oxide-dependent pulmonary vasodilation.
[Mh] Termos MeSH primário: Hipóxia/fisiopatologia
Óxido Nítrico
Circulação Pulmonar
Vasoconstritores/farmacologia
Vasodilatação
[Mh] Termos MeSH secundário: Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacologia
Animais
Animais Recém-Nascidos
Doença Crônica
Inibidores Enzimáticos/farmacologia
Depuradores de Radicais Livres/farmacologia
Pulmão/efeitos dos fármacos
Pulmão/metabolismo
Óxido Nítrico Sintase/antagonistas & inibidores
Nitroarginina/farmacologia
Ratos
Ratos Sprague-Dawley
Tirosina/análogos & derivados
Tirosina/metabolismo
Resistência Vascular/efeitos dos fármacos
Vasoconstrição/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Enzyme Inhibitors); 0 (Free Radical Scavengers); 0 (Vasoconstrictor Agents); 2149-70-4 (Nitroarginine); 31C4KY9ESH (Nitric Oxide); 3604-79-3 (3-nitrotyrosine); 42HK56048U (Tyrosine); 76898-47-0 (15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid); EC 1.14.13.39 (Nitric Oxide Synthase)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE
[do] DOI:10.1152/ajpheart.00123.2017


  8 / 20056 MEDLINE  
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[PMID]:28644040
[Au] Autor:Kelly VJ; Hibbert KA; Kohli P; Kone M; Greenblatt EE; Venegas JG; Winkler T; Harris RS
[Ad] Endereço:1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.
[Ti] Título:Hypoxic Pulmonary Vasoconstriction Does Not Explain All Regional Perfusion Redistribution in Asthma.
[So] Source:Am J Respir Crit Care Med;196(7):834-844, 2017 Oct 01.
[Is] ISSN:1535-4970
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Regional hypoventilation in bronchoconstricted patients with asthma is spatially associated with reduced perfusion, which is proposed to result from hypoxic pulmonary vasoconstriction (HPV). OBJECTIVES: To determine the role of HPV in the regional perfusion redistribution in bronchoconstricted patients with asthma. METHODS: Eight patients with asthma completed positron emission tomographic/computed tomographic lung imaging at baseline and after bronchoconstriction, breathing either room air or 80% oxygen (80% O ) on separate days. Relative perfusion, specific ventilation (sV), and gas fraction (Fgas) in the 25% of the lung with the lowest specific ventilation (sV ) and the remaining lung (sV ) were quantified and compared. MEASUREMENTS AND MAIN RESULTS: In the sV region, bronchoconstriction caused a significant decrease in sV under both room air and 80% O conditions (baseline vs. bronchoconstriction, mean ± SD, 1.02 ± 0.20 vs. 0.35 ± 0.19 and 1.03 ± 0.20 vs. 0.32 ± 0.16, respectively; P < 0.05). In the sV region, relative perfusion decreased after bronchoconstriction under room air conditions and also, to a lesser degree, under 80% O conditions (1.02 ± 0.19 vs. 0.72 ± 0.08 [P < 0.001] and 1.08 ± 0.19 vs. 0.91 ± 0.12 [P < 0.05], respectively). The Fgas increased after bronchoconstriction under room air conditions only (0.99 ± 0.04 vs. 1.00 ± 0.02; P < 0.05). The sV subregion analysis indicated that some of the reduction in relative perfusion after bronchoconstriction under 80% O conditions occurred as a result of the presence of regional hypoxia. However, relative perfusion was also significantly reduced in sV subregions that were hyperoxic under 80% O conditions. CONCLUSIONS: HPV is not the only mechanism that contributes to perfusion redistribution in bronchoconstricted patients with asthma, suggesting that another nonhypoxia mechanism also contributes. We propose that this nonhypoxia mechanism may be either direct mechanical interactions and/or unidentified intercellular signaling between constricted airways, the parenchyma, and the surrounding vasculature.
[Mh] Termos MeSH primário: Asma/fisiopatologia
Hipóxia/fisiopatologia
Pulmão/fisiopatologia
Circulação Pulmonar/fisiologia
Vasoconstrição/fisiologia
[Mh] Termos MeSH secundário: Adulto
Asma/diagnóstico por imagem
Broncoconstrição/fisiologia
Feminino
Seres Humanos
Pulmão/irrigação sanguínea
Pulmão/diagnóstico por imagem
Masculino
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170624
[St] Status:MEDLINE
[do] DOI:10.1164/rccm.201612-2438OC


  9 / 20056 MEDLINE  
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[PMID]:28628189
[Au] Autor:Ciurzynski M; Kurzyna M; Kopec G; Blaszczak P; Chrzanowski L; Kaminski K; Mizia-Stec K; Mularek-Kubzdela T; Mroczek E; Biederman A; Pruszczyk P; Torbicki A
[Ad] Endereço:Klinika Chorób Wewnetrznych i Kardiologii z Centrum Diagnostyki i Leczenia Zylnej Choroby Zakrzepowo Zatorowej, Warszawski Uniwersytet Medyczny, Warszawa, Polska. michal.ciurzynski@wum.edu.pl.
[Ti] Título:[A statement the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for CTEPH patients after acute pulmonary embolism].
[Ti] Título:Opinia Sekcji Krazenia Plucnego Polskiego Towarzystwa Kardiologicznego dotyczaca badan przesiewowych w kierunku CTEPH u chorych po przebytej ostrej zatorowosci plucnej..
[So] Source:Kardiol Pol;75(6):620-627, 2017.
[Is] ISSN:1897-4279
[Cp] País de publicação:Poland
[La] Idioma:pol
[Ab] Resumo:Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool. The authors suggest that a diagnostic process of patients with significant clinical suspicion of CTEPH and right ventricle overload in echocardiography should be performed in reference centres. The document contains a list of Polish centres diagnosing patients with suspected CTEPH. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Multi-detector computed tomography with precise detection of thromboembolic residues in pulmonary circulation is important for planning of pulmonary endarterectomy. Right heart catheterisation definitely confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for identification of lesions suitable for thromboendarterectomy or pulmonary balloon angioplasty. In this document a diagnostic algorithm in patients with suspected CTEPH is also proposed. With individualised sequential diagnostic strategy each patient can be finally qualified for a particular mode of therapy by dedicated CTEPH Heart Team. Moreover the document contains short information for the primary care physician about the management of patients after APE.
[Mh] Termos MeSH primário: Cardiologia
Gerenciamento Clínico
Hipertensão Pulmonar/diagnóstico por imagem
Embolia Pulmonar/diagnóstico por imagem
Sociedades Médicas
[Mh] Termos MeSH secundário: Doença Crônica
Ecocardiografia
Seres Humanos
Hipertensão Pulmonar/etiologia
Hipertensão Pulmonar/terapia
Polônia
Circulação Pulmonar
Embolia Pulmonar/etiologia
Embolia Pulmonar/terapia
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.5603/KP.2017.0110


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[PMID]:28577680
[Au] Autor:Goldberg DJ; Zak V; Goldstein BH; Chen S; Hamstra MS; Radojewski EA; Maunsell E; Mital S; Menon SC; Schumacher KR; Payne RM; Stylianou M; Kaltman JR; deVries TM; Yeager JL; Paridon SM; Pediatric Heart Network Investigators
[Ad] Endereço:Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA. Electronic address: goldbergda@email.chop.edu.
[Ti] Título:Results of a phase I/II multi-center investigation of udenafil in adolescents after fontan palliation.
[So] Source:Am Heart J;188:42-52, 2017 Jun.
[Is] ISSN:1097-6744
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Fontan operation results in a circulation that is dependent on low pulmonary vascular resistance to maintain an adequate cardiac output. Medical therapies that lower pulmonary vascular resistance may augment cardiac output and improve long-term outcomes. OBJECTIVES: This phase I/II clinical trial conducted by the Pediatric Heart Network was designed to evaluate short-term safety, pharmacokinetics (PK), and preliminary efficacy of udenafil in adolescents following Fontan. METHODS: A 5-day dose-escalation trial was conducted in five study cohorts of six subjects each (37.5, 87.5, and 125 mg daily, 37.5 and 87.5 mg by mouth twice daily). A control cohort with 6 subjects underwent exercise testing only. Adverse events (AEs) were recorded, PK samples were collected on study days six through eight, and clinical testing was performed at baseline and day five. RESULTS: The trial enrolled 36 subjects; mean age 15.8 years (58% male). There were no significant differences in subject characteristics between cohorts. No drug-related serious AEs were reported during the study period; 24 subjects had AEs possibly or probably related to study drug. Headache was the most common AE, occurring in 20 of 30 subjects. The 87.5 mg bid cohort was well tolerated, achieved the highest maximal concentration (506 ng/mL) and the highest average concentration over the dosing interval (279 ng/mL), and was associated with a suggestion of improvement in myocardial performance. Exercise performance did not improve in any of the dosing cohorts. CONCLUSIONS: Udenafil was well-tolerated at all dosing levels. The 87.5 mg bid cohort achieved the highest plasma drug level and was associated with a suggestion of improvement in myocardial performance. These data suggest that the 87.5 mg bid regimen may be the most appropriate for a Phase III clinical trial.
[Mh] Termos MeSH primário: Débito Cardíaco/efeitos dos fármacos
Técnica de Fontan
Cardiopatias Congênitas/terapia
Ventrículos do Coração/fisiopatologia
Cuidados Pós-Operatórios/métodos
Pirimidinas/administração & dosagem
Sulfonamidas/administração & dosagem
Resistência Vascular/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adolescente
Relação Dose-Resposta a Droga
Esquema de Medicação
Ecocardiografia
Feminino
Seguimentos
Cardiopatias Congênitas/metabolismo
Cardiopatias Congênitas/fisiopatologia
Ventrículos do Coração/anormalidades
Ventrículos do Coração/diagnóstico por imagem
Seres Humanos
Masculino
Inibidores da Fosfodiesterase 5/administração & dosagem
Inibidores da Fosfodiesterase 5/farmacocinética
Circulação Pulmonar/efeitos dos fármacos
Pirimidinas/farmacocinética
Sulfonamidas/farmacocinética
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Phosphodiesterase 5 Inhibitors); 0 (Pyrimidines); 0 (Sulfonamides); L5IB4XLY36 (udenafil)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170605
[St] Status:MEDLINE



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