Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-08T05:34:55.237Z Has data issue: false hasContentIssue false
  • English
  • Français

Mechanical properties of the pulmonary arteries after the arterial switch operation for complete transposition

Published online by Cambridge University Press:  19 August 2008

Toshio Nakanishi ,
Nobuo Momoi ,
Hirohide Kobayashi ,
Toshio Nishikawa ,
Makoto Nakazawa ,
Yasuharu Imai  and
Kazuo Momma
Toshio Nakanishi*
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Nobuo Momoi
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Hirohide Kobayashi
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Toshio Nishikawa
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Makoto Nakazawa
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Yasuharu Imai
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
Kazuo Momma
Affiliation:
Department of Pediatric Cardiology, Pediatric Cardiovascular Surgery, and Pathology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan
*
Toshio Nakanishi, M.D., Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku, Tokyo, Japan, Tel: 81-3-3353-8111; Fax 81-3-3356-0441
Get access Rights & Permissions [Opens in a new window]

Abstract

This study was designed to determine, first, the stiffness of the pulmonary arteries and, second, the relationship between the stiffness of the pulmonary arteries and the success rate of balloon angioplasty in patients with complete transposition after an arterial switch operation. Indexes of pulmonary arterial wall stiffness, percent change in the radius during a cardiac cycle and the pressure elastic modulus, were calculated from the pulmonary arterial pressure and radius measured from a cineangiogram. Of the patients, 13 had no significant stenosis, while 25 had significant stenoses and, therefore, underwent balloon angioplasty. In all, we dilated 33 stenotic lesions. In the presence or absence of postoperative pulmonary stenosis, the percent change in the radius of the pulmonary trunk was significantly less than the normal value. The pressure elastic modulus of the trunk and its branches was significantly greater than normal, and increased significantly with time after the operation. In patients without pulmonary stenosis, the systolic pulmonary arterial pressure increased concomitantly with the pressure elastic modulus. Balloon dilation was successful at 17 locations and unsuccessful at 16 locations. The percent change in radius was significantly less for the failures than for the successes. Prior to 3.5 years after the operation, the pressure elastic modulus was < 400 g/cm2 at most locations and balloon dilation was successful in 88%. More than 3.5 years after the operation, the pressure elastic modulus was < 400 g/cm2 in 11 of 15 locations, and balloon dilation was successful in only one location. The increased stiffness of the pulmonary artery may result in increased pulmonary systolic pressure in patients without pulmonary stenosis, and result in a low success rate for balloon angioplasty in patients with pulmonary stenosis.

Keywords

Complete transpositionarterial switch operationpulmonary artery stiffness
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 3 , July 1997 , pp. 266 - 276
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jarmakani, JM, Graham, TP, Benson, DW, Canent, RV, Greenfield, JC. In vivo pressure-radius relationships of the pulmonary artery in children with congenital heart disease. Circulation 1971,43:585–592.CrossRefGoogle ScholarPubMed
2.Sievers, H, Lange, PE, Arensman, FW, Radley-Smith, R, Yacoub, MH, Harms, D, Heintzen, PH, Bernhard, A. Influence of two-stage anatomic correction on size and distensibility of the anatomic pulmonary/ functional aortic root in patients with simple transposition of the great arteries. Circulation 1984, 70:202–208.CrossRefGoogle ScholarPubMed
3.Isnard, RN, Pannier, BM, Laurent, S, London, GM, Diebold, B, Safar, ME. Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension: a nonivasive study. J Am Coll Cardiol 1989, 13:399–405.CrossRefGoogle Scholar
4.Stefanadis, C, Wooley, CF, Bush, CA, Kolibash, AJ, Boudoulas, H. Aortic distensibilicy abnormalities in coronary artery disease. Am J Cardiol 1987, 59:1300–1304.CrossRefGoogle ScholarPubMed
5.Hirai, T, Sasayama, S, Kawasaki, T, Yagi, S. Stiffness of systemic arteies in patients with myocardial infarction. Circulation 1989; 80:78–86.CrossRefGoogle Scholar
6.Ross, R. The pathogenesis of atheroschlerosis - An update. N Engl J Med 1986; 314:488–500.CrossRefGoogle Scholar
7.Wernovsky, G, Hougen, TJ, Walsh, EP, Sholler, GF, Colan, SD, Sanders, SP, Parness, IA, Keane, JF, Mayer, JE, Jonas, RA, Castaneda, AR, Lang, P. Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum; clinical, hemodynamic, echocardiographic, and electrocardiographic data. Circ 1988;77:1333–1344.CrossRefGoogle Scholar
8.Lupinetti, FM, Bove, EL, Minich, LL, Snider, AR, Callow, LB, Meliones, JN, Crowley, DC, Beekman, RH, Serwer, G, Dick, M, Vermilion, R, Rosenthal, A. Intermediate-term survival and functional results after arterial repair for transposition of the great arteries. J Thorac Cardiovasc Surg 1992;103:421–427.CrossRefGoogle ScholarPubMed
9.Yamaguchi, M, Hosokawa, Y, Imai, Y, Kurosawa, H, Yasui, H, Yagihara, T, Okamoto, F, Wakaki, N. Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J Thorac Cardiovasc Surg 1990;100:261–269.CrossRefGoogle ScholarPubMed
10.Zeevi, B, Keane, JF, Perry, SB, Lock, JE. Balloon dilation of postoperative right ventricular outflow obstructions. J Am Coll Cardiol 1990;14:401–408.CrossRefGoogle Scholar
11.Saxena, A, Fong, LV, Ogilvie, BC, Keeton, BR. Use of balloon dilatation to treat supravalvar pulmonary stenosis developing after anatomical correction for complete transposition. Br Heart J 1990;64:151–5.CrossRefGoogle ScholarPubMed
12.Nakanishi, T, Matsumoto, Y, Seguchi, M, Nakazawa, M, Imai, Y, Momma, K. Balloon angioplasty for postoperative pulmonary artery stenosis in transposition of the great arteries. J Am Coll Cardiol 1993;22:859–866.CrossRefGoogle ScholarPubMed
13.Nakanishi, T, Takao, A, Nakazawa, M, Endo, M, Niwa, K, Takahashi, Y. Mucocutaneous lymph node syndrome: clinical, hemodynamic and angiographic features of coronary obstructive disease. Am J Cardiol 1985; 55:662–668.CrossRefGoogle ScholarPubMed
14.Lock, JE, Keane, JF, Fellows, KE. ed. Diagnostic and interventional catheterization in congenital heart disease. Martinus Nijhoff Publishing, Norwell, MA 1987.Google Scholar
15.Graham, TP, Jarmakani, JM. Hemodynamic investigation of congenital heart disease in infancy and childhood. Prog Cardiovasc Dis 1972; 15:191–212.CrossRefGoogle ScholarPubMed
16.Pacifico, AD, Stewart, RW, Bargeron, LM Jr: Repair of transposition of the great arteries with ventricular septal defect by an arterial switch operation. Circulation 1983; 68 (suppl II): 11–49–1155.Google ScholarPubMed
17.Ring, JC, Kulik, TJ, Burke, BA, Lock, JE. Morphologic changes induced by dilation of the pulmonary valve anulus with overlarge balloons in a normal newborn lambs. Am J Cardiol 1984; 55:210–214.CrossRefGoogle Scholar
18.Zeevi, B, Keane, JF, Perry, SB, Lock, JE. Balloon dilation of postoperative right ventricular outflow obstructions. J Am Coll Cardiol 1990; 14:401–408.CrossRefGoogle Scholar
19.Hanya, S, Sugawara, M. Stenosis: clinical measurements. In: Sugawara, M, Kajiya, F, Kitabatake, A, Matsuo, H. ed. Blood Flow in the Heart and Large Vessels. Springer-Verlag. Tokyo, 1989:105–118.CrossRefGoogle Scholar
20.Peterson, LH, Jensen, RE, Parnell, J. Mechanical properties of arteries in vivo. Circ Res 1960; 8:622–639.CrossRefGoogle Scholar
21.Patel, DJ, DeFreitas, FM, Mallos, AJ. Mechanical function of the main pulmonary artery. J Appl Physiol 1962; 17:205–208.CrossRefGoogle ScholarPubMed
22.Burton, AC: Relation of structure to function of the tissues of the wall of blood vessels. Physiol Rev 1954; 34: 619–642.CrossRefGoogle ScholarPubMed
23.Lecompte, Y, Zannini, L, Hazan, E, Jarreau, MM, Bex, JP, Tan Viet, Tu, Neveux, JY: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1981; 82: 629–631.CrossRefGoogle ScholarPubMed
24.Aziz, KU, Nanton, MA. Variation in the size and distensibility of the pulmonary arteries in d-transposition of the great arteries. Am J Cardiol 1976; 38:452–457.CrossRefGoogle ScholarPubMed
25.Gentles, TL, Lock, JE, Perry, SB. High pressure balloon angioplasty for branch pulmonary artery stenosis: early experience. J Am Coll Cardiol 1993; 22:867–872.CrossRefGoogle ScholarPubMed