Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-29T11:39:27.094Z Has data issue: false hasContentIssue false
  • English
  • Français

Morphology of the elastic pulmonary arteries in pulmonary hypertension: a quantitative study

Published online by Cambridge University Press:  19 August 2008

Karen A. McLeod ,
Leon M. Gerlis  and
Gordon J. Williams
Karen A. McLeod*
Affiliation:
Royal Hospital for Sick Children, Glasgow
Leon M. Gerlis
Affiliation:
Imperial College, London
Gordon J. Williams
Affiliation:
Yorkshire Heart Centre, Leeds, UK
*
Dr Karen A McLeod, Department of Cardiology, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK. Tel: 0141 201 0000; Fax: 0141 201 0853
Get access Rights & Permissions [Opens in a new window]

Abstract

Recent studies of intravascular ultrasound of the pulmonary arteries suggest that the technique can detect intimal and medial thickening in patients with pulmonary hypertension, potentially providing a method of assessing severity of pulmonary vascular disease in life. A major drawback of the technique is that only the elastic pulmonary arteries are accessible to current ultrasound catheters. The aim of this study was to determine whether morphological changes in vessels accessible to intravascular imaging reflect severity of pulmonary vascular disease and are of a sufficient degree to be detectable by current ultrasound catheters. Morphometric studies of the elastic pulmonary arteries were performed in specimens of lungs from 24 patients who had died with pulmonary hypertension (aged 3 weeks–9 years) and compared with measurements from infants who had died from sudden infant death syndrome. Morphological changes evident in the elastic pulmonary arteries in pulmonary hypertension included luminal dilation and medial thickening but these changes were too variable to be predictive of the severity of peripheral pulmonary vascular disease. Intimal thickening and atherosclerosis were present only in those with advanced pulmonary hypertensive disease. The changes of medial thickening and luminal dilation, nonetheless, are too variable to be predictive of the severity of peripheral pulmonary vascular disease. Thus, imaging by intravascular ultrasound may help confirm advanced pulmonary vascular disease, but is unlikely to differentiate less severe pulmonary vascular disease when the patient may still potentially be operable.

Keywords

Elastic pulmonary arteriespulmonary hypertensionpulmonary vascular disease
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 4 , July 1999 , pp. 364 - 370
Copyright
Copyright © Cambridge University Press 1999

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.Gussenhoven, WJ, Essed, CE, Frietman, P, Mastik, F, Lancee, C, Slager, C, Serruys, P, Gerritsen, P, Pieterman, H, Bom, N. Intravascular echographic assessment of vessel wall characteristics; a correlation with histology. Int J Cardiac Imaging 1989; 4: 105–116.CrossRefGoogle ScholarPubMed
2.Gussenhoven, EJ, Essed, CA, Lancee, CT, Mastik, F, Frietman, P, van Egmont, FC, Reiber, J, Bosch, H, van Urk, H, Roelandt, J, Bom, N. Arterial wall characteristics determined by intravascular imaging: an in vitro study. J Am Coll Cardiol 1989; 14: 947–952.CrossRefGoogle ScholarPubMed
3.Nishimura, RA, Edwards, WD, Warnes, CA, Reeder, GS, Holmes, DR, Tajik, AJ, Yock, PG. Intravascular ultrasound imaging; in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16: 145–154CrossRefGoogle ScholarPubMed
4.Ivy, DD, Neish, SR, Knudson, OA, Nihill, AR, Schaffer, MS, Tyson, W, Abman, SH, Schaffer, EM, Valdes-Cruz, L. Intravascular ultrasonic characteristics and vasoreactivity of the pulmonary vasculature in children with pulmonary hypertension. Am J Cardiol 1998; 81: 740–748.CrossRefGoogle ScholarPubMed
5.Pandian, NG, Weintraub, A, Kreis, A, Schwartz, SL, Konstam, MA, Salem, DN. Intracardiac, intravascular two-dimensional high frequency ultrasound imaging of pulmonary artery and its branches in humans and animals. Circulation 1990; 81: 2007–2012.CrossRefGoogle ScholarPubMed
6.Ishii, M, Kato, H, Kawano, T, Akagi, T, Maeno, Y, Sugimura, T, Hashino, K, Takagishi, T. Evaluation of pulmonary artery histopathologic findings in congenital heatt disease: an in vitro study using intravascular ultrasound imaging. J Am Col Cardiol 1995; 26: 272–276.CrossRefGoogle Scholar
7.Heath, D, Wood, EH, DuShane, JW, Edwards, JE. The structure of the pulmonary trunk at different ages and in cases of pulmonary hypertension and pulmonary stenosis. J Pathol Bacteriol 1959; 77: 443–456.CrossRefGoogle ScholarPubMed
8.Wagenvoort, CA, Wagenvoort, N. Pathology of Pulmonary Hypertension. Wiley, New York, 1977, p 48.Google Scholar
9.Heath, D, Edwards, JE. The pathology of hypertensive pulmonary vascular disease: A description of six grades of structural changes in the pulmonary arteries with special reference t o congenital cardiac septal defects. Circulation 1958; 18: 533.CrossRefGoogle Scholar
10.Blackenhorn, DH, Curry, PJ. The accuracy of arteriography and ultrasound imaging for atherosclerotic measurement. A review. Arch Pathol Lab Med. 1982; 106: 483–490.Google Scholar
11.Nissen, SE, Gurley, JC. Application of intravascular ultrasound for the detection and quantification of coronary atherosclerosis. Int J Cardiac Imaging 1991; 6: 165–177.CrossRefGoogle ScholarPubMed
12.Rabinovitch, M, Haworth, SG, Castenada, AR, Nadas, AS, Reid, LM. Lung biopsy in congenital heart disease; a morphometric approach to pulmonary vascular disease. Circulation 1978; 58: 1107–1122.CrossRefGoogle ScholarPubMed
13.Rabinovitch, M, Keane, JF, Norwood, WI, Castenada, AR, Reid, L. Vascular structure in lung tissue obtained at biopsy correlated with pulmonary haemodynamic findings after repair of congenital heart defects. Circulation 1984; 69: 655–667.CrossRefGoogle ScholarPubMed
14.Haworth, SG, Reid, L. A morphometric study of regional variation in lung structure in infants with pulmonary hypertension and congenital cardiac defect: a justification of lung biopsy. British Heart Journal 1978; 40: 825–831.CrossRefGoogle ScholarPubMed
15.Haworth, SG. Pulmonary vasculature. In Anderson, R, Macartney, F, Shinebourne, E, Tynan, M (eds). Paediatric Cardiology. Churchill Livingstone, Edinburgh, 1987, p 146.Google Scholar
16.Ross, R, Glomset, J, Kariya, B, Harker, L. A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. Proc Natl Acad Sci, USA, 1974; 71: 1207.Google Scholar
17. Intraluminal Ultrasound: A Physician's Guide. Kauai, Strategic Business Development, Inc., 1990.Google Scholar
18.Wagenwoort, CA. Vasoconstriction and medial hypertrophy in pulmonary hypertension. Circulation 1960; 22: 535–546.CrossRefGoogle Scholar