An importance of intravascular ultrasonic examination for diagnostics of pulmonary hypertension
Abstract
An intravascular ultrasonic examination of 105 lung segments was performed in 1995— 1998 in 29 patients with congenital cardiac defects or primary pulmonary hypertension aged of 9 months to 35 years. Linear dimensions of vascular structures and thickness indices of medium and internal vascular membranes were detected.
Initially the intravascular ultrasonic examination and histological investigation were carried out in anatomical preparations of 6 died patients. The identity of ultrasonic and histological structures of pulmonary arterial wall was revealed. The linear dimensions and the thickness indices of medium and internal vascular membranes have not differed reliably being measured by both of methods (p>0.05).
Then 23 patients with congenital cardiac defects and primary pulmonary hypertension were examined. Four patients with congenital cardiac defects without pulmonary hypertension were included into the first subgroup; they demonstrated the normal structure of pulmonary arterial walls and the normal thickness indices of the medium and internal vascular membranes (6.5±0.2% and 9.3±1.7%). 8 patients with pulmonary hypertension who could be operated according to clinical or haemodynamic data formed the second subgroup; they had the enlarged vascular wall thickness due to medium vascular membrane hypertrophy. The thickness index of the pulmonary •arterial medium membrane was increased up to 20.9±2.8%. Eight patients had both congenital cardiac defects and primary pulmonary hypertension and were recognized inoperable; three patients with primary pulmonary hypertension had a thinning of the pulmonary arterial medium membrane, hyperplasia of the internal vascular membrane and a thickening of the vascular wall; they formed the third subgroup. The thickness index of the internal vascular membrane was increased up to 24.8±3.5% whereas the thickness index of the medium vascular membrane was not very large.
The study performed evidences the sufficient informative level of the intravascular ultrasonic examination method and the possibility of their using for an evaluation of pulmonary vessels condition in pulmonary hypertension patients.
About the Authors
A. V. Ivanitsky
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
V. A. Kriukov
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
A. V. Sobolev
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
I. I. Lepikhova
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
R. A. Serov
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
S. V. Ghorbachevsky
Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева РАМН
Russian Federation
Russian Federation
References
1. Бураковский В.И., Бухарин В.А., Плотникова Л.P. Легочная гипертензия при врожденных пороках сердца.— М .: Медицина, 1975.
2. Иваницкий А.В., Алекян Б.Г., Крюков В.А. и др. Значение внутрисосудистого ультразвукового исследования в оценке состояния просвета и стенки сосудов при интервенционных радиологических процедурах / / Вестн. рентгенол.— 1996.— № 5.— С.26— 34.
3. Померанцев Е.В., Воронин В.А., Давыдов С.А., Нечаев Д.Д. Первый опыт клинического применения внутрисосудистого ультразвукового сканирования в общей ангиологии / / Тер. ' арх.— 1992.— Т.64, № 12.— С. 10— 17.
4. Cieszynsky Т. Intracardiac method for investigation of structure of the heart with the aid ultrasonics / / Arch. Immunol. Ter. [ dosw.— 1960.— V ol.8.— P.551.
5. Colombo A., Hall P., Nakamura S. et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance / / Circulation.— 1995.— Vol.91.— P .1676— 1688.
6. Day R.W., Tani L.Y. Pulm onary intravascular ultrasound in infants and children with congenital heart disease / / Cathet. cardiovasc. Diagn.— 1997.— Vol.41, № 4.— P.395— 398.
7. Di Mario C., Madretsma S. et al. Detection and characterization of vascular lesions by intravascular ultrasound: an in vitro study correlated with histology / / J. Amer. Soc. Echocardiol.— 1992.— Vol.5.— P.135— 146.
8. Haworth S.G., Sauer U., Buhlmeyer K. Development of pulmonary circulation in ventricular septal defect: a quantitative structural study / / Amer. J. Cardiol.— 1997.— Vol.40.— P.781— 788.
9. Haworth S.G ., Lynne L. A morphometric study of regional variation in lung structure in infants with pulmonary hypertension and congenital cardiac defect: a justification of lung biopsy / / Brit. Heart J . — 1978.— Vol.40.— P.825— 831.
10. Heath D., Edwards J.E. The pathology of hypertensive pulmonary vascular disease. A discription of six grades of structural changesin the pulmonary arteries with special reference to congenital cardiac septal defect / / Circulation.— 1958.— V o l.18.— P.533— 541.
11. Ino T., Akimoto S., Ohkubo M. et al. A role of intravascular imaging in pediatric inreventional catheterization / / Cardiol. Young.— 1993.— Vol.3.— P.28.
12. Ishii M., Kato H., Kawano T. et al. Evaluation of pulmonary artery histopathologic findings in congenital heart disease: an in vitro study using intravascular ultrasound imaging / / J. Amer. Coll. Cardiol.— 1995.— Vol.26.— P.272— 276.
13. Ivy D.D., Neish S.R ., Knudson O.A. et al. Intravascular ultrasonic characteristic and vasoreactivity of the pulmonary vasculature in children with pulmonary hypertension / / Amer. J. Cardiol.— 1998.— Vol.81.— P.740— 748.
14. Kawano T. W all morphology of the pulmonary artery — intravascular ultrasound imaging and evaluations / / Kurum e med. J . — 1994.— Vol.41.— P.221— 232.
15. Kravitz K.D., Scharf G.R., Chandrasekaran K. In vivo diagnosis of pulmonary atherosclerosis / / Chest.— 1994.— V o l.106.— P.632— 634.
16. Pandian N.G., Kreis A., Brockway B. et al. Ultrasound angioscopy: real-time, two-dimensional, intraluminal ultrasound imaging of blood vessel / / Amer. J. Cardiol.— 1988.— Vol.62.— P.493— 494.
17. Pandian N.G., Weitraub A., Kreis A. et al. Intracardiac, intravascular, two-dimensional high-frequency ultrasound imaging of pulmonary artery and its branches in humans and animals / / Circulation.— 1990.— Vol.81.— P.2007— 2012.
18. Pepine C.J., Hill J.A., Lambert C.R. Diagnostic and Therapeutic Cardiac Catheterization.— 2-nd Ed.— N ew York, 1995.
19. Porter T.R., Mohanty P.K., Pandian N.G. Intravascular ultrasound imaging of pulmonary arteries. Methodology, clinical applications, and future potential / / Chest.— 1994.— V o l.106.— P.1551 — 1557.
20. Rabinovich M., Haworth S.G ., Yance Z. et al. Early pulmonary vascular changes in congenital heart disease studied in biopsy tissue / / Hum. Pathol.— 1980.— Vol. 11.— P .499— 509.
21. Ricou F., Nicod P.H., Moser K.M., Peterson K.L. Catheter — based intravascular ultrasound im agingof chronic thromboembolic pulmonary disease / / Amer. J. Cardiol.— 1991.— Vol.67.— P.749— 752.
22. Rien A .J., Premininger T.J., Perry S.B . et al. Generalized arteriopathy in W illiam s syndrome: an intravascular ultrasound study / / J. Amer. Coll. Cardiol.— 1993.— Vol.21.— P. 1727— 1730.
23. Scott P.J., Esscop A.R., Al-Ashab W. et al. Im aging of pulmonary vascular disease by intravascular ultrasound / / Int. J. Cardiac Imag.— 1993.— Vol.9.— P. 179— 184.
24. Slepian M.J. Application of intraluminal ultrasound imaging to vascular stenting / / Ibid.— 1991.— V o l.6.— P.285— 311.
25. Yock P.G., Fitzgerald P.S., Sykes C. et al. Morphologic features of successful coronary atherectomy determined by intravascular ultravascular ultrasound imaging / / Circulation.— 1990.— Vol.82.— Suppl.3.— P .III— 676.
Review
For citations:
Ivanitsky A.V., Kriukov V.A., Sobolev A.V., Lepikhova I.I., Serov R.A., Ghorbachevsky S.V. An importance of intravascular ultrasonic examination for diagnostics of pulmonary hypertension. PULMONOLOGIYA. 1999;(4):35-43. (In Russ.)
Views:
181
Email this article 