PRODUCTION AND REVERSIBILITY OF RIGHT VENTRICULAR HYPERTROPHY AND RIGHT HEART-FAILURE IN DOGS
PRODUCTION AND REVERSIBILITY OF RIGHT VENTRICULAR HYPERTROPHY AND RIGHT HEART-FAILURE IN DOGS
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DOI：
10.1016/0003-4975(92)91152-y
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发表时间：
1992-07-01
影响因子：
4.6
通讯作者：
COOPER, JD
中科院分区：
文献类型：
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作者：
HSIEH, CM;MISHKEL, GJ;COOPER, JD
心肺联合移植已被用于治疗终末期原发性肺动脉高压。单肺移植治疗其他疾病的经验表明，在放置满意的同种异体肺移植后，由于后负荷增加而导致的相关严重右心功能障碍将会恢复。单肺移植治疗肺动脉高压的早期经验支持这一观点。我们设计了一种慢性进行性压力超负荷右心衰竭的可逆犬模型，通过肺动脉结扎来研究右心衰竭的超声心动图、血流动力学和病理可逆性。临床右心衰竭定义为发展为腹水和胸腔积液。23只狗在环扎后67-348天发生右心衰竭，他们被分成两组，以确定其早期和长期影响。第1组犬(n=11)在右心衰竭后立即处死(n=5)或解除束缚(n=6)；第2组犬(n=12)在右心衰竭后立即处死(n=6)或解除束缚(n=6)。两组未系带犬在处死前再观察4个月。另取6只正常犬作为对照组，进行病理学比较。右室收缩压分别从97±17 mm Hg(组1)和88±31 mm Hg(组2)降至44±11 mm Hg和47±13 mm Hg。尽管肺动脉持续倾斜，但超声心动图和血流动力学测量右室功能恢复正常，尽管在第二组犬中速度较慢。病理检查显示两组患者的肥厚不完全消退和持续的轻度纤维化。急性衰竭组和慢性衰竭组的恢复程度无差异。这些结果表明，肺后负荷的减少可以使右室恢复，并支持肺移植在重度肺动脉高压患者中的应用。
Combined heart-lung transplantation has been used for end-stage primary pulmonary hypertension. Experience with single-lung transplantation for other conditions suggested that associated severe right ventricular dysfunction resulting from increased afterload would recover after placement of a satisfactory lung allograft. Early experience with the application of single-lung transplantation for pulmonary hypertension supports this contention. We devised a reversible canine model of chronic progressive pressure-overloaded right heart failure by pulmonary artery banding to study the echocardiographic, hemodynamic, and pathological reversibility of the failing right heart. Clinical right heart failure was defined as the development of ascites and pleural effusions. Right heart failure developed in 23 dogs 67 to 348 days after banding, and they were divided into two groups to determine its early and long-term effects. Group 1 dogs (n = 11) were either sacrificed immediately after the onset of right heart failure (n = 5) or unbanded (n = 6); group 2 dogs (n = 12) were maintained in right heart failure for 3 months and then either sacrificed (n = 6) or unbanded. Unbanded dogs in both groups were observed for 4 additional months before sacrifice. A control group of 6 normal dogs was sacrificed for pathological comparisons. After unbanding, the right ventricular systolic pressure fell from 97 +/- 17 mm Hg (group 1) and 88 +/- 31 mm Hg (group 2) to 44 +/- 11 mm Hg and 47 +/- 13 mm Hg, respectively. Despite this persistent gradient across the pulmonary artery, echocardiographic and hemodynamic measures of right ventricular function returned to normal, albeit more slowly in the group 2 dogs. Pathologic examination revealed incomplete regression of hypertrophy and persistent mild fibrosis in both groups. There was no difference in the degree of recovery between the acute and chronic failure groups. These results suggest that reduction of pulmonary after-load permits right ventricular recovery and supports the application of lung transplantation in patients with severe pulmonary hypertension.