Smooth muscle cell hypertrophy of renal cortex arteries with chronic continuous flow left ventricular assist
Smooth muscle cell hypertrophy of renal cortex arteries with chronic continuous flow left ventricular assist
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DOI：
10.1016/s0003-4975(02)04087-0
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发表时间：
2003-01-01
影响因子：
4.6
通讯作者：
Griffith, BP
中科院分区：
文献类型：
--
作者：
Kihara, S;Litwak, KN;Griffith, BP
背景。长期连续血流左心室辅助的病理生理学尚未得到很好的描述。随着许多这些设备变得可用，重要的是要检查可能的病理影响。在这项研究中，我们研究了肾皮质动脉搏动减弱与病理变化之间的关系。29头小牛在左心室-胸降主动脉旁路配置中植入各种连续流左心室辅助系统。通过脉压和搏动指数量化搏动性。描述肾皮质动脉的病理变化，并通过中膜厚度、中膜/血管横截面积比和平滑肌细胞计数进行评价，以量化肥大或增生。7头小牛，接受假植入，作为对照。在植入泵的动物中，与植入前相比，收缩期动脉压、脉压和脉动指数显著降低，舒张压显著升高。29头泵植入小牛中有23头（79.3%）肾皮质动脉中膜平滑肌细胞肥大，而假植入小牛无任何异常病变。当根据平滑肌细胞肥大的存在对植入泵的小牛进行分组时，在有病变的小牛中存在明显的泵流速降低趋势。所有犊牛的肾功能均在正常范围内。肾皮质动脉平滑肌细胞肥大与持续血流左心室辅助之间似乎存在关系。此外，尽管病理变化可能是多因素的，但这些病变似乎与泵辅助率较低有关。2003年由胸外科医师协会
\Background. Pathophysiology of long-term continuous flow left ventricular assist is not well described. With many of these devices becoming available, it is important to examine for possible pathologic effects. In this study we examined the relationship between diminished pulsatility and pathologic changes in renal cortical arteries.Methods. Twenty-nine calves were implanted with various continuous flow left ventricular assist systems in a left ventricle-descending thoracic aorta bypass configuration. Pulsatility was quantified by pulse pressure and pulsatility index. Pathologic changes of the renal cortex arteries were described and evaluated by medial thickness, medial/vascular cross-sectional area ratio, and smooth muscle cell count, to quantify hypertrophy or hyperplasia. Seven calves, which underwent a sham-implant, were used as controls.Results. Systolic arterial pressure, pulse pressure, and pulsatility index were significantly lower and diastolic pressure was significantly higher than before implant in pump-implanted animals. Twenty-three of 29 pumpimplanted calves (79.3%) had medial smooth muscle cell hypertrophy in renal cortex arteries, whereas none of sham-implanted calves had any abnormal lesions. When the pump-implanted calves were grouped according to the presence of smooth muscle cell hypertrophy, there was a clear trend toward lower pump flow rate in calves with lesions. Renal function was within the normal range in all calves.Conclusions. There appears to be a relationship between smooth muscle cell hypertrophy in renal cortex arteries and continuous flow left ventricular assist. Furthermore, although the pathologic changes are likely multifactorial, these lesions appear to be related to lower pump assist rates. 2003 by The Society of Thoracic Surgeons