Pulmonary artery denervation reduces pulmonary artery pressure and induces histological changes in an acute porcine model of pulmonary hypertension.
Pulmonary artery denervation reduces pulmonary artery pressure and induces histological changes in an acute porcine model of pulmonary hypertension.
复制标题
DOI：
10.1161/circinterventions.115.002569
复制
发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Lawrie A
中科院分区：
文献类型：
--
作者：
Rothman AM;Arnold ND;Chang W;Watson O;Swift AJ;Condliffe R;Elliot CA;Kiely DG;Suvarna SK;Gunn J;Lawrie A
文本中提供了补充数字内容。肺动脉高压是一种具有高发病率和死亡率的毁灭性疾病，治疗选择有限。最近的研究表明，在实验模型和早期临床试验中，肺动脉去神经可改善肺血流动力学。我们的目的是评估肺动脉周围的神经分布，以确定射频肺动脉去神经对血管收缩引起的急性肺动脉高压的影响，并在组织学水平上证明肺动脉去神经。组织学评价确定了近端肺动脉周围的神经周向分布。神经直径较小，数量较多，位于肺动脉分叉以外的肺动脉壁管腔附近。为了确定肺动脉去神经的效果，在8只猪中通过静脉输注血栓烷A2类似物诱导急性肺动脉高压。动物被分配到肺动脉去神经，使用原型射频导管和发生器，或假手术。肺动脉去神经导致平均肺动脉压和肺血管阻力降低，心输出量增加。肺动脉腔表面的消融损伤伴有外膜神经的组织学和生化改变，并与血流动力学参数的改善相关。肺动脉去神经术为肺动脉高压患者提供了一种新的治疗选择。需要进一步的工作来确定长期有效性和安全性。
Supplemental Digital Content is available in the text. Pulmonary arterial hypertension is a devastating disease with high morbidity and mortality and limited treatment options. Recent studies have shown that pulmonary artery denervation improves pulmonary hemodynamics in an experimental model and in an early clinical trial. We aimed to evaluate the nerve distribution around the pulmonary artery, to determine the effect of radiofrequency pulmonary artery denervation on acute pulmonary hypertension induced by vasoconstriction, and to demonstrate denervation of the pulmonary artery at a histological level. Histological evaluation identified a circumferential distribution of nerves around the proximal pulmonary arteries. Nerves were smaller in diameter, greater in number, and located in closer proximity to the luminal aspect of the pulmonary arterial wall beyond the pulmonary artery bifurcation. To determine the effect of pulmonary arterial denervation acute pulmonary hypertension was induced in 8 pigs by intravenous infusion of thromboxane A2 analogue. Animals were assigned to either pulmonary artery denervation, using a prototype radiofrequency catheter and generator, or a sham procedure. Pulmonary artery denervation resulted in reduced mean pulmonary artery pressure and pulmonary vascular resistance and increased cardiac output. Ablation lesions on the luminal surface of the pulmonary artery were accompanied by histological and biochemical alteration in adventitial nerves and correlated with improved hemodynamic parameters. Pulmonary artery denervation offers the possibility of a new treatment option for patients with pulmonary arterial hypertension. Further work is required to determine the long-term efficacy and safety.