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The Re-organization of Circulation in Lungs with Advanced Hypertensive Arteriopathy and Obstructed Vascular Bed. A Computer-aided Reconstruction of Lung Vasculature in Patients with Congenital Heart Disease

晚期高血压动脉病和血管床阻塞的肺循环的重组。

基本信息

批准号：
62480136
负责人：
TAKAHASHI Tohru
金额：
$ 3.07万
依托单位：
TOHOKU UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1987
资助国家：
日本
起止时间：
1987 至 1988
项目状态：
已结题

项目摘要

Computered 3-D reconstruction of pulmonary vessels was performed on lungs from eleven patients with pulmonary hypertension secondary to congenital heart diseases, in order to visualize the distribution of vascular diseases and understand how the pulmonary circulation is re-organized by newly formed collaterals. Arteriopathy was within grade 3 of Heath ＆ Edwards classification in two patients, while in the others it was grade 4 or higher. Reconstruction disclosed that patients of lower grade had an arterial bed which was only partially and unevenly obstructed, whereas those of grade 4 or higher had increasingly uniform obstruction of the arterial bed, and this would account for the elevated resistance in these patients. Plexiform lesions were shown to develop usually in a monopodial artery arising laterally from a parent vessel; in contrast, fibrously occluded arteries prevailed in dichotomous branches at the treetops, suggesting some haemodynamic factors involved in the pathogenesis of arteriopathies. Collaterals were demonstrated to develop so as to bypass in various ways the obstructive diseases. The dilatation lesions, overriding a severely stenosed arteriolar segment, were shown to lead some of the blood away from the peripheral bronchial arteries and to the alveolar capillaries. Also, broncho-pulmonary arterial anastomosis proved to exist at more proximal levels, allowing pulmonary arterial blood to circumvent the obstruction. Thus the blood flow to the alveolar tissue is mainly sustained via two pathways, one through the minute channels contained in the plexiform lesions o intimal thickenings and the other, via "bypass type" collaterals which lead pulmonary arterial blood along the bronchial arteries.

本文对11例先天性心脏病继发肺动脉高压患者的肺血管进行了计算机三维重建，以观察血管病变的分布，了解新生侧支循环如何重组肺循环。2例患者的动脉病变在Heath & Edwards分类的3级内，而其他患者的动脉病变为4级或更高。重建显示，较低级别的患者动脉床仅部分和不均匀阻塞，而4级或更高级别的患者动脉床阻塞越来越均匀，这可以解释这些患者阻力升高的原因。丛状病变通常发生在从载瘤血管侧向产生的单足动脉中;相反，纤维闭塞动脉在树梢的二分分支中占主导地位，这表明动脉病的发病机制涉及一些血液动力学因素。结肠炎的发展被证明是为了以各种方式绕过阻塞性疾病。扩张病变覆盖了严重狭窄的小动脉段，导致部分血液从外周支气管动脉流到肺泡毛细血管。此外，支气管肺动脉吻合术被证明存在于更近端的水平，允许肺动脉血绕过阻塞。因此，流向肺泡组织的血流主要通过两条途径维持，一条途径通过包含在内膜增厚的丛状病变中的微小通道，另一条途径通过“旁路型”侧支，其将肺动脉血沿着支气管动脉引导。