Document Detail

Histologic Identification of Prominent Intrapulmonary Anastomotic Vessels in Severe Congenital Diaphragmatic Hernia.
MedLine Citation:
PMID:  25306189     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To determine whether prominent intrapulmonary anastomotic vessels (IPAVs) or bronchopulmonary "shunt" vessels can be identified in lungs from infants with fatal congenital diaphragmatic hernia (CDH).
STUDY DESIGN: We performed histology with immunostaining for CD31 (endothelium) and D2-40 (lymphatics), along with high-precision 3-dimensional (3D) reconstruction on lung tissue from 9 patients who died with CDH.
RESULTS: Each patient with CDH required mechanical ventilation, cardiotonic support, and pulmonary hypertension (PH)-targeted drug therapy. All patients were diagnosed with severe PH by echocardiography, and 5 received extracorporeal membrane oxygenation therapy. Death occurred at a median age of 24 days (range, 10-150 days) from refractory hypoxemia with severe PH, pneumonia, or tension pneumothorax. Histology showed decreased alveolarization with pulmonary vascular disease. In each patient, prominent IPAVs were identified as engorged, thin-walled vessels that connected pulmonary veins with microvessels surrounding pulmonary arteries and airways in lungs ipsilateral and contralateral to the CDH. Prominent anastomoses between pulmonary arteries and bronchial arteries were noted as well. The 3D reconstruction studies demonstrated that IPAVs connect pulmonary vasculature to systemic (bronchial) vessels both at the arterial and venous side.
CONCLUSION: Histology and 3D reconstruction identified prominent bronchopulmonary vascular anastamoses in the lungs of infants who died with severe CDH. We speculate that IPAVs connecting pulmonary and bronchial arteries contribute to refractory hypoxemia in severe CDH.
Shannon N Acker; Erica W Mandell; Sunder Sims-Lucas; Jason Gien; Steven H Abman; Csaba Galambos
Related Documents :
1708049 - Altered responsiveness of saphenous vein grafts to norepinephrine and tyramine: relatio...
16642669 - 20-year experience with operations for popliteal artery aneurysm.
3573769 - Valvulotomy in in situ vein bypasses performed by angioscope-assisted laser probe.
14752409 - Gene delivery to aortocoronary saphenous vein grafts in a large animal model of intimal...
14770249 - Minimally invasive vein surgery.
9546239 - Enhancement of tissue factor expression by vein segments exposed to coronary arterial h...
25029079 - Analysis of emboli and blood flow in the ophthalmic artery to understand retinal artery...
17107989 - Dendritic cell recruitment in lesions of human and experimental pulmonary hypertension.
17034799 - Mechanics of arterial subfailure with increasing loading rate.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-9
Journal Detail:
Title:  The Journal of pediatrics     Volume:  -     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-12     Completed Date:  -     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  A filter-flow perspective of haematogenous metastasis offers a non-genetic paradigm for personalised...
Next Document:  Minimizing the Risk of Preoperative Brain Injury in Neonates with Aortic Arch Obstruction.