Document Detail


Histomorphometric analysis of intrapulmonary vessels in patients undergoing bidirectional Glenn shunt and total cavopulmonary connection.
MedLine Citation:
PMID:  20621309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purposes of this study were to elucidate the histomorphometry of the intrapulmonary arteries in patients undergoing univentricular type of repairs and to identify the histomorphometric characteristics, if any, that may predispose patients to postoperative Fontan failure.
PATIENTS AND METHODS: Operatively resected wedges of lung tissue from 44 patients undergoing univentricular type of repairs (aged 17 months to 34 years; mean, 83.52 ± 75.90 months) was subjected to histomorphometric analysis.
RESULTS: Despite pulmonary arterioplasty, a low Nakata index was associated with 9.61 (95% confidence interval: 1.01-91.5; P = .003) times increased risk of death after the operation. A statistically significant difference in the mean indexed diameter of the intra-acinar pulmonary arteries (P = .03) was observed between patients undergoing superior and total cavopulmonary connections. Overall, there were 8 (8.2%), 4 (9.1%), 13 (29.5%), and 29 (65.9%) instances of intrapulmonary arterial intimal lesions, thrombosis, smooth muscle extension, and interstitial fibrosis, respectively. Among patients undergoing total cavopulmonary connection, only low Nakata index was significantly associated with the presence of severe intimal lesions, abnormal smooth muscle extension, intra-acinar pulmonary arterial thrombus, and smaller intra-acinar pulmonary arteries.
CONCLUSIONS: A low Nakata index is significantly associated with the presence of severe intimal lesions, thrombus, abnormal smooth muscle extension, a lower mean indexed area of the intrapulmonary arteries, and poor postoperative outcome. However, none of the histomorphometrically derived parameters could conclusively predict the outcome after univentricular repair.
Authors:
Ujjwal K Chowdhury; Raghu M Govindappa; Prasenjit Das; Ruma Ray; Mani Kalaivani; Srikrishna M Reddy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-16     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1251-6.e1-14     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010. Published by Mosby, Inc.
Affiliation:
Cardiothoracic Sciences Centre, AIIMS, New Delhi, India. ujjwalchow@rediffmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Chi-Square Distribution
Child
Child, Preschool
Female
Fontan Procedure* / mortality
Heart Defects, Congenital / mortality,  pathology,  surgery*
Heart Ventricles / abnormalities*,  surgery*
Humans
Infant
Logistic Models
Male
Photomicrography
Prospective Studies
Pulmonary Artery / pathology*
Risk Factors
Treatment Outcome

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


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