Showing papers on "Pulmonary artery published in 1981"
TL;DR: It is demonstrated that ischemia is the cause of failure in acute RV hypertension, as evidenced by decreased aortic pressure and cardiac output and increased RV end-diastolic pressure and RV systolic pressure.
Abstract: Acute right ventricular (RV) hypertension and failure occur clinically. In this study we examined the mechanism of RV failure. Adult dogs were studied acutely under anesthesia; dogs were instrumented for measurement of pressures and right coronary artery blood flow. Myocardial blood flow and cardiac output were determined with radionuclide-labeled microspheres, and the presence of ischemia was determined by biochemical analysis of ventricular biopsies. RV hypertension was produced by constricting the pulmonary artery and was increased until RV failure occurred, as evidenced by decreased aortic pressure and cardiac output and increased RV end-diastolic pressure. With increasing RV systolic pressure, RV myocardial blood flow failed to increase in proportion to demand. At the onset of RV failure, there was no reactive hyperemia of right coronary flow compared with control, indicating the absence of further coronary vascular reserve; biochemical analysis demonstrated that the RV free wall was ischemic; the LV free wall was not. Infusion of phenylephrine raised aortic pressure and hence, myocardial perfusion pressure; RV failure reversed as shown by decreased RV end-diastolic pressure and increased cardiac output and RV systolic pressure; reactive hyperemia of right coronary flow was restored and the biochemical indexes of ischemia were reversed, demonstrating that ischemia is the cause of failure in acute RV hypertension.
521 citations
TL;DR: The results emphasise the high prognostic value of PAP since survival rates after four and seven years were significantly lower in the subgroup with PAP greater than 20 mmHg (2.7 kPa).
Abstract: In 175 patients with chronic obstructive lung disease (157 chronic bronchitic and 18 emphysematous patients) exhibiting moderate to severe airway obstruction (mean FEV1/vital capacity = 40.2 +/- 11.1%), cumulative survival rates calculated by the actuarial method were compared in subgroups according to the initial level of mean pulmonary artery pressure, pulmonary volumes, and arterial blood gases. Patients were catheterised between 1968 and 1972 and were followed for at least five years. The results emphasise the high prognostic value of PAP since survival rates after four and seven years were significantly lower in the subgroup with PAP greater than 20 mmHg (2.7 kPa). Certain other parameters ("driving" pressure across the pulmonary circulation, FEV1 and Paco2) appear to be equally good at predicting survival as PAP in these obstructed patients. The effect of age should be taken into account in prognostic studies such as ours since survival rates were significantly lower in patients over 60 years of age. In 64 patients who underwent a second right heart catheterisation at least three years after the first (average delay: 5.5 +/- 2 years), the prognostic value of changes in PAP, arterial blood gases, and pulmonary volumes was studied but with the exception of Pao2 was unremarkable. Further studies are needed in this field.
442 citations
TL;DR: The origin of the epicardium and the formation of the early blood vessels of the heart prior to the opening of the coronary arteries from the aorta have been studied in the 9–13.5 day post coitum mouse embryo heart.
Abstract: The origin of the epicardium and the formation of the early blood vessels of the heart prior to the opening of the coronary arteries from the aorta have been studied in the 9–13.5 day post coitum (dpc) mouse embryo heart. The epicardium begins to appear by 9 dpc. The majority of the epicardial cells derive from the somatopleural investment of the septum transversum, from where they migrate, associated to form vesicles, to the dorsal aspect of the ventricles and atria. The epicardial cells then migrate over the lateral surfaces and the AV sulcus to the ventral aspect of the heart. In the subepicardial space around the sulcuses, the proliferating epithelial tissue is found, also in vesicular form, for a time. The ventrally migrating primordial epicardial tissue ensheaths lastly the truncus arteriosus, while the sinus venosus is coated with epicardium ab initio, where (and also in the SA sulcus) the epicardial cells derive in part from the cuboidal cells of the pleuroperitoneal canal and in part from the somatopleural cells. The early blood vessel formation follows in space and time the development of the epicardium. The first blood vessels appear by 10 dpc by the invagination of the endocardium into the early sinus muscle, and at the same time in the ventricular chamber by the encasing of the endocardium, as the trabeculae become consolidated into the myocardial walls. By this process sinusoids are formed, some of which penetrate through the myocardium and which, by rapid proliferation, form an interconnected subepicardial plexus. These capillaries proliferate ventrally in the wide subepicardial space, reaching the septating truncus, in which the aorta and pulmonary artery are developing. The definitive coronary artery openings appear by 13 dpc, allowing the high pressure blood from the aorta to flow into a preexisting vascular bed.
296 citations
TL;DR: It is suggested that this particular group of patients remained refractory to all current modes of therapy because of these severe structural pulmonary vascular changes and does not merely represent a failure of the fetal pattern to regress.
281 citations
TL;DR: The separate and combined effects of hyperventilation and administration of dopamine and tolazoline in five infants with pulmonary hypertension managed with indwelling pulmonary artery catheters were studied.
278 citations
TL;DR: It is suggested that shock was produced mainly by right ventricular impairment in patients with postinfarction ventricular septal rupture, and that perioperative survival was much higher in patients who did not have shock preoperatively than in those who did.
Abstract: Forty-one patients with postinfarction ventricular septal rupture were cared for in our hospital during 1971-1975. Cardiogenic shock developed after septal rupture in 55% of these patients. Shock was unrelated to site of infarction, extent of coronary artery disease, left ventricular ejection fraction, or pulmonary-to-systemic flow ratio, but mean pulmonary artery pressure was lower in shock than in nonshock patients. These observations suggest that shock was produced mainly by right ventricular impairment. Perioperative survival was much higher in patients who did not have shock preoperatively (14 of 17 [82+]) than in those who did (three of 11 [27%]). Magnitude of shunt, left ventricular ejection fraction, extent of coronary artery disease, and performance of aortocoronary bypass grafting were not distinctly correlated with perioperative survival. After a minimum 4-year follow-up, 76% of the perioperative survivors are alive, and none suffer more than New York Heart Association functional class II disability. All 13 unoperated patients (11 in shock) died within 3 months.
261 citations
TL;DR: It is concluded that circulating leukocytes are essential for the microvascular injury that results in increased permeability in the lungs of sheep after microembolization.
Abstract: We studied the effects of uneven pulmonary artery obstruction by microemboli on steady state transvascular fluid and protein exchange in normal and leukopenic sheep. We measured pulmonary artery and left atrial pressures, cardiac output, lung lymph flow, and lymph plasma protein concentrations. Sheep were made profoundly leukopenic by administration of intra-arterial mechlorethamine hydrochloride (0.4 mg/kg, two doses) and colchicine (0.1-0.2 mg/kg, anesthetized sheep only). In anesthetized sheep, we injected glass beads 200 micrometers in diameter via the right atrium to raise pulmonary vascular resistance to 2-3 times baseline values. With normal levels of circulating leukocytes, sheep developed an increased protein-rich lymph flow from the lung characteristic of increased permeability edema. Leukopenic sheep had a significantly attenuated response after embolization for equivalent degrees of vascular obstruction. In unanesthetized sheep, we continuously infused air bubbles 1 mm in diameter via the right atrium to raise pulmonary vascular resistance to about 2 times baseline values. Each sheep served as its own control. With normal circulating leukocyte levels, there was an increase in protein-rich lymph flow from the lung during embolization. When the air infusion ended, the sheep recovered to the baseline condition in 24 hours. We induced emboli with the same amount of air when the sheep were profoundly leukopenic; lymph and protein flow from the lung were significantly less for equivalent degrees of obstruction. We conclude that circulating leukocytes are essential for the microvascular injury that results in increased permeability in the lungs of sheep after microembolization.
257 citations
TL;DR: Systolic pressure in the pulmonary artery was estimated from the interval between pulmonary valve closure and tricuspid valve opening, and the heart rate using a nomogram previously described, and was found useful both in detecting pulmonary hypertension and in the follow-up of patients.
Abstract: Systolic pressure in the pulmonary artery was estimated from the interval between pulmonary valve closure and tricuspid valve opening, and the heart rate using a nomogram previously described. The timing of valve movements was recorded by Doppler ultrasound. The estimated pressure correlated well with that obtained at catheterisation in 45 of 48 patients with pulmonary hypertension. Instantaneous variations in pressure and changes with treatment and during exercise could be measured. The method was easy to apply in all age groups, and was found useful both in detecting pulmonary hypertension and in the follow-up of patients. It may help to determine the optimal time for surgery or the effect of treatment.
203 citations
TL;DR: It is indicated that vasodilators produce clinical improvement in many patients with refractory heart failure and that hemodynamic measurements are helpful in predicting the outcome of therapy.
Abstract: To assess the clinical efficacy of chronic vasodilator therapy for refractory congestive heart failure, the long-term follow-up (mean 13 months, range 3-30 months) was evaluated in 56 patients treated with hydralazine, usually in combination with nitrates. In the first 6 months, 73% improved subjectively and 59% improved by one or two New York Heart Association classifications; early improvement was usually sustained. Mortality was high, 22% at 6 months and 37% at 12 months, but was significantly lower in patients who had a clinical response to vasodilators (21% in responders vs 55% in nonresponders at 1 year). The only clinical indicator that differentiated responders from nonresponders was the presence or absence of symptomatic progression before initiation of vasodilator therapy. Pulmonary artery pressure, pulmonary capillary wedge (PCW) pressure and stroke work index (SWI) before and during vasodilator therapy correlated with clinical response and survival. Fifteen of 20 patients with PCW < 20 mm Hg and SWI greater than or equal to 30 g-m/m2 improved and survived, compared with two of 19 with PCS greater than or equal to 20 mm Hg and SWI < 30 g-m/m2. Patients who did not have acute hemodynamic improvement generally did not improve clinically, but neither the percentage change nor the absolute change in any hemodynamic variable predicted outcome in the remaining patients. The findings of this study indicate that vasodilators produce clinical improvement in many patients with refractory heart failure and that hemodynamic measurements are helpful in predicting the outcome of therapy.
192 citations
TL;DR: The normal structural and functional development of the pulmonary circulation has been studied in the pig, from fetal life to six months of age, with emphasis on the first 2 weeks, where a significant reduction in the amount of arterial muscle was associated with a reduction in pulmonary vascular resistance.
Abstract: The normal structural and functional development of the pulmonary circulation has been studied in the pig, from fetal life to six months of age, with emphasis on the first 2 weeks. Pulmonary and systemic arterial pressures were measured in 50 animals, in 21 of which pulmonary vascular resistance was determined. After post mortem arterial injection, lung structure was analysed using quantitative morphometric techniques. Changes in the pulmonary circulation consisted of three overlapping phases:
1 Dilatation and recruitment of small arteries within the acinar region, beginning during the first 5 min and associated with a reduction in pulmonary arterial pressure. These changes continued during the first 24 h, associated with a loss of arterial muscle.
2 Between 24 h and 2 weeks, a significant reduction in the amount of arterial muscle was associated with a reduction in pulmonary: systemic vascular resistance ratio from 0.58 to 0.18.
3 Functionally, the pulmonary circulation appeared mature at rest by 2 weeks but growth and remodelling of the pulmonary arteries continued until an adult pattern was reached by 6 months of age.
180 citations
TL;DR: Six cases of pulmonary artery perforation associated with the use of Swan-Ganz catheters are reviewed and consideration is given to redesigning the pulmonary artery flow-guided catheter, particularly for use in patients undergoing cardiac operations with systemic anticoagulation.
TL;DR: The risks of operative correction appear to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients with congenital coronary fistulas.
Abstract: Congenital fistulas are the most common of the coronary arterial malformations and with the widespread use of selective coronary arteriography are being recognized with increasing frequency. Twenty-eight patients with congenital coronary fistulas have been evaluated at the Duke University Medical Center between 1960 and 1981. An additional 258 patients have previously been reported in the literature, making a total of 286 available for review. The right coronary artery is most commonly involved, and the fistulous communication is most often to the right ventricle, right atrium or pulmonary artery. Slightly more than half of the patients with coronary fistulas are symptomatic at the time the diagnosis is made. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolization. There were no operative or late deaths in the patients who underwent operations. Moreover, there have been no recurrent fistulas during a mean follow-up period of ten years. The risks of operative correction appear to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.
TL;DR: Through newly placed flow-directed pulmonary artery catheters (Swan-Ganz), bedside balloon occlusion angiography is used to assess the frequency of intravascular occlusive disease in patients with chronic obstructive pulmonary disease.
Abstract: Through newly placed flow-directed pulmonary artery catheters (Swan-Ganz), we used bedside balloon occlusion angiography to assess the frequency of intravascular occlusive disease in patients suffe...
TL;DR: Use of the ventricular-assist pump in patients provided complete support of the systemic or pulmonary circulation or both, and Profoundly depressed ventricular function is potentially reversible if technical problems in employing the pump can be avoided.
Abstract: A ventricular-assist pump was used to support the circulation in eight patients who could not be separated from cardiopulmonary bypass after open-heart operations. In five patients with left ventricular failure, the systemic circulation was maintained with pumping from the left atrium to the aorta for 7.0 +/- 1.8 days (mean +/- S.E.M.); three of these patients were well four to 17 months after surgery. In two patients with biventricular failure, right and left ventricular bypass supported the circulation, but neither patient survived. One other patient had isolated right ventricular failure; pumping from the right atrium to the pulmonary artery maintained the pulmonary circulation for 2.2 days. This patient lived for 18 months. Use of the ventricular-assist pump in our patients provided complete support of the systemic or pulmonary circulation or both. Profoundly depressed ventricular function is potentially reversible if technical problems in employing the pump can be avoided.
TL;DR: There is a positive correlation between progressive pulmonary hypertension, thickening of the medical wall of small pulmonary vessels, and right ventricular hypertrophy as a function of time.
Abstract: Monocrotaline, a pyrrolizidine alkaloid derived from Crotalaria spectabilis, is known to be toxic to a variety of domestic and laboratory animals and to humans. Major pathological effects induced by monocrotaline poisoning include hepatic cirrhosis and megalocytosis, venocclusive disease, pulmonary hypertension, and right ventricular hypertrophy. The present investigation explored the structural and functional relationships that exist between pulmonary artery pressure, small pulmonary artery medial thickness, and right ventricular hypertrophy. The results of this physiological and histological study on monocrotaline-intoxicated rats has demonstrated that there is a positive correlation between progressive pulmonary hypertension, thickening of the medical wall of small pulmonary vessels, and right ventricular hypertrophy as a function of time.
TL;DR: It is concluded that large doses of methylprednisolone given before or soon after endotoxemia prevent the increase in lung vascular permeability that endotoxin causes, but do not reverse the abnormality once it occurs.
Abstract: A B S T R A C T To see whether methylprednisolone would affect the pulmonary vascular response to endotoxemia, we studied responses to endotoxemia in the presence and absence of methylprednisolone in the same chronically instrumented, unanesthetized sheep Infusion of Escherichia coli endotoxin (070-133,g/ kg) caused an initial period of marked pulmonary hypertension followed several hours later by a long period of increased vascular permeability when pulmonary vascutlar presstures were niear base linie (baseline pulmonary artery pressure (PPa) = 21+1 cm H2O SE, left atrial pressure (Pla) = 1+3; experimental PPa = 20±3, Pla = 3±4; P = NS), lung lymph flow (Qlym) was high (base-line Qlym = 72±02 ml/h; experimental Olym = 232+10; P < 005) and lymph/ plasma protein conceintration (L/P) was high (base-line L/P = 065±004; experimental L/P = 079±005; P < 005) When methylprednisolone (10 g + 05 g/h iv) was begtuni 30 min before the same dose of endotoxin was infused, the initial ptilmonary hypertension was less and the late phase increase in lutng vascutlar permeability was prevented (experimental PPa = 24± 1, Pla = 1± 1, Olym = 100± 04; L/P = 056± 003) Olym and L/P were significantly (P < 005) lower than with endotoxin alone Methylprednisolone began duiring the initial putlmonary hypertensive response to endotoxin also prevented the late phase increase inl lutiig vasecular permeability, but the druLg had no effect once vascutlar permeability was increased We conclude that large doses of methylprednisolone given before or sooIn after endotoxemia prevent the increase in luing vasctular permeability that endotoxin cauises, but do not reverse the abnormality once it occurs
TL;DR: All eight patients with these extensive lesions survived without complication using the techniques described in this report, and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation.
Abstract: The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference had been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication.
TL;DR: Gas chromatography with electron-capture detection of the extensively purified pentafluorobenzyl derivative of 6-oxo-PGF1 alpha was used to determine prostacyclin in blood, and results lend no support to theories based on the concept that prostacyClin is a circulating hormone under normal conditions.
TL;DR: Six patients with sleep apnea syndrome were studied with continuous hemodynamic monitoring during sleep and increases in pulmonary wedge pressures may be contributing to increase in pulmonary artery pressures in these patients during sleep.
TL;DR: A rational therapy for catheter-induced pulmonary artery hemorrhage in patients having cardiac operations is described, developed and described herein.
TL;DR: It is found that a ductus arteriosus that fails to close normally is liable to show morphologic lesions, including intimal fibrinous deposits, medial hemorrhages, and dissecting aneurysms.
TL;DR: Positive catheter-tip culture was associated significantly with known presence of a focus of infection before catheter insertion and with periods exceeding four days that the catheter remained in place, suggesting infection of indwelling pulmonary artery catheters may result from contamination during placement or removal or from transient or persistent bacteremia.
Abstract: Bacteriologic cultures were performed on the tips of pulmonary artery catheters removed from 153 critically ill patients, who had required pulmonary artery catheterization for management of hypovolemic or septicemic shock or for hemodynamic monitoring during mechanical ventilation with positive end-expiratory pressure. Positive results were obtained in 29 (19%) of the cases. Infection of indwelling pulmonary artery catheters may result from contamination during placement or removal or from transient or persistent bacteremia. Colonization was probable in 17 cases, and contamination in 12. There were no instances of sepsis definitely attributable to the catheter. Positive catheter-tip culture was associated significantly with known presence of a focus of infection before catheter insertion and with periods exceeding four days that the catheter remained in place.
TL;DR: Four of the six patients underwent pulmonary angiography, which in all cases showed wide-spread occlusions of pulmonary arteries, accompanied in three cases by segmental or lobular pulmonary artery aneurysms corresponding to the proximal opacities visible on the plain films.
Abstract: The radiologic appearance of pulmonary involvement in six cases of Behcet disease is described. Chest radiographs in five patients showed infiltrates and/or rounded opacities followed by excavation in two cases and by pleural rupture in one. Repeat chest films on four of these five patients 3 weeks to 9 months after diagnosis showed resolution of the infiltrates and the subpleural opacities. The other findings from chest radiography in three patients were rounded or lobulated opacities near the hila. Four of the six patients underwent pulmonary angiography, which in all cases showed wide-spread occlusions of pulmonary arteries, accompanied in three cases by segmental or lobular pulmonary artery aneurysms corresponding to the proximal opacities visible on the plain films. Two of the three patients who displayed pulmonary artery aneurysms died of massive hemoptysis 3 and 13 months after angiography. In the third patient, progress under medical treatment was favorable; chest film 10 months after treatment started showed complete resolution of the aneurysms. Repeat angiogram also showed partial recanalization of the occluded arteries.
TL;DR: Analysis of RDPA and LDPA diameters on the plain chest radiograph is a sensitive and accurate method of detecting the presence and severity of pulmonary artery hypertension in COPD.
Abstract: Pulmonary artery hypertension is a frequent complication of severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine whether analysis of the chest radiograph can reveal the presence of pulmonary artery hypertension in COPD. Sixty-one men with COPD (forced expiratory volume in 1 second 0.97 +/- 0.35 liters, mean +/- SD) underwent right heart catheterization, and in 46 the mean pulmonary artery pressure was elevated (greater than 20 mmHg). Plain chest radiographs of the 61 patients and 42 normal control subjects were evaluated. The right descending pulmonary artery (RDPA) was enlarged (greater than 16 mm) in 43 of 46 patients (93%) with an elevated mean pulmonary artery pressure, and the left descending pulmonary artery (LDPA) diameter also was enlarged (greater than 18 mm) in 43 of 46. Combined increased RDPA and increased LDPA diameter measurements permitted correct diagnosis in 45 of 46 patients (98%) with pulmonary artery hypertension, including all 26 a mild elevation of mean pulmonary artery pressure (21-30 mmHg). There was a significant correlation between pulmonary artery pressure and both RDPA and LDPA measurements. Analysis of RDPA and LDPA diameters on the plain chest radiograph is a sensitive and accurate method of detecting the presence and severity of pulmonary artery hypertension in COPD.
TL;DR: It is suggested that segments of lung connected to collaterals alone should, and sometimes can, be connected to central pulmonary arteries, the aim being to produce a unifocal blood supply as a prelude to total correction.
Abstract: In nine patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries, the effect of a systemic-pulmonary anastomosis on the lung was studied by comparison of pre- and postoperative cine angiograms. Selective injections into the collateral arteries were performed in all patients and the source of blood supply to each bronchopulmonary segment was sought. Central pulmonary arteries were present in six children and absent in three, as confirmed at thoracotomy. After insertion of a shunt, central pulmonary arteries increased in size, but the intrapulmonary vessels with which they connected remained abnormally small and were frequently stenosed. In addition, in each case the central pulmonary arteries increased flow to only five to 11 segments of lung. In the absence of central pulmonary arteries, shunting to a hilar or a lobar pulmonary artery increased perfusion to five to nine segments of lung per case. In all these three cases the pulmonary arteries at lobar level showed aneurysmal dilatation proximal to a severe stenosis. Sixty-eight per cent of collateral arteries were stenosed. The findings suggest that in this anomaly, when the central pulmonary arteries are hypoplastic, the intrapulmonary branches are also hypoplastic, emphasising the need for early surgical intervention to increase blood flow while the lung still has growth potential. Further, one collateral artery may connect with at least as many bronchopulmonary segments as does a central pulmonary artery, and the peripheral intrapulmonary arteries with which it connects may appear at least as normal angiographically as do vessels connected to central pulmonary arteries. These observations suggest that segments of lung connected to collaterals alone should, and sometimes can, be connected to central pulmonary arteries, the aim being to produce a unifocal blood supply as a prelude to total correction.
Journal Article•
TL;DR: The use of tolazoline may prevent a fatal outcome from acute elevation of PVR in the perioperative period from infants and children with highly reactive pulmonary vasculature.
Abstract: Infants and children with highly reactive pulmonary vasculature may die of an acutely increased pulmonary vascular resistance (PVR) during or after correction of congenital heart defects. Fifteen patients, 11 infants ages 2--12 months (mean 5.3 months) and 4 children ages 2--10 years (mean 5.8 years), were treated with tolazoline to reduce an acutely elevated PVR during or after operation. Five patients had total anomalous pulmonary venous drainage, six had ventricular septal defect and four had truncus arteriosus. Preoperatively, the ratio of systolic pulmonary artery pressure to systemic artery pressure (PAP/SAP) was 0.57--1.54 (mean 0.93), and PVR was 1.8--20 units/m2 (mean 6.2 units/m2). The pulmonary artery pressure was monitored postoperatively by pulmonary artery lines placed at surgery (12 patients) or by balloon flotation catheters (two patients). Acute elevations in PAP/SAP accompanied by clinical deterioration occurred during attempted withdrawal from cardiopulmonary bypass in three patients, during apparently optimal ventilation postoperatively in eight patients, and after withdrawal of ventilatory support in four patients. Administration of tolazoline as a bolus (1--2 mg/kg) followed by infusion of 1--2 mg/kg/hour resulted in a rapid and sustained decrease in PAP/SAP, from 1.00 +/- 0.18 (mean +/- SD) to 0.40 +/- 0.09 (p less than 0.001), and was effective management for all these clinical crises. The use of tolazoline may prevent a fatal outcome from acute elevation of PVR in the perioperative period.
TL;DR: This report concerns three patients who had a rupture of the pulmonary artery who survived, including one of almost fatal ex-anguination.
Abstract: Swan-Ganz catheters have become a very valuable and frequently used method of monitoring hemodynamics in sick patients. Although the incidence of complications is very low, more reports are beginning to appear. One of the more serious complications is the rupture of the pulmonary artery. This report concerns three patients who had a rupture of the pulmonary artery who survived, including one of almost fatal exanguination. A literature review of all cases of pulmonary artery rupture is presented. Fifty-three per cent (8/15) were fatal. Emphasis is placed on the prevention of this by using the guidelines. Discussion also covers possible contributing causes and treatment. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained cardiac or respiratory changes.
TL;DR: It is concluded that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism.
Abstract: One hundred consecutive patients undergoing neurosurgical procedures in the seated position were monitored for venous air embolism with a Swan-Ganz pulmonary artery (PA) catheter, precordial Doppler ultrasound device, and continuous end-tidal CO2 (FETCO2) analysis Simultaneous determinations of right atrial and pulmonary capillary wedge pressures were also performed during each operation Although 80 episodes of air embolism were detected by changes in Doppler sounds, only 36 were associated with increased PA pressure, and only 30 developed a decrease in FETCO2 Changes in PA pressure and FETCO2 agreed closely (r = 086), and only marked changes were associated with systemic hypotension Air was recovered from the right atrium and PA only in small amounts (2 to 20 ml) during air embolism, although it was possible to aspirate large quantities of blood Twenty-nine patients were found to have right atrial pressures that were higher than pulmonary capillary wedge pressures Paradoxical air embolism from a probe-patent foramen ovale was possible in these patients, and one developed signs and symptoms of systemic air embolism postoperatively We conclude that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism The unique advantage of Swan-Ganz monitoring, however, is that it permits identification of patients who may sustain paradoxical air embolism, and that it differentiates the hemodynamic effects of brain-stem manipulation from those caused by air embolism
TL;DR: Cases of pulmonary artery aneurysms of obscure origin, including those found in the Hughes-Stoven syndrome, are reviewed and both clinical and pathologic findings in these reports are found to be remarkably similar to those observed in Behcet's disease.
Abstract: Histopathologic changes in the lung in a patient with Behcet's disease are described and the literature dealing with pulmonary pathologic changes in this disease is summarized. The basic lesion is a lymphocytic and necrotizing vasculitis involving all sized pulmonary arteries, veins and septal capillaries. Complications include aneurysms of elastic pulmonary arteries, arterial and venous thromboses, pulmonary infarcts, and bronchial erosion by pulmonary artery aneurysms. Striking periadventitial fibrosis develops and is believed to be related to repetitive vascular inflammatory insults. Peculiar newly formed collateral vessels, lacking elastic lamellae and derived from smooth muscle metaplasia around arterioles, are found in the periadventitial fibrous tissues around thrombosed arteries and aneurysms. Cases of pulmonary artery aneurysms of obscure origin, including those found in the Hughes-Stoven syndrome, are reviewed and both clinical and pathologic findings in these reports are found to be remarkably similar to those observed in Behcet's disease. It is suggested that such cases represent unrecognized or incomplete expressions of Behcet's disease.
TL;DR: The data suggest that the pulmonary arteries may possess leukotriene receptors which differ from those of airway smooth muscle.