丰坦姑息治疗患者的肺血管疾病和光学相干断层成像。

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Marie-A Chaix, Réda Ibrahim, Jean-Claude Tardif, Colombe Roy, François-Pierre Mongeon, Annie Dore, Blandine Mondésert, Paul Khairy
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引用次数: 0

摘要

导言丰坦手术是单心室生理患者的首选姑息手术。肺血管疾病(PVD)是导致丰坦循环衰竭的重要因素:我们回顾了丰坦姑息术患者肺血管病变的病理生理学,并分享了我们使用光学相干断层扫描(OCT)补充标准血流动力学特征描述丰坦相关肺血管病变的初步经验。在没有肺下心室的情况下,维持最佳肺血流需要较低的肺血管阻力(PVR;≤2 WU/m2)。PVD 与非搏动性低剪切力低流量循环导致的肺动脉(PA)重塑有关。PVD的诱发因素包括肺动脉生长受损、内皮功能障碍、高凝状态和心室舒张末压增高。专家认为,OCT参数可用于描述Fontan相关心血管病变,包括PA内膜与中膜比值和壁面积比值(即全血管面积与管腔面积之差除以全血管面积):专家意见:OCT 有助于确定丰坦缓和期患者心血管内膜异位的特征。PA 重塑的特点是内膜增生,内侧退变。需要进一步研究确定OCT在为管理决策提供信息和评估治疗反应方面的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pulmonary vascular disease and optical coherence tomography imaging in patients with Fontan palliation.

Introduction: The Fontan procedure is the palliative procedure of choice for patients with single ventricle physiology. Pulmonary vascular disease (PVD) is an important contributor to Fontan circulatory failure.

Areas covered: We review the pathophysiology of PVD in patients with Fontan palliation and share our initial experience with optical coherence tomography (OCT) in supplementing standard hemodynamics in characterizing Fontan-associated PVD. In the absence of a sub-pulmonary ventricle, low pulmonary vascular resistance (PVR; ≤2 WU/m2) is required to sustain optimal pulmonary blood flow. PVD is associated with adverse pulmonary artery (PA) remodeling resulting from the non-pulsatile low-shear low-flow circulation. Predisposing factors to PVD include impaired PA growth, endothelial dysfunction, hypercoagulable state, and increased ventricular end-diastolic pressure. OCT parameters that show promise in characterizing Fontan-associated PVD include the PA intima-to-media ratio and wall area ratio (i.e. difference between the whole-vessel area and the luminal area divided by the whole-vessel area).

Expert opinion: OCT carries potential in characterizing PVD in patients with Fontan palliation. PA remodeling is marked by intimal hyperplasia, with medial regression. Further studies are required to determine the role of OCT in informing management decisions and assessing therapeutic responses.

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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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