Virtual Histology to Evaluate Mechanisms of Pulmonary Artery Lumen Enlargement in Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Journal of Clinical Medicine

Marcin Waligóra¹  Kamil Jonas¹  Martyna Sikorska¹  Jakub Stępniewski¹  Piotr Podolec¹  Grzegorz Kopeć¹  Wojciech Magoń¹  Roman Przybylski² 

[1] Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;Department of Heart Transplantation and Mechanical Circulatory Support, Centre for Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland;

关键词: intravascular ultrasound;    virtual histology;    mechanism of balloon pulmonary angioplasty;   

DOI  :  10.3390/jcm9061655

来源: DOAJ

【 摘 要 】

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before (n = 159) and after (n = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0–64.0)%), light-green (34.0 (21.4–46.4)%), red (6.4 (2.9–11.7)%;) and white (0.2 (0.0–0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01–1.17); p = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA (r = 0.50; p = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA.

【 授权许可】

Unknown