Pulmonary artery reconstruction using autologous pericardium or azygos venae substitute for surgical treatment of central non-small cell lung cancer.

We evaluated the clinico-surgical significance of pulmonary artery (PA) reconstruction using a patch of autologous pericardium/azygos venae substitute to treat central non-small cell lung cancer in 62 patients with pulmonary arteries invaded by tumor. According to TNM-classification, four patients were stage IIb, 46 were stage IIIa, and 12 were stage IIIb. Depending on tumor infiltration, surgical procedures included partial PA tangential resections/reconstructions by a patch of autologous azygos venae, a patch of autologous pericardium and complete PA sleeve resection and reconstruction by a custom-made autologous pericardial conduit interposition. 47 patients received postoperative chemotherapy and 19 received radiotherapy. There were 2 (3.2%) postoperative early deaths due to bronchial anastomotic leakage. Postoperative complications occurred in 17.7% (11/62) patients and all recovered uneventfully. Mean follow-up time after surgical resection was 49.5 (6-12) months and overall ≤1-, 3-, 5-, and ≥10-year survival rates were 80.2, 44.7, 31.4, and 23.1%, respectively. It was concluded that autologous pericardial patch and azygos vein patch reconstruction of PA were safe and effective. Regarding extended circumferential defects after sleeve resection in which end-to-end anastomosis is not feasible, autologous pericardial conduit interposition may be useful for reconstruction when a tumor extensively infiltrates full circumference of the PA.

Porcine model of congenital heart defect with decreased pulmonary blood flow.

A porcine model was produced to study the pathophysiology of congenital heart defect (CHD) with decreased pulmonary blood flow. Twenty piglets (1-2 months) were randomly divided as mild to moderate stenosis/T(1) group (n = 7) in which artificial atrial septal defect (ASD) with pulmonary artery banding generated a systolic pressure gradient of 20-30 mmHg; severe stenosis/T group (n = 7) group with a systolic pressure gradient of ≥30-50 mmHg; and controls/C group (n = 6) underwent sham surgery. At 1 month postoperatively, 64-slice computed tomography (CT) was performed. At 2 months, left-chest surgery was performed to measure ASD diameter, arterial blood gas, hemoglobin, and Trans-PABP. Our data show successful establishment of porcine CHD model. ASDs in T(1)/T(2) groups were 8.0 ± 0.5/8.9 ± 1.4 mm, respectively. Trans-PABP showed that the pressure increase in T(2) was higher (P < 0.01) than in T(1) group. Arterial blood PaO(2) and SaO(2) of T(1/)T(2) groups were significantly lower than controls. AoD was significantly lower in T(1) than in C group. Balloon dilation was significantly lower than AoD in T(1)/T(2) groups. Besides, one animal in T(1), two animals in T(2) ,and one animal in C group died. We conclude that ASD with pulmonary artery banding is a successful intervention to establish such a model, and our findings may influence the treatment of patients with similar heart disease.