摘要
This paper describes the occurrence of cor triatriatum sinister, a rare cardiac malformation in dogs, associated with pulmonary edema and pulmonary hypertension in a 5-year-old Poodle female with history of acute dyspnea and cyanosis. The animal presented acute respiratory failure, heart failure with low cardiac output, progressing to acute tubular necrosis and death. The diagnosis was made posmortem due to the clinical instability of the dog. This malformation was diagnosed by the subdivision of the left atrium into two compartments separated by an abnormal fibromuscular membrane, absence of structural abnormalities of the mitral valve and thickening of pulmonary artery tunica media associated with renal tubular degeneration. The occurrence of cor triatriatum in dogs is most common in the right atrium, defined as cor triatriatum dexter. Additionally, pulmonary arterial hypertension associated with this malformation is described only in humans with this heart defect.
Subject(s)
Animals , Dogs , Pulmonary Artery/anatomy & histology , Heart Defects, Congenital/diagnosis , Hypertension/pathology , Dogs/classification摘要
La variabilidad del arco aórtico y sus ramas emergentes presentan implicaciones en los abordajes quirúrgicos de tórax y cuello, y posiblemente en el desarrollo de procesos ateromatosos ubicados a ese nivel y accidentes cerebrovasculares. Se evaluaron 122 arcos aórticos de individuos adultos de ambos sexos obtenidos como material de autopsia. Se identificó la configuración general de la emergencia de las ramas colaterales de los arcos y se determinó la morfometría de sus componentes con medición electrónica. Se observó la presencia de la configuración usual (tipo A) en 87 arcos (71,3 por ciento); un tronco braqui-bicarotideo (tipo B) en 21 piezas anatómicas (17,2 por ciento) y en 10 casos (8,2 por ciento) la arteria vertebral izquierda se originó directamente del arco aórtico (tipo C); en 4 especímenes (3,3 por ciento) se presentó emergencia atípica de las ramas. El calibre de la aorta en el punto previo a la emergencia de sus ramas y justo después de emitir su última colateral fue de 20,1mm (DE 3,19) y 17,2mm (DE 2,57) respectivamente, con una disminución del 14,5 por ciento. El calibre de las arterias sublavias (7,7mm, DE 1,10) fue significativamente mayor (P=0,0001) que el de las arterias carótidas (6,4mm, DE 0,78). El diámetro de las arterias carótidas derecha e izquierda fue de 6,5mm (DE 0,81) y 6,3mm (DE 0,75) respectivamente. La arteria subclavia derecha presentó mayor calibre que la izquierda (7,9mm, DE 1,09; 7,6mm, DE 1,12) sin diferencia estadisticamente significativa (P=0,0801). La distancia entre el origen del tronco braquiocefálico y el de la subclavia izquierda fue de 32,8mm (DE 6,16) y la longitud del tronco braquiocefálico fue 30,2mm+/-5,27. Se destaca la alta frecuencia de arcos con emergencia de dos y cuatro ramas. Los calibres de las ramas son menores a lo reportado en la literatura.
The variability of the aortic arch and its emergent branches have implications in the surgical approaches of the thorax and neck, and possibly in the development of the atheromatous processes located at that level and the cerebrovascular accidents. We evaluated 122 aortic arches from adult individuals of both sexes obtained as autopsy material. We identified the general configuration of the emergence of the collateral branches of the arcs and determined the morphometry of its components with electronic measurement. We observed the usual configuration (type A) in 87 arches (71.3 percent); a brachio-bicarotid trunk (type B) in 21 anatomical specimens (17.2 percent) and in 10 cases (8.2 percent) the left vertebral artery originated directly from the aortic arch (type C); 4 specimens (3.3 percent) presented atypical emergency in the branches. The caliber of the aorta at the point prior to the emergence of its branches and just after casting his last side was 20.1mm (DS 3.19) and 17.2mm (DS 2.57) respectively, with a decrease of 14.5 percent. The caliber of the subclavian arteries (7.7mm, SD 1.1) was significantly higher (P=0.0001) than of the carotid arteries (64mm, SD 0.78). The diameter of the carotid arteries both right and left were 6.5mm (DS 0.81) and 6.3mm (DS 0.75) respectively. The right subclavian artery presented higher caliber than the left (7.9mm, DS 1.09; 7.6mm, DS 1.12) without significant statistical difference (P=0.0801). The difference between the origin of the brachiocephalic trunk and the left subclavian artery was 32.8 (DS 6.16); the brachiocephalic trunk length was 30.2mm +/- 5.27. It highlights the high frequency of arches with emergency of two and four branches. The calibers of the branches are smaller than those reported in the literature.
Subject(s)
Female , Aorta, Thoracic/anatomy & histology , Aorta, Thoracic/innervation , Carotid Artery, Common/anatomy & histology , Pulmonary Artery/anatomy & histology , Subclavian Artery/anatomy & histology , Cross-Sectional Studies/methods摘要
An anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is a rare congenital coronary anomaly. It usually presents in infancy with intractable left sided heart failure. Most patients die in infancy, but survival into adulthood is possible. Patients may complain of dyspnea, syncope or effort angina. They may remain asymptomatic; or experience sudden death after exercise. A 56-year-old woman presented with a twomonth history of exertional chest discomfort. Echocardiography showed a coronary anomaly with preserved systolic function and no resting regional wall motion abnormality. The coronary and CT [computed tomography] angiography studies revealed the anomalous origin of the left coronary artery. A review of ALCAPA studies is presented along with images from the echocardiogram, coronary angiogram and CT scan performed for this case
Subject(s)
Humans , Female , Pulmonary Artery/anatomy & histology , Pulmonary Artery/abnormalities , Heart Failure , Adult , Echocardiography , Angiography , Tomography, Spiral Computed , Angina Pectoris , Dyspnea , Syncope , Death, Sudden, Cardiac摘要
OBJETIVO: Comparar a resposta arterial dos casos de embolia aguda e crônica, procurando associar o remodelamento isquêmico pulmonar à evolução para cronificação. MÉTODOS: Análise retrospectiva de 61 casos de necropsia de pacientes que evoluíram a óbito no Instituto do Coração (31 casos de embolia pulmonar e 30 casos de infarto agudo do miocárdio). Foram obtidas lâminas de tecido pulmonar de todos os casos e análise qualitativa e quantitativa (mensuração da espessura da camada média das artérias). RESULTADOS: A análise qualitativa permitiu diferenciar os casos de embolia do grupo controle, caracterizando os dois grupos e definindo a escolha adequada do grupo controle. Houve predomínio das alterações nos pacientes com embolia (edema e inflamação alveolar, infarto, vasoconstrição, proliferação intimal concêntrica, presença de trombo). A análise quantitativa demonstrou porcentagem de espessura da camada média mais elevados nos casos de embolia do que no grupo controle; dentre os casos de embolia não houve diferença nas artérias intra (agudo - 19,74 e crônico - 20,04) e pré-acinares (agudo - 18,85 e crônico - 18,68). CONCLUSÃO: A ausência de diferença entre os grupos com embolia e os valores mais elevados de porcentual de espessura nas artérias da periferia permite concluir que a resposta vascular é mais intensa e se inicia nessas artérias.
OBJECTIVE: To compare the arterial response of cases of acute and chronic embolism, seeking to associate ischemic pulmonary remodeling with progression to chronicity. METHODS: Retrospective analysis of 61 necropsies of patients who died in the Instituto do Coração (31 cases of pulmonary embolism and 30 cases of acute myocardial infarction). Slides of pulmonary tissue were obtained from all cases and analyzed qualitative and quantitatively (medial thickness measurement). RESULTS: Qualitative analysis enabled the differentiation between cases of embolism and the control group, thus characterizing the two groups and defining the adequate choice of the control group. The alterations predominated in patients with embolism (alveolar inflammation and edema, infarction, vasoconstriction, concentric intimal proliferation, presence of thrombus). Quantitative analysis demonstrated higher percent medial thickness in the cases of embolism than in the control group; among the cases of embolism, no differences in intra (acute - 19.74 and chronic - 20.04) and pre-acinar (acute - 18.85 and chronic - 18.68) arteries were observed. CONCLUSION: The lack of difference among the groups with embolism and the higher values of percent medial thickness in the peripheral arteries allow the conclusion that the vascular response is more intense and starts in these arteries.
Subject(s)
Humans , Lung/pathology , Myocardial Infarction/pathology , Pulmonary Artery/ultrastructure , Pulmonary Embolism/pathology , Tunica Intima/pathology , Acute Disease , Autopsy , Chronic Disease , Constriction, Pathologic/etiology , Disease Progression , Edema/etiology , Hypertrophy/pathology , Inflammation/etiology , Pulmonary Artery/anatomy & histology , Pulmonary Embolism/complications , Retrospective Studies , Thrombosis/etiology摘要
Os ramos da artéria pulmonar direita que se distribuem para o lobo médio do pulmão apresentam controvérsias na sua descrição anatômica e cirúrgica, embora muitas vezes sejam citados dois ramos, um para o segmento medial e outro para o segmento lateral. Essa descrição pode não corresponder à realidade observada quando se disseca as artérias pulmonares ou durante procedimentos cirúrgicos que envolvam o lobo médio. Os autores dissecaram as artérias de 84 pulmões direitos e verificaram que a disposição clássica referida não é constante, podendo-se encontrar mais freqüentemente para o lobo um ou dois ramos e em menor número de casos três ramos arteriais.
There are controversies in the anatomical and surgical description of the branches of the right lung artery that are distributed to the medium lung lobe, although most usually two branches are mentioned, one for the medial and othersegment for the lateral segment. That description may not correspond to the observed reality when lung arteries aredissected or during surgical procedures involving the medium lobe. The authors dissected the arteries of 84 right lungs and verified that the classic referred disposition is not constant, most frequently finding one or two arterial branches for the lobe and in smaller number of cases, three branches.
Subject(s)
Pulmonary Artery/anatomy & histology , Lung/anatomy & histology , Lung/blood supply摘要
Esta pesquisa objetivou estudar as características anatômicas do pulmão da cutia, particularmente os aspectos relativos a lobação, distribuição dos ramos da artéria pulmonar e sua relação com os brônquios. Para tal utilizaram-se dez conjuntos coração-pulmão, dos quais oito tiveram a artéria pulmonar injetada com látex neoprene corado. Os conjuntos foram fixados em solução de formol a 10% e os ramos arteriais no parênquima pulmonar foram dissecados. Em dois pulmões injetou-se vinil corado nas artérias e estes foram submetidos à corrosão no ácido clorídrico a 30%. O pulmão da cutia é dividido externamente por fissuras bastante pronunciadas, separando os lobos pulmonares, tanto à direita quanto à esquerda. O pulmão direito apresenta quatro lobos: cranial, médio, caudal e acessório, e o esquerdo dois lobos: cranial e caudal, sendo o lobo cranial dividido em segmentos cranial e caudal. Do brônquio principal direito derivam os brônquios lobares cranial direito, médio, caudal direito e acessório. O brônquio principal esquerdo origina um pequeno tronco, que emite o brônquio lobar cranial, o qual se bifurca, fornecendo ramos para as porções cranial e caudal do lobo cranial esquerdo, e segue como brônquio lobar caudal esquerdo. A artéria pulmonar direita origina, respectivamente, ramos para os lobos cranial, médio, acessório e caudal, e a esquerda fornece, isoladamente, os ramos ascendente e descendente para os segmentos cranial e caudal do lobo cranial esquerdo, prosseguindo para o lobo caudal. Conclui-se que, no pulmão da cutia, as artérias pulmonares seguem as ramificações bronquiais, caracterizando a segmentação anátomo-cirúrgica broncoarterial.
Subject(s)
Anatomy, Veterinary , Pulmonary Artery/anatomy & histology , Lung/anatomy & histology , Rodentia摘要
This study was based on two issues, the 1[st] one was that the pulmonary artery anatomy is the key factor that determines the type of surgical treatment required in tetralogy of Fallot [TOF]. The 2[nd] one was that many studies showed a good correlation of the echocardiographic measurements of cardiac structures with the angiographic and pathological findings. So, the aim of this work was to evaluate the reliability of echocardiography in assessment of the pulmonary blood flow status in pediatric patients with TOF. Only patients with the usual anatomy of TOF were included in this study. It included 68 patients distributed into two groups; group I included 18 patients [26.5%], their mean age was 29.1 +/- 21.4 months and their mean weight was 11.2 +/- 2.1 kg. Group II included 50 patients [73.5%], their mean age was 34 +/- 23 months, their mean weight was 12.6 +/- 4.1 kg. We tested the accuracy of the 2-D echocardiography in measuring the right and the left pulmonary arteries [RPA and LPA] and compared them to the measurements taken by angiography [group I] as well as to the measurements taken at surgery [group II]. The standard deviation unit [Z value] for the RPA and LPA was calculated as well as the pulmonary artery index [PAI] from echocardiographic and angiographic measurements for group I and from echocardiographic and surgical measurements for group II. The results showed that For group I patients, there was statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between echocardiographic and angiographic modalities. Similarly, group II patients demonstrated a statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between the echocardiographic and surgical methods. Despite these significant differences found in both groups, the echocardiographic measurements correlated well with the angiographic measurements in group I as well as with the surgical measurements in group II. The differences detected between the echocardiographic and the surgical measurements were less than the differences detected between the echocardiographic and angiographic measurements. This mostly related to our earlier experience in measurement of the pulmonary artery branches using 2-D echocardiography in group I, but with time, we got more experienced in this issue, thus the differences in measurements were minimized in group II. The maximum difference between the echocardiography and surgery for the RPA and LPA was 2.1 mm and 2.0 mm and the mean difference was 0.71 +/- 0.45 and 0.63 +/- 0.46 mm respectively. Our results reflect a clinically acceptable accuracy of 2-D echocardiography in estimation of the pulmonary artery branches and thus surgical management of TOF, guided by echocardiography alone, can be confidently performed in selected infants and children. Cardiac catheterization should be reserved for patients in whom the echocardiographic measurements are not fully certain or suggest association of cardiovascular malformation
Subject(s)
Humans , Male , Female , Echocardiography , Pulmonary Circulation , Cardiac Catheterization/instrumentation , Pulmonary Artery/anatomy & histology , Pediatrics , Angiography , Tetralogy of Fallot/surgery , Cardiovascular Abnormalities摘要
Este trabalho objetiva realizar um estudo anatomotopográfico do Canal Arterial em fetos natimortos enfatizando o seu comprimento e seu diâmetro de acordo com o tamanho de cada feto. Além de que, descrevemos as distâncias entre este e pontos de reparo importantes para sua abordagem por videotoracoscopia. Estudamos dezesseis fetos natimortos, sendo que oito eram do sexo masculino. O tamanho do feto e os perímetros torácico e cefálico variaram de 42-57, 26-35 e 29-35,5 cm, respectivamente. A média de comprimento e diâmetro foram 11,06 e 5,56 cm. Distâncias entre o Canal e as seguintes estruturas: clavícula-22,13mm, segunda costela-20,75mm, esterno-33,88mm e a.subclávia esquerda-5,30mm. Acreditamos que as medidas apresentadas podem facilitar a abordagem do canal por videotoracoscopia.
Subject(s)
Humans , Male , Female , Arteries/anatomy & histology , Fetal Death , Thoracoscopy , Weights and Measures , Aorta/anatomy & histology , Pulmonary Artery/anatomy & histology摘要
Esta investigaçäo avaliou, através de microscopia ótica, as alterações histológicas nos grandes vasos da base em portadores de valva aórtica bicúspide (VAB) e valva aórtica pulmonar (AP) de 20 portadores de VAB, 11 portadores de VAT e 21 espécimens de indivíduos sem doença cardíaca. As alterações histológicas foram classificadas de 1 a 3 de acordo com sua intensidade. Na AA, a necrose cística da média (p<0,0001), a fragmentaçäo elástica (p=0,0020) e a alteraçäo na orientaçäo das células musculares lisas (p=0,0017) foram significativamente mais intensas (moderadas a graves) nos portadores VAB. Na AP, essas mesmas alterações histológicas também foram mais intensas no grupo VAB (p<0,0001,p=0,0304 e p=0,0420, respectivamente). Posteriormente, empregou-se imunofluorescência indireta e análise computadorizada das imagens para a quantificaçäo de fibrilina-1 e elastina na camada média dos grandes vasos, expressas como densidade óptica integrada média (DOI). Foram avaliados espécimens de 24 portadores aórticos e 6 de artéria pulmonar provenientes de indivíduos sem doença cardíaca. Os portadores de VAB apresentaram reduçäo significativa de fibrilina-1 na AA (p=0,0017). Näo foi observada diferença significativa na quantidade de elastina na AA (p=0,09597) e AP (p=0,09374), bem como associaçäo entre a reduçäo de fibrilina-1 e a idade dos portadores de VAB (p=0,887). Conclui-se que os portadores de VAB apresentaram alterações hsitológicas mais intensas nos vasos da base que os portadores de VAT, principalmente necrose cística da camada média. Na aorta ascendente, essas alterações histológicas podem estar associadas à reduçäo significativa de fibrilina-1 e näo associadas à idade. A reduçäo de fibrilina-1 ocorreu, provavelmente, na matriz extracelular
Subject(s)
Humans , Adult , Middle Aged , Aorta , Pulmonary Artery/anatomy & histology , Aortic Valve Stenosis/pathology , Aortic Valve Insufficiency/pathology , Microfibrils , Microscopy , Necrosis , Pulmonary Valve , Thoracic Surgery , Tunica Media/anatomy & histology摘要
Este trabalho analisou as alteraçoes nos diâmetros da artéria pulmonar (AP) após a derivaçao cavopulmonar bilateral (DCPB). Foram incluídos 18 pacientes submetidos a DCPB, no período de março de 1990 a janeiro de 1997 que possuíam exames cineangiográficos disponíveis no período pré e pós-operatório. As medidas da APD e APE foram realizadas em três locais: na origem, imediatamente antes da bifurcaçao e no início da artéria do lobo inferior. Em seguida, os diâmetros de cada local foram indexados a superficie corpórea ou ao diâmetro da aorta, medido em nível do diafragma. Os dados angiográflcos e oximétricos foram submetidos à análise estatística. Quando analisados os diâmetros absolutos observou-se que a maioria sofreu um aumento nao-significante, no período pós-operatório, ao passo que o diâmetro H da APE apresentou uma diminuiçao. Os índices totais I e UI apresentaram diminuiçao significante, no período pós-operatório, e no índice total 11 a reduçao nao foi significante. A análise da variável seguimento pós-operatório demonstrou uma reduçao significativa dos índices totais nos pacientes com seguimento pós-operatório inferior a 23,6 meses. A presença de fluxo sanguíneo adicional determinou o aumento dos índices APD II e IH, e uma pequena reduçao nos outros índices. As medidas da AP indexadas pelo diâmetro da aorta revelou comportamento semelhante à indexaçao pela superfície corpórea. Na ausência de circulaçao venosa colateral (CVC) observou-se aumento significante da saturaçao de 02, por outro lado, a sua presença determinou um aumento nao-significante, durante o período de observaçao
Subject(s)
Heart Bypass, Right , Heart Defects, Congenital , Pulmonary Artery/anatomy & histology , Pulmonary Artery/growth & development摘要
Twenty six arterial casts of human lung were obtained of fresh adult cadaveres and both sexes. The branches of pulmonary arteries were injected with 20 per cent solution of vinilit and macerated in 25 per cent KOH solution. The results show that arterial segments is a analogous the broncopulmonary segments.