RESUMEN
In the pulmonary circulation, resistive and compliant properties overlap in the same vessels. Resistance varies nonlinearly with pressure and flow; this relationship is driven by the elastic properties of the vessels. Linehan et al. correlated the mean pulmonary arterial pressure and mean flow with resistance using an original equation incorporating the distensibility of the pulmonary arteries. The goal of this study was to validate this equation in an in vivo porcine model. In vivo measurements were acquired in 6 pigs. The distensibility coefficient (DC) was measured by placing piezo-electric crystals around the pulmonary artery (PA). In addition to experiments under pulsatile conditions, a right ventricular (RV) bypass system was used to induce a continuous pulmonary flow state. The Linehan et al. equation was then used to predict the pressure from the flow under continuous flow conditions. The diameter-derived DC was 2.4%/mmHg (+/-0.4%), whereas the surface area-based DC was 4.1 %/mmHg (+/-0.1%). An increase in continuous flow was associated with a constant decrease in resistance, which correlated with the diameter-based DC (r=-0.8407, p=0.044) and the surface area-based DC (r=-0.8986, p=0.028). In contrast to the Linehan et al. equation, our results showed constant or even decreasing pressure as flow increased. Using a model of continuous pulmonary flow induced by an RV assist system, pulmonary pressure could not be predicted based on the flow using the Linehan et al. equation. Measurements of distensibility based on the diameter of the PA were inversely correlated with the resistance.
Asunto(s)
Arteria Pulmonar/fisiología , Circulación Pulmonar/fisiología , Flujo Pulsátil/fisiología , Resistencia Vascular/fisiología , Función Ventricular Derecha/fisiología , Animales , PorcinosAsunto(s)
Impedancia Eléctrica , Endarterectomía , Hipertensión Pulmonar , Arteria Pulmonar , Embolia Pulmonar/complicaciones , Adulto , Anciano , Bélgica , Endarterectomía/efectos adversos , Endarterectomía/métodos , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Arteria Pulmonar/cirugía , Circulación Pulmonar , Estudios Retrospectivos , Resistencia VascularRESUMEN
Atrial fibrillation is a very common arrhythmia that carries a considerable risk of thromboembolic complications. Surgical treatment is an effective way to convert atrial fibrillation into sinus rhythm and significantly prevents thromboembolism postoperatively. In this review we describe recent advancements in the surgical options and detail our strategy for the surgical treatment of atrial fibrillation.
Asunto(s)
Fibrilación Atrial/cirugía , Fibrilación Atrial/clasificación , Fibrilación Atrial/fisiopatología , Procedimientos Quirúrgicos Cardíacos/métodos , Ablación por Catéter , Crioterapia , Humanos , Terapia por Láser , Microondas , Tromboembolia/prevención & control , Resultado del TratamientoRESUMEN
Secundum atrial septal defect is the most common congenital heart defect in adulthood. As an alternative to surgery, the transcatheter occlusion appears to be safe. We herein report a case of a residual shunt after transcatheter closure of ASD of a 66 year old man. Surgical repair was indicated. Real and potential problem with device closure of ASD are discussed.
