RESUMO
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.
Assuntos
Artéria Pulmonar/fisiologia , Circulação Pulmonar/fisiologia , Fluxo Pulsátil/fisiologia , Resistência Vascular/fisiologia , Função Ventricular Direita/fisiologia , Animais , SuínosAssuntos
Impedância Elétrica , Endarterectomia , Hipertensão Pulmonar , Artéria Pulmonar , Embolia Pulmonar/complicações , Adulto , Idoso , Bélgica , Endarterectomia/efeitos adversos , Endarterectomia/métodos , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Circulação Pulmonar , Estudos Retrospectivos , Resistência VascularRESUMO
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.
Assuntos
Fibrilação Atrial/cirurgia , Fibrilação Atrial/classificação , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter , Crioterapia , Humanos , Terapia a Laser , Micro-Ondas , Tromboembolia/prevenção & controle , Resultado do TratamentoRESUMO
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.
