应用血管内超声评价高压性心脏病中肺动脉的病理变化

血管内超声是超声与心导管技术相结合的新型显像技术，它在肺血管中的应用，弥补了肺血管造影检查的不足，开创了肺血管影像检查的新途径。它既能观测到血管横断面积、血流情况，又能探及血管内膜、中层、外膜的结构形态，能与病理检查结果相吻合，从而以微创方法判定肺血管的结构形态学变化，这对选择手术适应证提供了良好依据。同时对肺血管疾病介入性治疗的术中引导、术后疗效的判定都起着重要作用。     

血管内超声评价先天性心脏病合并肺动脉高压肺血管病理变化的初步探讨

目的 :探索血管内超声在合并肺动脉高压的先天性心脏病 (先心病 )患儿肺动脉内检查的可行性并评价肺血管病理变化。　　方法 :对 6例合并肺动脉高压的先心病患儿进行肺动脉血管内超声检查 ,观测其管腔大小、内膜和中层的厚度以及血管的搏动性 ,同时与右心导管血液动力学在吸氧前后的变化结果进行了比较。　　结果 :肺动脉内超声能够清晰观测到其管壁的三层组织学变化 ,中层增厚 ,吸氧后肺动脉搏动性明显增强 ,与右心导管血液动力学检查结果有高度相关性。　　结论 :血管内超声对肺动脉的检查安全可靠 ,检查结果能够较好的反映肺动脉形态学变化。     

不同的超声心动图技术在肺动脉高压评估中的作用

肺动脉高压是一组以肺血管阻力进行性增加,最终导致右心增大,右室壁肥厚、右心功能衰竭而死亡的疾病。由于其早期症状和体征的非特异性,肺动脉高压常在晚期阶段才被临床诊断。超声心动图由于其无创、安全、简便易行、重复性高等优点,是诊断肺动脉高压的主要筛查工具。现就不同的超声心动图方法在肺动脉高压评估中的作用做一综述。     

血管内超声辅助大动脉炎患者经皮球囊肺动脉成形术一例

<正>1临床资料患者女性,59岁,因“活动后呼吸困难5年,加重15天”入院。5年前开始出现活动后呼吸困难,伴乏力,CT血管成像（CTA）示左锁骨下动脉起始部闭塞,诊断为“肺动脉高压（PH）”,给予波生坦、地尔硫草卓、托拉塞米、螺内酯、利伐沙班等治疗,其后多次入院,经药物治疗后症状缓解不明显。15天前患者活动耐量较前明显下降,快步行走100 m即出现明显喘息症状。     

超声心动图在肺动脉高压患者右心功能评估中的应用进展

肺动脉高压是一种以呼吸困难、胸痛等为主要临床症状的常见病,其诊断及治疗困难,预后极差,患者多因右心衰竭死亡。因此,右心功能在一定程度上决定了肺动脉高压患者的危险分层、生存状况及预后。近年来随着超声心动图技术发展,其评估右心室功能的准确性不断提高,且其能够对右心疾病患者进行危险分层及提供预后信息。本文主要综述了超声心动图在肺动脉高压患者右心功能评估中的应用进展。     

超声心动图评估肺动脉高压的研究进展

正肺动脉高压是由多种心脏、肺脏或者肺血管本身疾病所引起的一类疾病,表现为肺循环的压力和阻力进行性增加,导致右心负荷增大、右心功能不全及肺血流减少,从而引起一系列临床表现~([1-2])。目前广泛采用的肺动脉高压血流动力学的定义为:在海平面静息状态下,右心导管检查测定肺动     

内钠素与肺动脉高压

心钠素是心肌细胞产生和释放的一种循环激素，具有利尿，增加尿钠的排泄，扩张血管和降低血压等作用。本介绍心钠素在肺动脉高压时的变化及其对肺血管的调节作用。     

血管内超声显像在冠心病中的应用

近年来，血管内超声显像发展迅速。本文介绍了所需的设备及其在正常冠脉显像，冠心病诊断和介入性治疗中的应用。     

缺氧性肺动脉高压大鼠肺动脉血管内皮损伤的研究

近年来,血管内皮细胞(ＶＥＣ)在肺动脉高压发病中的作用逐渐引起重视,而循环内皮细胞(ＣＥＣ)被确认为是反映血管内皮损伤的特异性指标。本实验通过观察血ＣＥＣ数量、形态变化和血浆一氧化氮(ＮＯ)、丙二醛(ＭＤＡ)变化及电镜下血管内皮的变化,观察缺氧性肺动脉高压时血管内皮损伤的变化。一、材料与方法1动物模型的复制与分组:雄性Ｗｉｓｔａｒ大鼠30只,体重200～250ｇ,随机分成3组,正常组、缺氧2周组和缺氧4周组,每组10只,缺氧模型的复制参照薛全福法复制[1]。2方法:(1)血流动力学测定采用孙波等方法。(2)血ＣＥＣ测定参照杨映波和王正国…     

急性血管反应试验在肺动脉高压患者中应用的研究进展

肺动脉高压是一种病死率很高的疾病,在治疗之前对患者实施预后评估,同时选择行之有效的药物是治疗的关键.急性血管扩张试验不仅有助于我们判断预后及预测应用血管扩张剂是否有效,同样在评估肺血管阻力的可恢复性方面也具有重要的价值.     

Intravascular Ultrasound Pulmonary Artery Denervation to Treat Pulmonary Arterial Hypertension (TROPHY1): Multicenter,Early Feasibility Study

ObjectivesThe aim of this study was to investigate whether therapeutic intravascular ultrasound pulmonary artery denervation (PDN) is safe and reduces pulmonary vascular resistance (PVR) in patients with pulmonary arterial hypertension (PAH) on a minimum of dual oral therapy.BackgroundEarly studies have suggested that PDN can reduce PVR in patients with PAH.MethodsTROPHY1 (Treatment of Pulmonary Hypertension 1) was a multicenter, international, open-label trial undertaken at 8 specialist centers. Patients 18 to 75 years of age with PAH were eligible if taking dual oral or triple nonparenteral therapy and not responsive to acute vasodilator testing. Eligible patients underwent PDN (TIVUS System). The primary safety endpoint was procedure-related adverse events at 30 days. Secondary endpoints included procedure-related adverse events, disease worsening and death to 12 months, and efficacy endpoints that included change in pulmonary hemodynamic status, 6-min walk distance, and quality of life from baseline to 4 or 6 months. Patients were to remain on disease-specific medication for the duration of the study.ResultsTwenty-three patients underwent PDN, with no procedure-related serious adverse events reported. The reduction in PVR at 4- or 6-month follow-up was 94 ± 151 dyn·s·cm⁻⁵ (p = 0.001) or 17.8%, which was associated with a 42 ± 63 m (p = 0.02) increase in 6-min walk distance and a 671 ± 1,555 step (p = 0.04) increase in daily activity.ConclusionsIn this multicenter early feasibility study, PDN with an intravascular ultrasound catheter was performed without procedure-related adverse events and was associated with a reduction in PVR and increases in 6-min walk distance and daily activity in patients with PAH on background dual or triple therapy.     

Pulmonary Arterial Hypertension

The treatment of pediatric pulmonary arterial hypertension (PAH) is challenging due to the serious nature of the disease, its rapid progression, and the limited treatment options available. While oral calcium channel antagonists and continuous intravenous epoprostenol have been used successfully for over a decade, novel treatment options - including prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors - may change the course of this disease for many children in the future.Prostacyclin analogs offer the benefit over continuous intravenous epoprostenol of an alternative delivery system. However, the efficacy of these medications compared with intravenous epoprostenol and the risk/benefits of each analog need to be weighed in future trials, which need to include larger numbers of pediatric patients to optimize therapy and outcome for individual children with PAH.For patients who do not have an acute response to vasodilator testing or have failed treatment with oral calcium channel antagonists, endothelin receptor antagonists may offer a viable treatment option. Furthermore, in the future, the addition of endothelin receptor antagonists to long-term therapy with calcium channel antagonists or to epoprostenol or a prostacyclin analog may increase the overall efficacy of treatment of PAH. Large multi-institutional randomized trials to determine whether sildenafil is effective and safe for the long-term treatment of PAH in children are in progress.A comprehensive review of these newer agents with an emphasis on the pathobiology/pathophysiology of PAH provides insight into the future management of pediatric PAH patients.     

Pediatric Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) can cause morbidity and mortality in children. Although adult and pediatric PAH share many similarities, many differences have been found in children. Thus, a new classification for pediatric pulmonary hypertensive vascular disease has been proposed. Both child and adult gene mutation carriers with PAH tend to have worse prognoses. Pediatric patients present with better preserved functional class, and parents should pay high attention to any children with unexplained shortness of breath, fatigue or syncope, as symptoms of PAH in children are often misleading. Right heart catheterization is necessary for diagnosis. Although there are few medications approved for pediatric PAH and evidence-based treatment algorithms for children are still lacking, the survival of pediatric patients has been improved significantly since targeted therapies approved for adults were introduced to pediatric patients. PAH in children is unique, and further studies are needed to have a better understanding of it.     

Dasatinib-Induced Pulmonary Arterial Hypertension

A 73-year-old woman with chronic myeloid leukemia developed severe pulmonary arterial hypertension (PAH) and pleural effusions after treatment with dasatinib. During workup, partial anomalous pulmonary venous connection and a sinus venosus atrial septal defect were found; these anomalies may have predisposed her to developing this rare and life-threatening condition. Fortunately, her PAH was completely reversible by discontinuation of dasatinib. This case highlights dasatinib’s ability to cause PAH in patients predisposed to pulmonary vascular disease.     

Epidemiology of Pulmonary Arterial Hypertension

The epidemiology of pulmonary arterial hypertension (PAH) has changed over the last decade. Remarkable advances in understanding the pathobiology and clinical care required in PAH have resulted in improved quality of life and survival. Despite such important progress, the long-term rate of survival is still unacceptable. The epidemiology of PAH could not be easily generalized globally, due to the fact that nearly all of the present data has been gathered from Western, multicenter, prospective registries. There are potentially marked differences in PAH patients from Western and Eastern populations, and from developed and developing countries. Therefore, it is clear that more registry data will be needed to address novel questions emerging with improved knowledge of PAH.