Anastomoses Between Bronchial and Pulmonary Arteries in Pulmonary Thromboembolic Disease

Orell, S. R.; Hultgren, Simon

doi:10.1111/apm.1966.67.3.322

Cited by 20 publications

(11 citation statements)

References 9 publications

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“…In humans, preexisting bronchopulmonary arterial anastomoses are commonly seen slightly proximal to the lobular arteries. 17 The pressure gradient between the systemic arteries and the pulmonary arteries distal to the site of occlusion would increase when small distal arteries and arterioles are unaffected in patients with main or lobar type of CTEPH, 1 and it would result in systemic arterial blood flow increasing in ischemic areas. Another possibility for the development of systemic arterial supply to an occluded lung, related to the location of thrombi, is hyperplasia of the pulmonary artery vasa vasorum, which is of bronchial arterial origin.…”

Section: Discussionmentioning

confidence: 99%

“…Another possibility for the development of systemic arterial supply to an occluded lung, related to the location of thrombi, is hyperplasia of the pulmonary artery vasa vasorum, which is of bronchial arterial origin. 6,17 In addition, the extent of central disease per se may lead to nonhemodynamic factors, including pro-and anti-angiogenic factors. Our previous study showed that monocyte chemoattractant protein-1 is produced in endothelial cells, mononuclear cells, and smooth muscle cells in the fibrinous portion adjacent to the vascular lumen in endarterectomized tissue.…”

Section: Discussionmentioning

confidence: 99%

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Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

Shimizu

Tanabe

Terada

et al. 2008

Circ J

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Background Dilatation of the bronchial arteries is a well-recognized feature in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of the current study was to use computed tomography (CT) to assess the relationship between dilated bronchial arteries and the extent of thrombi, and to evaluate the predictive value of the former for surgical outcome. Methods and ResultsFifty-nine patients with CTEPH and 16 with pulmonary arterial hypertension (PAH) were retrospectively evaluated. The total cross-sectional area of bronchial arteries was measured by CT and its relationship with the central extent of thrombi or surgical outcome was assessed. The total area of the bronchial arteries in CTEPH patients was significantly larger than that in PAH patients (median [range], 6.9 [1.7-29.5] mm 2 vs 3.2 [0.8-9.4] mm 2 ), with the total area of bronchial arteries correlating with the central extent of thrombi. In patients who had undergone pulmonary thromboendarterectomy (PTE) (n=22), the change in PaO2 after surgery had a tendency to correlate with the total area of the bronchial arteries. Conclusion The total cross-sectional area of the bronchial arteries correlated with the extent of central disease in patients with CTEPH, and it might predict gas exchange improvement after PTE. (Circ J 2008; 72: 1136 -1141

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

Shimizu

Tanabe

Terada

et al. 2008

Circ J

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“…The pattern of hypertrophy and enlargement of systemic bronchial arteries is well known in CTEPH [25,29]. It has been speculated that a decrease of postobstructive pulmonary artery pressure and the eventual increase of the pressure gradient between bronchial arteries and pulmonary arteries might lead to an opening of pre-existing bronchopulmonary arterial anastomoses [30,31]. Interestingly, JOHNSON et al [32] reported a significant increase in number of muscularised veins as well as an increase of wall thickness of pulmonary veins in sheep with PH induced by continuous air embolisation into the main pulmonary artery.…”

Section: Intrapulmonary Systemic Vesselsmentioning

confidence: 99%

Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature

et al. 2014

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Limited numbers of operated patients with chronic thromboembolic pulmonary hypertension (CTEPH) are refractory to pulmonary endarterectomy (PEA) and experience persistent pulmonary hypertension (PH).We retrospectively assessed lung histology available from nine patients with persistent PH (ineffective PEA (inPEA) group) and from eight patients transplanted for distal CTEPH inaccessible by PEA (noPEA group). Microscopically observed peculiarities were compared with the histology of a recently developed CTEPH model in piglets. Pre-interventional clinical/haemodynamic data and medical history of patients from the inPEA and noPEA groups were collected and analysed.Conspicuous remodelling of small pulmonary arteries/arterioles, septal veins and pre-septal venules, including focal capillary haemangiomatosis, as well as pronounced hypertrophy and enlargement of bronchial systemic vessels, were the predominant pattern in histology from both groups. Most findings were reproduced in our porcine CTEPH model. Ink injection experiments unmasked abundant venular involvement in so-called small vessel or microvascular disease, as well as post-capillary bronchopulmonary shunting in human and experimental CTEPH.Microvascular disease is partly due to post-capillary remodelling in human and experimental CTEPH and appears to be related to bronchial-to-pulmonary venous shunting. Further studies are needed to clinically assess the functional importance of this finding. @ERSpublications Pulmonary veins and systemic vasculature contribute to microvascular disease in CTEPH

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“…Similar systemic collateral connections with the distal epicardial branches are occasionally noted during coronary arteriography and have been well documented [2]. Since other systemic (pleural and bronchial) to pulmonary artery collateral pathways are well known and have been associated with pulmonary thromboembolism, especially when chronic [3,4], coronary-pulmonary connections are not really surprising but are probably rare because of reasons discussed in the foregoing article.Regardless, this case again shows that there is more to coronary arteriography than looking for coronary atherosclerotic disease [5]. In the process Benitez has described a new interarterial connection.…”

mentioning

confidence: 56%

The coronary connection revisited: A fistula or collateral anastomosis?

Grollman

1998

Cathet. Cardiovasc. Diagn.

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Anastomoses Between Bronchial and Pulmonary Arteries in Pulmonary Thromboembolic Disease

Cited by 20 publications

References 9 publications

Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

Dilatation of Bronchial Arteries Correlates With Extent of Central Disease in Patients With Chronic Thromboembolic Pulmonary Hypertension

Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature

The coronary connection revisited: A fistula or collateral anastomosis?

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