Experimental Pulmonary Hypertension Produced by Surgical and Chemical Denervation of the Pulmonary Vasculature

Juratsch, Craig E.; Jengo, James A.; Castagna, John; Laks, Michael M.

doi:10.1378/chest.77.4.525

Cited by 80 publications

(62 citation statements)

References 12 publications

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“…Stretch of the main pulmonary artery in vivo by means of a nonocclusive balloon has been previously reported to increase pulmonary vascular resistance downstream in dogs, sheep, and human infants (15)(16)(17)(18)21). These results have been refuted on the basis that the increase in pulmonary vascular resistance was caused by the balloon obstruction of one of the main pulmonary artery branches (19,20).…”

Section: Discussionmentioning

confidence: 99%

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Myogenic Response in Large Pulmonary Arteries and Its Ontogenesis

Belik

1994

Pediatr Res

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To evaluate the myogenic response and its ontogeny in large pulmonary arteries, we studied 45 newborn and 30 adult guinea pigs. Compared with the those of the adult, the newborn arterial vessels possessed a significantly @ < 0.01) smaller diameter (1153 ~t-34 versus 1656 5 65 km), static compliance (2.2 * 0.3 versus 4.6 * 0.7 pm/mN), and active stress (3.4 + 0.4 versus 5.8 ~t-0.7 mN/mm2). Stretchinduced contraction was obtained by quick stretch of the vessel segments to 120, 140, 160, 180, or 200% of their optimal length, and the myogenic response was measured as the change in force after muscle relaxation with papaverine. A myogenic response was observed in 94% of the newborn and 93% of adult vessel segments, and significant age differences in the response were present. The magnitude of the active force generated for any stretch over 120% was significantly greater in the newborn (p < 0.01), and as a percentage of K+ (127 mM) stimulation, a 2-fold Vessels respond to an increase in intraluminal pressure with vasoconstriction. This phenomenon, called the myogenic response or stretch-induced contraction, was originally described by Bayliss in 1902 (1). Previous data on in vitro vessel segments and in vivo organ perfusion studies of several animal species have confirmed its existence in a variety of systemic vessels (2-7). The phenomenon is most prevalent in small resistance units, and this has led to the current belief that the myogenic response plays an important role in organ autoregulation of blood flow after arterial pressure changes (2).Limited data are available on the myogenic response of lung vessels. In pulmonary allografts in the hamster, Davis et al. (8) were unable to observe any changes in arteriolar diameter after alterations in transmural pressure, whereas vasoconstriction was observed in systemic cheek pouch arterioles under similar conditions. T o the best of our knowledge, the only other study of the myogenic response in pulmonary vessels was reported by

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Section: Discussionmentioning

confidence: 99%

“…Juratsch et al have shown that nonocclusive distension of the main pulmonary artery results in a significant increase in pulmonary vascular resistance in the dog (15)(16)(17) and sheep (18). Compared with the young and adult sheep, the increase in pulmonary vascular resistance was greatest in newborn sheep (18).…”

Section: Abbreviationsmentioning

confidence: 99%

Myogenic Response in Large Pulmonary Arteries and Its Ontogenesis

Belik

1994

Pediatr Res

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“…In the conscious adult dog distention of the proximal main pulmonary artery, near the bifurcation, by a partially inflated balloon, results in a significant elevation of pulmonary artery pressure distal (as well as proximal) to the balloon (19,20,22). This elevation in pressure is produced by an increase in pulmonary vascular resistance which occurred without significant change in right ventricular end-diastolic pressure, aortic pressure, and cardiac output.…”

Section: Speculationmentioning

confidence: 99%

“…Left atrial pressure either did not change or decreased. We have reported that stepwise balloon distention of the main pulmona artery results in step increases in pulmonary artery pressure abwnstream from the balloon (22) and that this phenomenon is most likely due to sympathetic reflex pulmonary vasoconstriction (19,20).A prominent feature of this pulmonary artery distention reflex is its presumably positive feedback nature. The term "positive feedback" is used to describe this pulmonary vascular pressor reflex because it appears to depend on the excitation of stretch receptors upstream from the pulmonary vascular bed to cause the constriction of the downstream pulmonary vessels such that the greater the distention of the main pulmonary artery the greater the downstream vasoconstriction.…”

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confidence: 99%

“…It is possible that at birth this reflex mechanism operates in reverse to help lower the pulmonary vascular resistance smoothly, thus avoiding volume overload of the neonatal lungs and left ventricle. Finally, we postulate that this reflex may play a role in the pathogenesis of the persistant fetal circulation syndrome (7).In the conscious adult dog distention of the proximal main pulmonary artery, near the bifurcation, by a partially inflated balloon, results in a significant elevation of pulmonary artery pressure distal (as well as proximal) to the balloon (19,20,22). This elevation in pressure is produced by an increase in pulmonary vascular resistance which occurred without significant change in right ventricular end-diastolic pressure, aortic pressure, and cardiac output.…”

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Pulmonary Arterial Hypertension Induced by Distention of the Main Pulmonary Artery in Conscious Newborn, Young, and Adult Sheep

et al. 1980

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SummaryDistention of the main pulmonary artery by balloon inflation in sheep results in presumably reflex elevation of pulmonary arterial pressure and resistance distal to the balloon. This response to main pulmonary artery distention is significantly greater in newborn lambs than in older lambs or adult sheep. In several of the newborn lambs, pulmonary artery pressure was raised to suprasystemic levels. Further, in some of the newborn animals, these increases in pulmonary artery pressure and resistance were sustained after deflation of the balloon for periods up to 2 hr. The functional significance of this pulmonary hypertension reflex was not elucidated. However, the data strongly suggest that this reflex may contribute to the maintenance of high pulmonary vascular resistance during fetal and early neonatal life. SpeculationProximal distention of the main pulmonary artery induces a positive feedback reflex which significantly elevates pulmonary artery pressure and resistance. We postulate that this reflex operates in conjunction with hypoxia to maintain high pulmonary vascular resistance in the fetus. It is possible that at birth this reflex mechanism operates in reverse to help lower the pulmonary vascular resistance smoothly, thus avoiding volume overload of the neonatal lungs and left ventricle. Finally, we postulate that this reflex may play a role in the pathogenesis of the persistant fetal circulation syndrome (7).In the conscious adult dog distention of the proximal main pulmonary artery, near the bifurcation, by a partially inflated balloon, results in a significant elevation of pulmonary artery pressure distal (as well as proximal) to the balloon (19,20,22). This elevation in pressure is produced by an increase in pulmonary vascular resistance which occurred without significant change in right ventricular end-diastolic pressure, aortic pressure, and cardiac output. Left atrial pressure either did not change or decreased. We have reported that stepwise balloon distention of the main pulmona artery results in step increases in pulmonary artery pressure abwnstream from the balloon (22) and that this phenomenon is most likely due to sympathetic reflex pulmonary vasoconstriction (19,20).A prominent feature of this pulmonary artery distention reflex is its presumably positive feedback nature. The term "positive feedback" is used to describe this pulmonary vascular pressor reflex because it appears to depend on the excitation of stretch receptors upstream from the pulmonary vascular bed to cause the constriction of the downstream pulmonary vessels such that the greater the distention of the main pulmonary artery the greater the downstream vasoconstriction. Consideration of the implications and significance of the existence of such a pulmonary arterial stretch receptor system to raise pulmonary vascular resistance, via positive feedback mechanisms, as shown in the dog, poses the following questions: (I) is this pulmonary hypertension reflex present in other species? (2) is this reflex more active in the newbo...

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Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience

Witkowski

Szumowski

Urbanek

et al. 2021

Cathet Cardio Intervent

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Objectives: The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF).Background: Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. Methods:The combination of pulmonary artery systolic pressure (PAPs) ≥60 mmHg, transpulmonary pressure gradient (TPG) ≥12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) ≥3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6 months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45 C and energy 10 W.

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Experimental Pulmonary Hypertension Produced by Surgical and Chemical Denervation of the Pulmonary Vasculature

Cited by 80 publications

References 12 publications

Myogenic Response in Large Pulmonary Arteries and Its Ontogenesis

Myogenic Response in Large Pulmonary Arteries and Its Ontogenesis

Pulmonary Arterial Hypertension Induced by Distention of the Main Pulmonary Artery in Conscious Newborn, Young, and Adult Sheep

Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience

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