Wedge Pulmonary Arteriography in Congenital Heart Disease

Castellanos, A; Hernandez, Francisco A.; Mercado, H

doi:10.1148/85.5.838

Cited by 8 publications

(6 citation statements)

References 7 publications

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“…We found that the pulmonary circulation time is longest in patients with the highest Rp values and peripheral vascular changes of at least grade C severity and Heath-Edwards grade III and in those with pulmonic stenosis; this reflects, in part, the lower pulmonary blood flows in these patients and is in keeping with the findings of Castellanos et al 6 In the patients with elevated Rp, delay in transit of the contrast medium is presumably due to the numerically reduced pulmonary vascular bed and the small remaining arteries with compromised lumens. The two patients in our series with elevated left atrial pressure and pulmonary venous hypertension on the basis of mitral regurgitation alone did have somewhat more prolonged pulmonary circulation times, compatible with previously described findings.6…”

Section: Pulmonary Circulation Timesupporting

confidence: 90%

“…Our method of estimating pulmonary circulation time differs from that suggested by Castellanos et al 6 These authors measured the average pulmonary circulation time as the number of seconds from the beginning of the injection to the time of identification of contrast material in the left atrium. This time interval, however, may be influenced by the rate of injection.…”

Section: Analysis Of the Techniquementioning

confidence: 99%

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Quantitative analysis of the pulmonary wedge angiogram in congenital heart defects. Correlation with hemodynamic data and morphometric findings in lung biopsy tissue.

Rabinovitch¹,

Keane²,

Fellows³

et al. 1981

Circulation

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SUMMARY At cardiac catheterization, 93 pulmonary wedge angiograms were performed in 85 patients with congenital heart defects. The pulmonary wedge angiogram was quantitatively analyzed and the findings were compared with hemodynamic features and morphometric assessment of lung biopsy tissue when available (27 patients). A pulmonary wedge catheter was directed into the right or left lower lobe to the origin of the posterobasal segment artery. The balloon was inflated and 0.3 mI/kg Renovist injected; then, the balloon was deflated and the venophase was followed. From the cine, the following were assessed: (1) abruptness of tapering of the pulmonary arteries (mean length of the artery segment between luminal diameters of 2.5 mm and 1.5 mm was calculated), (2) intensity of background haze with reference to standard films and (3) pulmonary circulation time, i.e., the time from balloon deflation to entrance of Renovist into the left atrium.Progressively more abrupt tapering of the pulmonary arteries was observed in patients with increasingly abnormal hemodynamics (p < 0.001). Four patient groups were significantly different from each other (p < 0.05): group I, normal mean pulmonary artery pressure (Pp.), group II, increased Ppa pulmonary vascular resistance (Rp) < 3 U/m2, group IIIa, Rp > 3 <5 U/in and group II1b, Rp 5 U/in. Tapering was also more abrupt with increasingly severe structural changes in lung biopsy tissue (p < 0.001). Those with grade A (abnormal extension of muscle into peripheral arteries), grade B (A + increased medial wall thickness) and grade C (B + reduced artery concentration) were significantly different from each other (p < 0.02). Patients with grade IIIb hemodynamics and grade C lung biopsy changes also differed from all other groups in that they had significantly more reduction in background haze (p < 0.05) and tended to have a more prolonged pulmonary circulation time.After repair, the rate of tapering reflected both the current hemodynamic state as well as preoperative Pp, and lung biopsy findings. Thus, the pulmonary wedge angiogram assessed quantitatively correlates with the hemodynamic findings and is also informative of the structural state of the peripheral pulmonary vascular bed.THE NEED for and the timing of corrective congenital heart surgery are usually dictated by the patient's symptoms and hemodynamic data. The structural changes in the pulmonary vascular bed, however, influence both the immediate and long-term postoperative functional results, which do not always closely correlate with the preoperative hemodynamic findings.' 3 It would therefore be of considerable value if the structural state of the pulmonary vascular bed could also be assessed at cardiac catheterization using a simple technique such as a pulmonary wedge angiogram.Previous studies of pulmonary wedge angiograms in patients with congenital heart defects have been carried out, but these were largely qualitative analyses and described such features as sparcity of arborization of the pulmonary tree, abrupt terminatio...

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Section: Pulmonary Circulation Timesupporting

confidence: 90%

Section: Analysis Of the Techniquementioning

confidence: 99%

Quantitative analysis of the pulmonary wedge angiogram in congenital heart defects. Correlation with hemodynamic data and morphometric findings in lung biopsy tissue.

Rabinovitch¹,

Keane²,

Fellows³

et al. 1981

Circulation

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“…1 24 21 Since Bell's first report of the clinical use of magnification pulmonary wedge angiography,' many investigators have been able to 1104 CIRCULATION reproduce detailed angiograms of the secondary pulmonary lobule and of vessels as small as 100-300 , in diameter. [5][6][7][8][9] Previous studies in animals,9 patients with mitral stenosis7 and children with congenital heart disease' 6 10 have shown a correlation between changes in the magnified wedge angiogram or postmortem magnification angiograms with histological changes in the pulmonary arteries.…”

Section: Discussionmentioning

confidence: 99%

Magnification pulmonary wedge angiography in the evaluation of children with congenital heart disease and pulmonary hypertension.

Nihill¹,

McNamara²

1978

Circulation

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In order to determine the presence and extent of obstructive pulmonary vascular disease in patients with congenital heart disease, magnified cineangiograms were obtained with a catheter in the pulmonary artery wedge position in 155 infants and children undergoing cardiac catheterization. The wedge angiograms (WA) were analyzed in groups according to the pulmonary hemodynamics: group A normal pulmonary blood flow (PBF) and pulmonary artery pressure (PAP) (31 patients; 53 WA); group B increased PBF and normal PAP (46 patients; 69 WA); group C: increased PBF and PAP but a pulmonary vascular resistance (PVR) < 6 u/m2 (19 patients; 33 WA); group D increased PAP and PVR > 6 u/M2 (30 patients; 66 WA); group E pulmonary venous hypertension (15 patients; 27 WA); and group F: infants < 3 months old with a variety of congenital heart defects (14 patients; 19 WA).WA from group A patients defined the microcirculation of the secondary pulmonary lobule with an evenly tapering, orderly arborization of muscular pulmonary arteries and numerous supernumerary vessels as small as 100 ,u in diameter with a full, even granular capillary blush surrounding each small, muscular artery. Increased PBF produced dilation of the elastic and muscular vessels with engorgement of the lobule, while increased PAP produced tortuosity of the vessels. An elevated PVR was manifest by dilation and tortuosity of the elastic vessels and a more abrupt tapering of the muscular arteries. Patients with a PVR > 12 u/M2 and those with obstructive vascular disease by histological examination (eight patients) showed marked reduction or absence of supernumerary vessels and decreased arborization of the distal muscular pulmonary arteries as well as the other hypertensive changes, and the capillary blush was incomplete, patchy and reticular. Obstructive signs were distributed randomly within the lobules and the lung lobes.Pulmonary venous hypertension was associated with dilation of the paralobular veins with a vein:central artery ratio of > 1.3: 1. WA in the infants showed no obstructive pattern, and the microvascular morphology reflected the pulmonary hemodynamics seen in groups A, B and C.We conclude that the presence of obstructive pulmonary vascular disease can be determined in patients with pulmonary hypertension and elevated PVR by magnification wedge angiography. The degree and extent of obstructive vascular lesions can be assessed more readily by this method than by histologic examination or random lung biopsy specimens.THE CLINICAL USE of magnification pulmonary wedge angiography was first described by Loomis Bell in 1958, to study the morphology of the small pulmonary arteries in patients with pulmonary hypertension.' These studies developed from work of Evans and Short,2 3 who studied magnified postmortem angiograms of lungs from patients with various forms of pulmonary hypertension. These workers compared the angiographic morphology with histological data and were able to identify specific angiographic patterns which corresponded with various stages of ...

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“…Children with large intracardiac communications and Down syndrome are at risk for pulmonary vascular disease in the first year of life, but symptoms and signs are not specific for the degree of pulmonary vascular disease. Even in infancy, many of these patients with atrioventricular septal defects have high-resistance, low-flow hemodynamics and advanced structural pulmonary vascular disease [ 1,2]. Cardiac catheterization remains the best method of assessing the pulmonary vascular resistance [3,4], but there are theoretical limitations to the use of Poiseuille's formula when calculating resistance of the pulmonary vascular bed [5].…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac catheterization remains the best method of assessing the pulmonary vascular resistance [3,4], but there are theoretical limitations to the use of Poiseuille's formula when calculating resistance of the pulmonary vascular bed [5]. Some groups, using lung biopsies, have found a poor correlation between hemodynamic studies and structural pulmonary vascular changes [2,6]. Although lung biopsy is 0 1993 Wiley-Liss, Inc.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary wedge angiography for prediction of pulmonary vascular disease in down syndrome

Wilson

Culham

Sandor

et al. 1993

Cathet. Cardiovasc. Diagn.

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We performed high resolution pulmonary wedge angiography (PWA) and conventional hemodynamics to predict the reversibility of structural pulmonary vascular disease. Sixty-one pulmonary wedge angiograms were performed on 41 patients with intracardiac shunts and Down syndrome (median age 8 months). Balloon occlusion wedge angiograms were analyzed for (1) monopedial branches from the distal 10 mm of muscular arteries, (2) capillary blush, (3) tapering indices, and (4) tortuosity. Twenty-five patients had open lung biopsy, graded by the Health Edwards classification, and analyzed morphometrically. Pulmonary vascular resistance of > or = 6 units was 100% sensitive and 94% specific for Heath Edwards Grade III-IV. A monopedial count < 3 vessels was 83% sensitive and 100% specific for Heath Edwards Grade III-IV. Abnormal capillary blush was 83% sensitive and 69% specific for Heath Edwards Grade III-IV. Tapering indices and tortuosity showed no significant correlation with lung biopsy. A combination of pulmonary vascular resistance < 6 units, monopedial count > or = 3, and normal capillary blush was 100% sensitive and specific for Heath Edwards Grade 0-II, and a combination of pulmonary vascular resistance > or = 6 units, monopedial count < 3, and abnormal capillary blush was 100% sensitive and specific for Heath Edwards Grade III-IV. Using the 3 criteria, Heath Edwards Grade was accurately predicted in 17 patients. In 4 patients, only 2 criteria were available. Morphometric analysis showed an inverse relationship between the lowest monopedial count and the number of occlusive vessels per cm of tissue, r = -0.74 p < 0.001. Arteries showing intimal and/or medial thickening causing > 90% luminal narrowing were scored as "occlusive." These results show that when the hemodynamic and pulmonary wedge angiography data are concordant, the structural changes of pulmonary vascular disease can be accurately predicted and lung biopsy may be avoided.

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Wedge Pulmonary Arteriography in Congenital Heart Disease

Cited by 8 publications

References 7 publications

Quantitative analysis of the pulmonary wedge angiogram in congenital heart defects. Correlation with hemodynamic data and morphometric findings in lung biopsy tissue.

Quantitative analysis of the pulmonary wedge angiogram in congenital heart defects. Correlation with hemodynamic data and morphometric findings in lung biopsy tissue.

Magnification pulmonary wedge angiography in the evaluation of children with congenital heart disease and pulmonary hypertension.

Pulmonary wedge angiography for prediction of pulmonary vascular disease in down syndrome

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