A Model of Pediatric End-Stage Lung Failure in Small Lambs

One in five children with end-stage lung failure (ESLF) die while awaiting lung transplant. No suitable animal model of ESLF exists for the development of artificial lung devices for bridging to transplant. Small lambs weighing 15.7 ± 3.1 kg (n = 5) underwent ligation of the left anterior pulmonary artery (PA) branch, and gradual occlusion of the right main PA over 48 hours. All animals remained hemodynamically stable. Over seven days of disease model conditions, they developed pulmonary hypertension (mean PA pressure 20 ± 5 vs. 33 ± 4 mm Hg), decreased perfusion (SvO2 66 ± 3 vs. 55 ± 8%) with supplemental oxygen requirement, and severe tachypneic response (45 ± 9 vs. 82 ± 23 breaths/min) (all p
Source: ASAIO Journal - Category: Medical Devices Tags: Pulmonary Source Type: research

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Authors: Boucly A, Savale L, Vuillard C, Turpin M, Jaïs X, Montani D, Humbert M, Sitbon O Abstract Right ventricular failure (RVF) is a common cause of admission to the intensive care unit and its presence is a major prognostic factor in acute pulmonary embolism (PE) and chronic pulmonary hypertension (PH). RVF results from an incapacity of the RV to adapt to an increase in afterload so it can become critical in acute PE and chronic PH. The presence of RVF in cases of acute PE with haemodynamic instability is an indication for thrombolytic therapy. RVF represents the most common cause of death in chronic PH. F...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
Between 16 and 51% of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). Whether residual PH is related to remaining (sub-)segmental macrovascular lesions or to microvascular disease is unknown. New imaging techniques can provide detailed information about (sub-)segmental pulmonary arteries and parenchymal perfusion. The aim of this study was to describe the prevalence after PEA of remaining (sub-)segmental vascular lesions on ECG-gated CT pulmonary angiography (CTPA) and parenchymal hypoperfusion on MR and to relate these imag...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Chronic thromboembolic pulmonary hypertension (CTEPH) can develop in 1 out of 25 (4%) patients following an acute pulmonary embolism (PE). It is recommended that high risk patients on anticoagulants, who have persistent shortness of breath post-PE, should be screened for CTEPH. Ventilation-perfusion scan is considered a gold standard tool for screening for CTEPH. This retrospective study sought to describe the use of CTEPH-related diagnostic and medical procedures post-PE in the United States.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: 298 Source Type: research
ács A, Czebe K, Csiszér E, Mihály S, Kovács L, Müller V, Elek J, Rényi-Vámos F, Lang G Abstract The first lung transplantation in Hungary was performed on 12th of December, 2015. It was a joint effort of the National Institute of Oncology and the Semmelweis University. Hereby we summarise the results and experiences from the first three years. Until August, 2018, 55 lung transplantations were performed in Hungary. This was a retrospective analysis. All patients were listed according to the recommendation of the Lung Transplantation Committee. All implanted lungs have ...
Source: Orvosi Hetilap - Category: General Medicine Authors: Tags: Orv Hetil Source Type: research
We present a case of vasculitis-associated PH initially diagnosed as CTEPH.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
AbstractPurposeHepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH) are extrahepatic complications of biliary atresia (BA). Their detection is sometimes delayed, which may result in missed opportunities for liver transplantation. The aim of this study was to determine the onset ages of HPS and PoPH in BA patients.MethodsBA patients followed at our institution were identified. Patients visited our clinic for routine blood work, as well as regular electrocardiography, chest X-rays, and arterial blood gas tests. Lung perfusion scintigraphy and cardiac ultrasound were performed to diagnose HPS. Cardiac cathete...
Source: Pediatric Surgery International - Category: Surgery Source Type: research
Conclusion: Comparing 2015 to 2000, lung scans for PE decreased 46% from 489 to 263, apparently due to CTA, while other uses rose from 3 to 88. Use of reduced number of particles rose significantly from 9% to 47% of (99m)Tc MAA doses. Although the total number of (99m)Tc MAA doses dropped 29% from 492 to 351, (99m)Tc MAA remains an important radiopharmaceutical for both PE and other uses. PMID: 28408704 [PubMed - as supplied by publisher]
Source: Journal of Nuclear Medicine Technology - Category: Nuclear Medicine Tags: J Nucl Med Technol Source Type: research
Purpose of review: The perioperative management of lung transplantation patients remains a challenge. The most important goal is the prevention or attenuation of primary graft failure due to ischemia and reperfusion, operative trauma, and activation of systemic inflammation; it significantly influences short-long and long-term outcome. This review focuses on different aspects regarding the management of these high-risk patients. Recent findings: The Lung Allocation Score was implemented to estimate the survival benefit from a lung transplant. As scarcity of lung grafts persists new techniques such as the ex-vivo lung perfu...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Thomas Hachenberg and Moritz A. Kretzschmar Source Type: research
The objective of this analysis was to assess the effectiveness, safety, and cost-effectiveness of extracorporeal lung support technologies in the improvement of pulmonary gas exchange and the survival of adult patients with acute pulmonary failure and those with end-stage chronic progressive lung disease as a bridge to lung transplantation (LTx). The application of these technologies in primary graft dysfunction (PGD) after LTx is beyond the scope of this review and is not discussed. CLINICAL APPLICATIONS OF EXTRACORPOREAL LUNG SUPPORT: Extracorporeal lung support technologies [i.e., Interventional Lung Assist (ILA) and ex...
Source: Ontario Health Technology Assessment Series - Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research
Abstract The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous...
Source: Pediatric Transplantation - Category: Transplant Surgery Authors: Tags: Original Article Source Type: research
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