Reevaluation of Histomorphometric Analysis of Lung Tissue in Decision Making for Better Patient Selection for Fontan-Type Operations Katsuhide Maeda,

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Presentation transcript:

Reevaluation of Histomorphometric Analysis of Lung Tissue in Decision Making for Better Patient Selection for Fontan-Type Operations Katsuhide Maeda, MD, Shigeo Yamaki, MD, Hideaki Kado, MD, Toshihide Asou, MD, Arata Murakami, MD, Shinichi Takamoto, MD The Annals of Thoracic Surgery Volume 78, Issue 4, Pages 1371-1381 (October 2004) DOI: 10.1016/j.athoracsur.2004.02.131

Fig 1 (A) A variety of degrees of vasoconstriction on the same biopsy section. Two intraacinar small pulmonary arteries (SPAs) are seen branching from one preacinar SPA. The medial hypertrophy of the left artery is judged to be more severe by direct measurement of the medial wall. (Left, 29%; right, 14% by the percent wall thickness method.) However, the quantitative analysis (B) shows that this is due to vasoconstriction of the media. When the internal elastic membrane is stretched, there is no difference in the medial thickness between the two SPAs. (B) Histometrical determination of the radius (R) and medial thickness (D). The constricted artery (left) has been reduced to the hypothetical state of a perfectly stretched internal elastic membrane (right). This method minimizes the influence of differing states of vasoconstriction during biopsy or at autopsy and makes comparisons among cases more reliable. (L = length of internal elastic lamina; S = cross-sectional surface area of media.) (C) Significant correlation between medial thickness (D) and radius (R) of SPAs on a logarithmic coordinate system in SPAs. The D value at R = 100 μm (D[R = 100 μm]) was calculated from the linear regression and used for comparative analysis. The D(R = 100 μm) value was calculated from at least 30 SPAs with radii of 15 to 250 μm (from intraacinar to preacinar SPA) and can be used as representative of the medial thickness of SPAs. The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 2 The relationship between pulmonary artery pressure (PAP) and D(R = 100 μm) has been plotted. The correlation is statistically significant. Open circles = surviving TCPC; solid circles = decreased or takedown TCPC; open triangles = surviving BDG; solid triangles = decreased or takedown BDG; solid line = correlation curve between pulmonary artery pressure and D(R = 100 μm) in all cases. (BDG = bidirectional Glenn shunt; TCPC = total cavopulmonary connections.) The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 3 Relationship between D(R = 100 μm) and outcome in bidirectional Glenn shunt groups. There is a marked difference between the two groups (p = 0.0004). Circles = bidirectional Glenn shunt cases; upper dotted line = cutoff point for the success of bidirectional Glenn shunt; lower dotted line = the lowest D(R = 100 μm) point in the deceased or takedown group. The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 4 Relationship between Heath-Edwards and outcome in bidirectional Glenn shunt (A) and total cavopulmonary connections (B). There are no differences between the two groups. The black dots are cases with fenestration. (NS = not significant.) The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 5 Relationship between index of pulmonary vascular disease (IPVD) and outcome in bidirectional Glenn shunt (A) and total cavopulmonary connections (B) groups. There are no differences between the two groups. The black dots are cases with fenestration. (NS = not significant.) The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 6 Relationship between corrected density of small pulmonary arteries (NA) and outcome in bidirectional Glenn shunt (A) and total cavopulmonary connections (B) groups. There are no differences between the two groups. The black dots are cases with fenestration. (NS = not significant.) The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 7 Relationship between percentage of small pulmonary artery containing a thrombus and outcome in bidirectional Glenn shunt (A) and total cavopulmonary connections (B) groups. There are no differences between the two groups. The black dots are cases with fenestration. (NS = not significant.) The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)

Fig 8 Relationship between D(R = 100 μm) and outcome in total cavopulmonary connections. There is a significant difference between the two groups (p < 0.0001). The black dots are cases with fenestration. Upper dotted line = the lowest D(R = 100 μm) point in the deceased or takedown group; lower dotted line = cutoff point for the success of total cavopulmonary connections. The Annals of Thoracic Surgery 2004 78, 1371-1381DOI: (10.1016/j.athoracsur.2004.02.131)