Periarteritis in Lung From a Continuous-Flow Right Ventricular Assist Device: Role of the Local Renin-Angiotensin System Chiyo Ootaki, MD, Michifumi.

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Periarteritis in Lung From a Continuous-Flow Right Ventricular Assist Device: Role of the Local Renin-Angiotensin System Chiyo Ootaki, MD, Michifumi Yamashita, MD, PhD, Yoshio Ootaki, MD, PhD, Diyar Saeed, MD, Tetsuya Horai, MD, Hideyuki Fumoto, MD, Alex L. Massiello, MEBME, Steven N. Emancipator, MD, Leonard A.R. Golding, MBBS, FRACS, Kiyotaka Fukamachi, MD, PhD The Annals of Thoracic Surgery Volume 96, Issue 1, Pages 148-154 (July 2013) DOI: 10.1016/j.athoracsur.2013.04.008 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Photomicrographs show hematoxylin and eosin staining of the lung and kidney (original magnification ×50). (A) Lung specimen obtained at autopsy after continuous-flow right ventricular assist device (CFRVAD) implantation, in which extensive hyperplasia of the media and adventitia of the arteries is evident, along with mononuclear inflammatory cell infiltrates. (B) Lung specimen taken before the CFRVAD implant shows no pathologic morphology or inflammatory cell infiltrates. (C) Kidney specimen taken at autopsy after CFRVAD implantation from the same animal shows no pathologic morphology or inflammatory cell infiltrates. (Bars = 500 μm.) The Annals of Thoracic Surgery 2013 96, 148-154DOI: (10.1016/j.athoracsur.2013.04.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Immunohistochemical staining for angiotensin II type 1 receptor, which was observed at autopsy in inflammatory cells that had infiltrated the periarterial areas of all animals (stained brown) (Left) Original magnification ×200; (Right) original magnification ×400; (Bottom), original magnification ×600, with macrophages indicated by red arrows, monocytes by solid blue arrows, and neutrophils by dashed black arrows. The Annals of Thoracic Surgery 2013 96, 148-154DOI: (10.1016/j.athoracsur.2013.04.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Numbers of (A) inflammatory cells and (B) cells positive for angiotensin II type 1 receptor (AT1R). The average number of inflammatory cells in periarterial areas was significantly higher at autopsy than before (Pre) continuous-flow right ventricular assist device implantation. The error bars show the standard deviation. *p < 0.01 vs Pre. The Annals of Thoracic Surgery 2013 96, 148-154DOI: (10.1016/j.athoracsur.2013.04.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Levels of angiotensin-converting enzyme (ACE) are shown in (A) serum and (B) tissue. The error bars show the standard deviation. The Annals of Thoracic Surgery 2013 96, 148-154DOI: (10.1016/j.athoracsur.2013.04.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions