1. New Approaches To Pulmonary Arteryial Hypertension--PADN 陈绍良 周 陵 南京市第一医院

2. Current medications 1/6/2016

3. Direct evidences of sympathetic nerves in PAH 1/6/2016 First description of PA denervation

4. Study design 1/6/2016

5. Surgical denervation on PAP 1/6/2016

6. Effect of 6-OHDA on PAP 1/6/2016

7. Evidence of sympathetic nerves in PAH anterior lateral posterior

8. Electron microscope HT staining

9. Experimental studies Acute study: 20 Mongolia dogs Group 1 IA occlusion During 10-minute occlusion: Hemodynamics measurement was performed at each minute Chen SL, et al, Eurointervention March 2013 Group 2 BT occlusion

10. Segments of left pulmonary artery IA BT Reprint with permission from Virginia university Chen SL, et al. Eurointervention,March 2013 Occlusion a t BT Occlusion a t IA

11. Group 1: interlobar occlusion Group 2: basal occlusion Before PADN Chen SL, et al. Eurointervention, March 2013

12. Experimental studies Acute study: 20 Mongolia dogs During 10-minute occlusion: Hemodynamics measurement was performed at each minute Chen SL, et al, Eurointervention March 2013 Group 3 PADN at level1-3, Group 4 PADN at level 4,5 IA occlusion

13. PADN levels Level 1 2 3 4 5 Level 1:distal MP Level 2: ostial LPA Level 3: ostial RPA Level 4: 5mm distal to os tial LPA Level 5: 5 mm distal to o stial RPA Chen SL, et al. Eurointervention, March 2013 Chen SL, et al. JACC September 2013

14. Group 3:PADN at level 1-3 Group 4:PADN at level 4,5 distal MPA, ostial LPA and RPA 5mm distal to ostial RPA or LPA Chen SL, et al. Eurointervention, March 2013 During IA occlusion

15. First-In-Man: PADN-1 study 22 patients unresponsive to medication between March and May 2012 1 patient excluded: (+) adenosine test 21 patients Control group(N=8) PADN group(N=13) Clinical follow-up at 3-month in all patients Hemodynamic measurements: post, 24h,1w,3-m 8 ptients refused PADN Chen SL,et al. JACC September 2013

16. PADN system

17. Baseline characteristics of all patients 1/6/2016

18. Hemodynamic Measurements by RHC 1/6/2016

19. Assessment of Functional Capacity 1/6/2016

20. Final results ◇ Reduction of mean PAP >15% ◇ PVR/NT-BNP ↓ ◇ 6MWD ↑ by 100 m ◇ Less rehospitalization/death

21. Before PADN: PAPs=91 mmHg PAPm=52 mmHg 10-month after PADN: PAPs=79 mmHg PAPm=41 mmHg

22. Baseline:PAPm=42mmHg Post-PADN:PAPm=30.48mmHg 10-month:PAPm=31.33mmHg

23. Study on PAH-model Dehydromonocrotaline ， 3mg/kg After 8 weeks –RHC confirmed PAH: mPAP ≥25mmHg PADN at level 1 6 weeks after PADN –Repeat RHC –Pathologic study –Gene-molecular study –Conduction velocity 1/6/2016

24. PAH after PADN 1/6/2016

25. In conclusionIn conclusion *PADN has been testified in animal model PADN-I, a FIM study, showed the potential of P ADN for IPAH PH patients with varying etiologies of PAH Further RCTs are required In conclusion

26. Thanks for your attention!