Vascular Histopathologic Reaction to Pulmonary Artery Banding in an In Vivo Growing Porcine Model
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ORIGINAL ARTICLE
Vascular Histopathologic Reaction to Pulmonary Artery Banding in an In Vivo Growing Porcine Model Luka´sˇ Nedorost • Hideki Uemura • Anke Furck Imran Saeed • Zdenek Slavik • Jirˇ´ı Kobr • Zbyneˇk Tonar
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Received: 21 December 2012 / Accepted: 29 March 2013 Ó Springer Science+Business Media New York 2013
Abstract Pulmonary artery banding (PAB) is used as a surgical palliation to reduce excessive pulmonary blood flow caused by congenital heart defects. Due to the lack of microscopic studies dealing with the tissue remodeling caused by contemporary PAB materials, this study aimed to assess histologic changes associated with PAB surgery by analyzing local tissue reaction to the presence of GoreTex strips fixed around the pulmonary artery. Gore-Tex strips were used for PAB in a growing porcine model. After 5 weeks, histologic samples with PAB (n = 5) were compared with healthy pulmonary arterial segments distal to the PAB or from a sham-treated animal (n = 1). Stereology was used to quantify the density of the vasa vasorum and the area fraction of elastin, smooth muscle actin, macrophages, and nervi vasorum within the pulmonary arterial wall. The null hypothesis stated that samples did not differ histopathologically from adjacent vascular segments or sham-treated samples. The PAB samples had a greater area fraction of macrophages, a lower amount of L. Nedorost Z. Tonar (&) Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University in Prague, Karlovarska 48, Pilsen 301 66, Czech Republic e-mail: [email protected] H. Uemura A. Furck I. Saeed Z. Slavik Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK Z. Slavik J. Kobr Department of Paediatrics, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Alej Svobody 80, Pilsen 304 60, Czech Republic Z. Tonar Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Husova 3, Pilsen 306 05, Czech Republic
nervi vasorum, and a tendency toward decreased smooth muscle content compared with samples that had no PAB strips. There was no destruction of elastic membranes, no medionecrosis, no pronounced inflammatory infiltration or foreign body reaction, and no vasa vasorum deficiency after the PAB. All the histopathologic changes were limited to the banded vascular segment and did not affect distal parts of the pulmonary artery. The study results show the tissue reaction of palliative PAB and suggest that Gore-Tex strips used contemporarily for PAB do not cause severe local histologic damage to the banded segment of the pulmonary arterial wall after 5 weeks in a porcine PAB model. Keywords Heart defects Nervi vasorum Pulmonary artery banding Smooth muscle Stereology Vasa vasorum
Pulmonary artery banding (PAB) has been used in the surgical palliation of various congenital heart defects in the pediatric population for almost 60 years [21]. Its concept and hemodynamic benefit still remain the same: reduction o
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