Leading Researcher; Chuvash State University named after I.N. Ulyanov, 15 Moskovsky Prospect, Cheboksary, Chuvash Republic, 428015, Russia.
Researcher; Chuvash State University named after I.N. Ulyanov, 15 Moskovsky Prospect, Cheboksary, Chuvash Republic, 428015, Russia.
Sovrem Tekhnologii Med. 2021;13(6):56-62. doi: 10.17691/stm2021.13.6.06. Epub 2021 Dec 28.
was to perform a histological assessment of the effectiveness of radiofrequency exposure for circular denervation of the pulmonary artery in patients with secondary high pulmonary hypertension.
The study was carried out on the autopsy material derived from non-operated patients. Three groups were formed. The experimental group included the material (207 histological samples) from the patients with chronic high pulmonary hypertension arising on the background of mitral heart disease. The samples of this group were exposed to circular radiofrequency ablation. In the comparison group, we used autopsy material (24 samples) obtained from the patients with high pulmonary hypertension. The control group included material (35 samples) from the patients without pulmonary hypertension who died from causes not associated with cardiovascular diseases. The samples of the comparison and control groups were not exposed to radiofrequency.Visual evaluation of the damage to the vascular wall was performed after hematoxylin and eosin staining, according to Van Gieson. Damage to the nerve plexuses was evaluated after their impregnation by silver salts. To assess the degree of damage to the vascular wall on the stained sections, a scoring method of semi-quantitative analysis of the observed pathological processes (fibrinoid necrosis, metachromasia, karyorrhexis, karyolysis, fibrinoid and mucoid swelling, lipid presence) was used. Silver salt impregnation allowed visualizing damage to the reticular fibers, trunks and endings of peripheral nerve fibers.
The mean optical density of the ablation group was statistically significantly lower than in the comparison and control groups (p<0.001). The mean specific area of tissue dissociation was higher in the "marginal zones" of the ablated sections, under pronounced mechanical compression in these areas. The difference in the mean areas of the argentophilic samples of the ablation and comparison and control groups was expressed in a lower percentage of argentophilic fibrous structures (p<0.05). At the same time, the highest concentration of argentophilic structures was observed in the comparison group, which points to a bigger content of nerve fiber structures in the patients with high pulmonary hypertension.
The results of the histological study demonstrated the feasibility of radiofrequency ablation of the pulmonary arteries in patients with high-grade secondary pulmonary hypertension. Radiofrequency denervation leads to the destruction of the sympathetic ganglia in the adventitial layer of the pulmonary arteries, which are responsible for the spasm of the precapillary bed of the pulmonary circulation, which promotes vasodilation, an increase in the vascular bed, and, as a result, a reduction in pulmonary hypertension.
评估射频消融在继发性肺动脉高压患者肺动脉环向去神经支配中的有效性。
该研究基于非手术患者的尸检材料。共分为三组：实验组为慢性重度肺动脉高压患者的材料（207 个组织样本），这些患者的肺动脉高压是由二尖瓣心脏病引起的。实验组的样本接受了环向射频消融。对照组为肺动脉高压患者的尸检材料（24 个样本）。空白对照组为无肺动脉高压患者的材料（35 个样本），这些患者死于非心血管疾病。比较组和空白对照组的样本均未接受射频消融。样本经过苏木精-伊红染色后，采用 Van Gieson 法进行血管壁损伤的直观评估；银盐染色后评估神经丛的损伤。为了评估染色切片上血管壁损伤的程度，采用半定量分析观察到的病理过程（纤维蛋白样坏死、变色、核碎裂、核溶解、纤维蛋白样和黏液样肿胀、脂质存在）的评分方法。银盐浸渍使网状纤维、神经纤维干和末梢可见。
实验组的平均光密度明显低于比较组和空白对照组（p<0.001）。在消融部位的“边缘区”，由于这些区域明显受到机械压迫，组织分离的平均特定区域较高。在消融和比较组及空白对照组的银染样本的平均区域方面，其差异表现为银染纤维结构的百分比较低（p<0.05）。同时，比较组中观察到银染结构的浓度最高，这表明在患有重度肺动脉高压的患者中，神经纤维结构的含量较大。
组织学研究的结果表明，在患有重度继发性肺动脉高压的患者中进行射频消融肺动脉是可行的。射频去神经支配导致肺动脉外膜层的交感神经节破坏，这有助于前毛细血管床的血管痉挛，促进血管扩张、血管床增加，从而降低肺动脉高压。
