Wagenvoort C A
Histopathology. 1985 Apr;9(4):417-36. doi: 10.1111/j.1365-2559.1985.tb02825.x.
For evaluation of pulmonary vascular disease 140 open lung biopsies were performed in 137 patients with congenital heart disease in order to decide whether the state of the lung vessels would allow corrective surgery. As far as possible follow-up was obtained in patients who underwent a cardiac repair. From the study of these biopsy specimens it appeared that medial hypertrophy of pulmonary arteries and changes in pulmonary veins should not be considered an impediment for a corrective operation as long as more advanced changes are absent. The same is true for intimal thickening due to longitudinal smooth muscle, post-thrombotic changes or cellular proliferation. Concentric-laminar intimal fibrosis forms no contra-indication as long as it is mild but, if severe, it is likely that hypertensive pulmonary vascular disease will progress in spite of cardiac repair. In the presence of fibrinoid necrosis or plexiform lesions correction of a cardiac anomaly should not be attempted. The presence of dilatation lesions is more disputable but probably, as long as they are scarce and not accompanied by fibrinoid necrosis or plexiform lesions, corrective surgery may be attempted. This becomes very dubious when they are more numerous.
为评估肺血管疾病，对137例先天性心脏病患者进行了140次开胸肺活检，以确定肺血管状况是否允许进行矫正手术。对接受心脏修复手术的患者尽可能进行随访。通过对这些活检标本的研究发现，只要不存在更严重的变化，肺动脉中层肥厚和肺静脉改变不应被视为矫正手术的障碍。因纵向平滑肌、血栓形成后改变或细胞增殖导致的内膜增厚情况同样如此。同心层状内膜纤维化只要程度较轻就不构成禁忌，但如果严重，尽管进行了心脏修复，高血压性肺血管疾病仍可能进展。存在纤维蛋白样坏死或丛状病变时，不应尝试矫正心脏畸形。扩张性病变的情况更具争议性，但只要数量稀少且不伴有纤维蛋白样坏死或丛状病变，可能可以尝试进行矫正手术。当扩张性病变较多时，这就很值得怀疑了。
