Wagenvoort C A, Wagenvoort N, Draulans-Noë Y
J Thorac Cardiovasc Surg. 1984 Jun;87(6):876-86.
In 28 patients with congenital heart disease with a shunt and pulmonary hypertension, lung biopsy specimens were taken during a banding procedure of the pulmonary artery; then, in the same patients, lung tissue became available during correction of the cardiac defect some years later. In this way the regression of pulmonary vascular changes could be studied. Medial hypertrophy appeared to have a prominent tendency to regression. With intimal lesions, regression depended to a large extent on the type of lesion. Intimal thickening based on longitudinal smooth muscle tissue was almost completely reversible. Post-thrombotic intimal fibrosis was also potentially reversible. In plexogenic pulmonary arteriopathy, the earlier lesions, particularly cellular intimal proliferation, showed regression. Concentric-laminar intimal fibrosis regressed as long as it was mild, that is, occluding less than one fifth of the average arterial lumen. If more severe, there was no tendency to regression and often it even progressed. Changes like fibrinoid necrosis and plexiform lesions are ominous because of their tendency to progression. Since preoperative open lung biopsies now are often undertaken for evaluation of hypertensive pulmonary vascular disease, when corrective operability is dubious, these findings may serve as a guide in reporting on such biopsy specimens.
在28例患有先天性心脏病且伴有分流和肺动脉高压的患者中，在肺动脉束带手术过程中获取肺活检标本；然后，几年后在同一批患者进行心脏缺陷矫正时又获得了肺组织。通过这种方式，可以研究肺血管变化的消退情况。中层肥厚似乎有明显的消退倾向。对于内膜病变，消退在很大程度上取决于病变类型。基于纵向平滑肌组织的内膜增厚几乎完全可逆。血栓形成后的内膜纤维化也有潜在的可逆性。在致丛性肺动脉病中，早期病变，特别是细胞性内膜增生，显示出消退。只要同心层状内膜纤维化较轻，即阻塞平均动脉管腔不到五分之一，就会消退。如果更严重，则没有消退倾向，甚至常常会进展。像纤维素样坏死和丛状病变这样的变化因其进展倾向而预后不良。由于现在术前常进行开放性肺活检以评估高血压性肺血管疾病，当矫正手术的可行性存疑时，这些发现可作为报告此类活检标本的指导。
