Ishii M, Kato H, Kawano T, Akagi T, Maeno Y, Sugimura T, Hashino K, Takagishi T
Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
J Am Coll Cardiol. 1995 Jul;26(1):272-6. doi: 10.1016/0735-1097(95)00154-r.
This study aimed to 1) compare in vitro intravascular ultrasound images of human pulmonary arteries with corresponding histologic sections, and 2) correlate the relation between intravascular ultrasound findings and Heath-Edwards pathologic grade of pulmonary vascular changes.
The pathologic assessment of the pulmonary vascular bed is essential for diagnosis and management of congenital heart disease with pulmonary hypertension.
We evaluated and compared intravascular ultrasound images with histologic findings at identical sites in 40 pulmonary artery segments from 17 autopsy studies: group 1 = 7 patients with pulmonary hypertension (Heath-Edwards grade I to V, 20 segments); group 2 = 10 patients without cardiopulmonary disease (20 segments).
In group 2, the pulmonary artery wall echo consisted of a single layer. In group 1, 1) all segments of pulmonary arteries from patients with pulmonary hypertension showed a three-layered appearance; 2) in patients with mild pulmonary hypertension (Heath-Edwards grades I and II), intravascular ultrasound demonstrated increased thickness of the echoluscent zone due to medial hypertrophy with no intimal reaction; 3) patients with severe pulmonary hypertension (Health-Edwards grade III or higher) had intravascular ultrasound findings of increased medial thickness and a bright inner layer from intimal hyperplasia; 4) percent wall thickness derived from intravascular ultrasound showed a significant correlation with that determined by histologic examination (r = 0.89, p = 0.0001, n = 20).
Changes observed with intravascular ultrasound imaging correlate well with histopathologic grade. Thus, intravascular ultrasound may have significant utility in the evaluation of pulmonary vascular morphology in patients with pulmonary hypertension.
本研究旨在1）比较人类肺动脉的体外血管内超声图像与相应的组织学切片，以及2）关联血管内超声检查结果与肺动脉血管病变的希思 - 爱德华兹病理分级之间的关系。
肺血管床的病理评估对于先天性心脏病合并肺动脉高压的诊断和管理至关重要。
我们在17例尸检研究的40个肺动脉节段的相同部位评估并比较了血管内超声图像与组织学结果：第1组 = 7例肺动脉高压患者（希思 - 爱德华兹分级I至V，20个节段）；第2组 = 10例无心肺疾病患者（20个节段）。
在第2组中，肺动脉壁回声由单层组成。在第1组中，1）肺动脉高压患者的所有肺动脉节段均呈现三层外观；2）轻度肺动脉高压患者（希思 - 爱德华兹分级I和II），血管内超声显示由于中层肥厚导致的无内膜反应的回声增强区厚度增加；3）重度肺动脉高压患者（希思 - 爱德华兹分级III或更高）的血管内超声表现为中层厚度增加和内膜增生导致的明亮内层；4）血管内超声得出的管壁厚度百分比与组织学检查确定的结果显著相关（r = 0.89，p = 0.0001，n = 20）。
血管内超声成像观察到的变化与组织病理学分级密切相关。因此，血管内超声在评估肺动脉高压患者的肺血管形态方面可能具有重要作用。
