Radiofrequency Denervation of Pulmonary Artery in Surgery of Dysplastic Mitral Valve Defects With Severe Pulmonary Hypertension

Железнев, С. И.; Демидов, Д. П.; Афанасьев, А. В.; Назаров, В. М.; Демин, И. И.; Богачев-Прокофьев, А. В.; Астапов, Д. А.; Караськов, А. М.

doi:10.15829/1560-4071-2016-11-70-72

Cited by 12 publications

(5 citation statements)

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“…Основными осложнениями пороков митрального клапана являются появление ФП, нарастание вторичной легочной гипертензии (ЛГ), дилатация полостей сердца, появление коморбидной патологии [14,15]. Нарастание вторичной ЛГ на фоне прогрессирования митрального порока способствует перегрузке правых отделов сердца, появлению относительной недостаточности трикуспидального клапана и, как следствие, неблагоприятному прогнозу заболевания, снижению качества жизни данной категории больных и преждевременной смерти [16].…”

Section: автор для перепискиunclassified

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

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Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

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Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

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“…В 2016г Железнев С. И., и др. (2016) представили сравнительный анализ результатов лечения пациентов с высокой ЛГ на фоне диспластических пороков митрального клапана (МК) без и с использованием РЧА ЛА [18]. В группе РЧА коррекция порока митрального клапана происходила после эпикардиальной аблации ЛС с использованием многофункционального радиочастотного электрода (AtriCure® Inc., West Chester, OH, США).…”

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Pulmonary artery denervation in patients with pulmonary hypertension: present state and clinical experience

et al. 2019

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Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

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“…The increased activity of sympathetic nerve system is one of the universal mechanisms participating in the pulmonary hypertension pathogenesis [11,12]. According to the experimental data, when the arterial pressure in PA increases and its opening closes completely, the resistance and pulmonary pressure spike [13,14,15].…”

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confidence: 99%

IMMUNOHISTOCHEMICAL CRITERIA OF PULMONARY ARTERY CIRCULAR DENERVATION EFFICIENCY IN EXPERIMENT (animals, pigs)

2022

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Research objective. Evaluation of the influence of various modes of radiofrequency circular exposure on immunohistochemical parameters of pulmonary trunk tissues in the experiment on animals (pigs).Materials and methods. The experiments were made on outbred pigs -12 animals. During the experiment 3 groups were formed, 4 animals in each. The first experimental group comprised 188 histological samples of pulmonary artery (PA) after circular radiofrequency exposure on PA using an ablator clamp. Two lines of ablation impact on the pulmonary trunk and two lines of impact on each mouth of PA were performed with the formation of 6 ablation lines. The ablation was performed until the target level of tissue impedance between the ablator jaws corresponding to the values for transmural damage was reached. The second experimental group comprised 162 histological samples of PA after circular denervation of the pulmonary trunk and mouths of both PAs according to the described method. The ablation was completed upon reaching 50% of the impedance level relative to the impedance values for transmural damage. The third groupcontrol, without circular radiofrequency exposure (55 histological samples). The obtained material was studied by light microscopy, typical general pathological processes were recorded with the help of staining with hematoxylin and eosin. The changes in the connective tissue (fibrous, muscle) were found with the help of Van Gieson staining. The thermoablative effect degree was assessed using semi-quantitative analysis of pathological processes (Olpred stain intensity assessment). In order to assess the degree of impact on the nerve fibers of different layers of PA, an immunohistochemical study (IHC) of the samples was carried out in all three groups. The expression of S-100 protein and synaptophysin was evaluated.Conclusion. Average optic density of the samples of the ablation groups was significantly lower than in the control group (p <0.001). When calculating the specific area of the connective tissue disconnection, its greater value was determined in "the edge zones" of the sections in both experimental groups, which is due to mechanical compression of tissues, compaction of their structure and, as a result, an increase in capacitive characteristics as a current collector and conductor for radio frequency rate ( p = 0.056). IHC analysis of preparations made it possible to qualitatively assess the damage to the trunks and endings of peripheral nerve fibers in the adventitial and intimal layers of PA section after radiofrequency exposure in the experimental groups.In the first experimental group the active expression of synaptophysin and protein S-100 of sympathetic nerve fibers was absent in the adventitial and, as a rule, in the intimal layers. In the preparations obtained from PA of animals of the second experimental group, the activity of synaptophysin in synaptic fibers and expression of protein S-100 of endothelium vasa vasorum were also not determined in the adventitial layer. At the same time, the posi...

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Radiofrequency Denervation of Pulmonary Artery in Surgery of Dysplastic Mitral Valve Defects With Severe Pulmonary Hypertension

Cited by 12 publications

References 3 publications

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Pulmonary artery denervation in patients with pulmonary hypertension: present state and clinical experience

IMMUNOHISTOCHEMICAL CRITERIA OF PULMONARY ARTERY CIRCULAR DENERVATION EFFICIENCY IN EXPERIMENT (animals, pigs)

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