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Kazunobu Nishimura
Tadashi Ikeda
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J Thorac Cardiovasc Surg 2004;127:1450-1457
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Hypoxic pulmonary vasoconstriction disappears in a rabbit model of cavopulmonary shunt

Akio Ikai, MDa, Mikiyasu Shirai, MD, PhDb, Kazunobu Nishimura, MD, PhDa, Tadashi Ikeda, MD, PhDa, Takayuki Kameyama, MDa, Koji Ueyama, MDa, Masashi Komeda, MD, PhDa,*

a Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
b Department of Cardiac Physiology, National Cardiovascular Center Research Institute, Osaka, Japan

Received for publication March 2, 2003; revisions received April 11, 2003; revisions received June 13, 2003; accepted for publication July 7, 2003.

* Address for reprints: Masashi Komeda, MD, PhD, Kyoto University, Graduate School of Medicine, Department of Cardiovascular Surgery, 54 Shogoinkawahara-cho Sakyo-ku, Kyoto, Japan, 606-8507
masakom{at}kuhp.kyoto-u.ac.jp

BACKGROUND: Cavopulmonary shunt is widely known as an interim staging procedure in patients with single-ventricle physiology. However, the physiologic characteristics of the pulmonary arterial system after cavopulmonary shunt are not clearly understood. In this article, we developed a rabbit cavopulmonary shunt model and studied the morphologic changes and physiologic characteristics (namely, hypoxic pulmonary vasoconstriction) of pulmonary arteries after cavopulmonary shunt.

METHODS: Male Japanese white rabbits aged 12 to 16 weeks were used for the study. In 5 rabbits, the superior vena cava was anastomosed to the right pulmonary artery in an end-to-side fashion, followed by a proximal side ligation of the right pulmonary artery (cavopulmonary shunt group). In 4 rabbits, the superior vena cava and the right pulmonary artery were dissected and clamped for 10 minutes without making a cavopulmonary shunt (sham group). Two weeks after the operation, we then measured the internal diameter of the acinar (internal diameter, 164 ± 7 µm), the lobular (305 ± 13 µm), and the segmental (669 ± 16 µm) pulmonary arteries in both controlled and hypoxic conditions by using a specially designed x-ray television system. Also, morphometric measurements were made in the pulmonary arteries around the terminal bronchioles.

RESULTS: Two weeks after the operation, the arterial oxygen tension under room air conditions was significantly lower in the cavopulmonary shunt group than in the sham group (68.2 ± 2.2 mm Hg vs 91.1 ± 1.9 mm Hg; P = .01). The baseline internal diameters in the acinar and the lobular (resistance), but not the segmental (conduit), pulmonary arteries on the anastomosed side of the cavopulmonary shunt group were significantly larger than those of pulmonary arteries on the nonanastomosed side of the cavopulmonary shunt group and the sham group. Moreover, the pulmonary arteries on the anastomosed side of the cavopulmonary shunt group did not respond to hypoxia, whereas those on the nonanastomosed side of the cavopulmonary shunt and sham groups did have local internal diameter reductions in the acinar and lobular arteries (–1.1% ± 1.0% in the anastomosed side vs –17.7% ± 3.5% in the nonanastomosed side vs –20.9% ± 6.1% in the sham group; P = .03). In the morphometric studies, the internal diameter of the pulmonary artery accompanying the terminal bronchiole in the anastomosed side of the cavopulmonary shunt group was significantly larger, and the ratio of medial thickness relative to the outer diameter was smaller compared with ratios in the nonanastomosed side of the cavopulmonary shunt group and the sham group.

CONCLUSIONS: We developed a rabbit cavopulmonary shunt model. In the anastomosed side of the cavopulmonary shunt group, the peripheral pulmonary arteries, which contributed greatly in regulating the pulmonary vascular resistance, had a local reduction in the basal vascular tone and no hypoxic vasoconstriction 2 weeks after the operation.




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