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Comparative Study
. 2013 Jul;96(1):148-54.
doi: 10.1016/j.athoracsur.2013.04.008. Epub 2013 May 31.

Periarteritis in lung from a continuous-flow right ventricular assist device: role of the local Renin-Angiotensin system

Chiyo Ootaki  1 , Michifumi Yamashita, Yoshio Ootaki, Diyar Saeed, Tetsuya Horai, Hideyuki Fumoto, Alex L Massiello, Steven N Emancipator, Leonard A R Golding, Kiyotaka Fukamachi
Affiliations
Comparative Study

Periarteritis in lung from a continuous-flow right ventricular assist device: role of the local Renin-Angiotensin system

Chiyo Ootaki et al. Ann Thorac Surg. 2013 Jul.

Abstract

Background: We previously reported renal arterial periarteritis after implantation of a continuous-flow left ventricular assist device in calves. The purpose of the present study was to investigate whether the same periarteritis changes occur in the intrapulmonary arteries after implantation of a continuous-flow right ventricular assist device (CFRVAD) in calves and to determine the mechanism of those histologic changes.

Methods: Ten calves were implanted with a CFRVAD for 29 ± 7 days, and we compared pulmonary artery samples and hemodynamic data before and after CFRVAD implantation prospectively.

Results: After implantation, the pulsatility index (pulmonary arterial pulse pressure/pulmonary arterial mean pressure) significantly decreased (0.88 ± 0.40 before vs 0.51 ± 0.22 after; p < 0.05), with severe periarteritis of the intrapulmonary arteries in all animals. Periarterial pathology included hyperplasia and inflammatory cell infiltration. The number of inflammatory cells positive for the angiotensin II type 1 receptor was significantly higher after implantation (7.8 ± 6.5 pre-CFRVAD vs 313.2 ± 145.2 at autopsy; p < 0.01). Serum angiotensin-converting enzyme activity significantly decreased after implantation from 100% to 49.7 ± 17.7% at week 1 (p = 0.01). Tissue levels of angiotensin-converting enzyme also demonstrated a significant reduction (0.381 ± 0.232 before implantation vs 0.123 ± 0.096 at autopsy; p = 0.043).

Conclusions: Periarteritis occurred in the intrapulmonary arteries of calves after CFRVAD implantation. The local renin-angiotensin system (not the angiotensin-converting enzyme pathway) plays an important role in such changes.

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Figures

Fig. 1
Fig. 1. Hematoxylin-eosin (HE) staining of the lung and kidney (magnification x50)
(A) Lung specimen obtained at autopsy after CFRVAD implantation, in which extensive hyperplasia of the media and adventitia of the arteries is evident, along with mononuclear inflammatory cell infiltrates. (B) Lung specimen taken prior to CFRVAD implant shows no pathologic morphology or inflammatory cell infiltrates. (C) Kidney specimen taken at autopsy after CFRVAD implantation from the same animal shows no pathologic morphology or inflammatory cell infiltrates.
Fig. 2
Fig. 2. Immunohistochemical staining for angiotensin II type 1 receptor (AT1R)
AT1R was observed at autopsy in inflammatory cells that had infiltrated the periarterial areas of all animals (stained brown; magnification x200 and x400).
Fig. 3
Fig. 3. Numbers of inflammatory cells and AT1R positive cells
The average number of inflammatory cells in periarterial areas was significantly higher at autopsy than pre-CFRVAD. *p < 0.01 vs. Pre.
Fig. 4
Fig. 4
Serum ACE and tissue ACE levels.
See this image and copyright information in PMC

References

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