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終末肺動脈 撮影術에(Wedge Pulmonary Arteriography)에 關한 硏究

Study on Wedge Pulmonary Arteriography

중앙의학 1964년 7권 5호 p.603 ~ 616
정준,
소속 상세정보
정준 (  ) - 서울대학교 의과대학 외과학교실

Abstract


The importance of the pulmonary vasculature in regulating the plumonary circulation tion and, therefore, in determining the clinical course and operability of patients with . congenital heart defects has been emphasized for a number of years.
These intimal lesions produce abrupt narrowing of occlusion of the pulmonary arteries and particularly of the small arteries and arterioles.
At present these fibrous intimal occlusive changes are believed to represent a fixed and irreversible pathologic lesions.
It is the smaller pulmonary artery and arterioles that are involved and clinically applicable methods of visualizing the smaller branches of pulmonary arterial tree should prove usefulness in the study of occurence, pathogenessis and differentiation of these lesion and in the selection of candidates for repair of the associated cardiac defect.
At present pulmonary arterial lesions are confirmed by lung biopsy.
Lung biopsy affords a direct method for assessment of the vascular lesion, but, because of the focal nature of the intimal lesion, in some instances the specimen . studied does not reflect the over-all condition of the vascular bed unless serial slides are examined.
Wedge pulmonary arteriography (W.P.A), a clinical method for visualizing the small pulmonary arteries radiographically, has been applied in 40 patients with cardiac diseases of congenital or acquired orgin to evaluate pulmonary vascular bed in the period from Jan. 1960 to Sep. 1964 in this department.
The usefulness of the W.P.A. in the selection of patients with cardiac lesions for surgical repair and hemodynamic relationship, especially histopathological relationship constitutes of this report.
The results can be summarized as fallows;
① W.P.A correlates well with the histopathological picture of the pulmonary vasulature
a) Normal W.P.A has abundunt arborization of small arteries, with filling of small arterioles and capillaries producing distinctive back ground markings.
b) When medial hypertrophy of the muscular arteries is present without intimal changes, the W.P.A shows reduced caliber of the arteries and less severe reduction of the arborization pattern and capillary filling.
c) When occulusive intimal lesions are present, the W.P.A appearance is distinctive, characterized by reduced arborization and abrupt termination of some arter-. ies while others narrow to tortuous channels. (The normal pattern of arteriolar and capillary filling is absent.)
② W.P.A. are not correlated with E. C. G., pulmonary arterial pressure pulmonary wedge pressure and clinical classification.
③ Pulmonary arterial pressure are not correlated with histopathological findings.
In this study, the wedge pulmonary arteriogram has provided an accurate clinical method for determing the type of the pathologic changes present in the pulmonary vascular bed preoperatively.
The W.P.A is useful in the selection of patients with cardiac lesions for surgical repair.

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