Observation of alveolar fibrosis in a goat following venoarterial bypass for up to 5 months using extracorporeal membrane oxygenation.
Prolonged cardiopulmonary bypass such as venoarterial bypass with extracorporeal membrane oxygenation (VA-ECMO) is becoming a potent therapeutic option in treating patients with severe respiratory and circulatory failure. However the chronic effects of this bypass modality have not yet been fully clarified. Recently, we developed an extremely durable thrombo-resistant ECMO system, and were successful with more than 5 months of continuous heparinless VA-ECMO in an animal experiment. This article presents the pathological findings on the lungs of the animal.A goat underwent VA-ECMO for a scheduled period of 151 days. This animal demonstrated a good general condition during the course of the experiment. On autopsy, however, the lungs of the animal showed severe alveolar fibrosis with topical atelectasis. von Willebrand factor levels on the endothelial cells in the alveolar capillaries were increased compared with those of normal goats. The ultrastructure of these cells showed ischemia-induced endothelial swelling. The pathological findings indicated that the vascular endothelial phenotypes had changed from respiratory type to nutrient type. The results of this study indicated that prolonged VA-ECMO may cause pulmonary alveolar fibrosis as a result of ischemia of the lungs accompanying reduced pulmonary blood flow.
Department of Artificial Organs, National Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. toshi@ri.ncvc.go.jp
Toshihide
T
Mizuno
Eisuke
E
Tatsumi
Tomohiro
T
Nishinaka
Nobumasa
N
Katagiri
Mitsuo
M
Ohikawa
Hiroshi
H
Naito
Yukitoshi
Y
Shirakawa
Tomonori
T
Tsukiya
Akihiko
A
Homma
Yoshinori
Y
Takewa
Hisateru
H
Takano
Soichiro
S
Kitamura
Yoshiyuki
Y
Taenaka
D000818:Animals; D001707:Biopsy, Needle; D002315:Cardiopulmonary Bypass / Q000379:methods; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D006041:Goats; D007150:Immunohistochemistry; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000473:pathology*; D012131:Respiratory Insufficiency / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors