title: Fibrin structure in organized thrombotic material removed during pulmonary artery endarterectormy: the effect of vessel calibre.
abstract: Pulmonary endarterectomy (PEA) is a curative therapeutic approach in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The location-dependent structural differences of thrombotic material found in pulmonary arteries in CTEPH are poorly investigated. We present the case of a 47-year-old woman with antiphospholipid syndrome, diabetes mellitus and abnormal fibrin phenotype, who underwent PEA for CTEPH. Intravascular material removed bilaterally during PEA (from lobar, segmental and sub-segmental arteries) has been studied using light and scanning electron microscopy (SEM). Light microscopy showed tighter fibrous network in the portions of intraluminal thrombotic material facing the vessel wall, which contained collagen and fibrin fibers, and abundant cells. Cells, evaluated by immunostaining, were present in the whole removed material. Tissue factor expression was also observed with the highest values in the portions of intravascular material facing the vessel wall. In the main pulmonary arteries, SEM images revealed thick fibers of fibrous proteins loosly meshed and few erythrocytes and platelets between them (both dysmorphic "wedged" and fresh cells were present). In the fibrotic layers, containing mainly collagen and fibrin, removed from the lobar/segmental pulmonary arteries we found a stepwise increase in fiber density with decreasing vessel calibre, followed by denser fibrous networks composed of thinner fibers. Elastic fibers in the lobar and segmental arteries were aligned along the blood flow vector. These findings demonstrate differences in the structure of endarterectomized PEA material dependent on the vessel calibre and might contribute to understanding of CTEPH pathophysiology.
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. piotr.k.mazur@gmail.com.|The John Paul II Hospital, Kraków, Poland. piotr.k.mazur@gmail.com.
authors.forename: Piotr
authors.initials: P
authors.lastname: Mazur
authors.affiliation: The John Paul II Hospital, Kraków, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Gawęda
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Natorska
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Ząbczyk
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Kopeć
authors.affiliation: The John Paul II Hospital, Kraków, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Waligóra
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.|The John Paul II Hospital, Kraków, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Kapelak
mesh_terms: D001773:Blood Cells; D003094:Collagen; D004547:Elastic Tissue; D004691:Endarterectomy; D005260:Female; D005337:Fibrin / Q000648:ultrastructure*; D006801:Humans; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D013927:Thrombosis / Q000473:pathology*
chemical_list: D005337:Fibrin; D003094:Collagen
keywords: Chronic thromboembolic pulmonary hypertension; Fibrin; Pulmonary arteries; Thrombus architecture