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Galambos C, Bush D, Abman SH, Caplan M. Prominent Intrapulmonary Shunt Vessels and Altered Lung Development in Infants With Sudden Unexplained Infant Death. J Pediatr 2023; 255:214-219.e1. [PMID: 36336004 DOI: 10.1016/j.jpeds.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to evaluate intrapulmonary arteriovenous shunts in patients with and without sudden unexplained infant death. We identified open intrapulmonary bronchopulmonary anastomoses as potential pathways for right-to-left shunt in a subset of infants with sudden unexplained infant death.
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Affiliation(s)
- Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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González-Ruiz FJ, Lazcano-Díaz EA, Baeza Herrera LA, Villalobos-Pedroza M, Toledo Alemán EL, Zuñiga-Salcedo MG, Cruz-Rodríguez C, López-Polanco A, Torres-Pulido A, Sierra-González de Cossio A, Cota Apodaca LA, Manzur-Sandoval D. Endotheliitis, Shunts, and Ventilation-Perfusion Mismatch in Coronavirus Disease 2019: A Literature Review of Disease Mechanisms. Ann Med Surg (Lond) 2022; 78:103820. [PMID: 35600188 PMCID: PMC9112604 DOI: 10.1016/j.amsu.2022.103820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 10/27/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has continued to impact global health. However, while immunity acquired by vaccines has been developed, 40% of the world's population has still not been vaccinated. Economic problems associated with acquiring novel therapies, misinformation, and differences in treatment protocols have generated catastrophic results, especially in low-resource countries. Understanding the pathophysiological aspects of coronavirus disease and the therapeutic strategies that have been validated to date is essential for successful medical care. In this review, I summarize the historical aspects of the virus, molecules involved in infecting the host, and consequences of viral interactions with and in tissues.
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Affiliation(s)
- Francisco J. González-Ruiz
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | - Emmanuel A. Lazcano-Díaz
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | - Luis A. Baeza Herrera
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | | | - Enma L. Toledo Alemán
- Department of Cardiovascular Diseases, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, Mexico
| | - Miriam G. Zuñiga-Salcedo
- Department of Cardiovascular Diseases, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, Mexico
| | - Camelia Cruz-Rodríguez
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | - Alexandra López-Polanco
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | - Abraham Torres-Pulido
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | | | - Luis A. Cota Apodaca
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
| | - Daniel Manzur-Sandoval
- Department of Cardiovascular Critical Care, National Institute of Cardiology “Dr. Ignacio Chávez,”, Mexico City, México
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Galambos C, Bush D, Abman SH. Intrapulmonary bronchopulmonary anastomoses in COVID-19 respiratory failure. Eur Respir J 2021; 58:13993003.04397-2020. [PMID: 33863743 PMCID: PMC8051184 DOI: 10.1183/13993003.04397-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a devastating and worldwide pandemic disease known as coronavirus disease 2019 (COVID-19). COVID-19 causes acute hypoxic respiratory failure (COVID-ARF), a major cause of mortality and morbidity, with an incompletely understood pathophysiological mechanism. Gattinoniet al. [1] noted that COVID-19 patients with acute hypoxic respiratory failure have lung disease that is often characterised by a remarkable dissociation between relatively well-preserved lung mechanics, including lung compliance, and severe hypoxaemia. These findings are consistent with the concept that profound hypoxaemia occurring in ventilated patients with highly compliant lungs could be due to the loss of regulation of lung perfusion and impaired hypoxic pulmonary vasoconstriction. Early autopsy studies suggest that the lung circulation is a major target of coronavirus infection, which leads to striking pulmonary vascular disease due to variable degrees of thrombosis, apoptosis, oedema, inflammation and angiogenesis [2–4]. These changes contribute to dysregulation of the pulmonary vasculature, which induces perfusion abnormalities and contributes to the physiological phenotypes reported in COVID-19 pneumonia. Further, computed tomography suggests a unique “tree in bud” appearance of small pulmonary arteries [3] and transcranial agitated saline microbubble doppler studies of COVID-19 patients with hypoxaemia have demonstrated intrapulmonary shunting of these bubbles, and that the presence and degree of transpulmonary bubble transit correlates with the degree of hypoxaemia [5]. Despite these studies, histopathological correlates of severe hypoxaemia and shunt in the setting of relatively normal lung compliance in COVID-19 patients are largely lacking. Open intrapulmonary bronchopulmonary anastomoses (IBA) were identified in COVID-19 patients who died of respiratory failure. IBA may be the microanatomical basis of intrapulmonary right to left shunt leading to severe hypoxaemia in COVID-19.https://bit.ly/3e2GajO
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Affiliation(s)
- Csaba Galambos
- Pediatric Heart Lung Center, Aurora, CO, USA .,Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Douglas Bush
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven H Abman
- Pediatric Heart Lung Center, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz School of Medicine, Aurora, CO, USA
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Bush D, Deterding R, Weinman J, Galambos C. Hypoxemia in Lipoid Pneumonia: Role of Intrapulmonary Bronchopulmonary Anastomoses. Am J Respir Crit Care Med 2017; 195:1531-1532. [PMID: 28534692 DOI: 10.1164/rccm.201611-2243im] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Douglas Bush
- 1 Section of Pulmonary Medicine, Department of Pediatrics
| | | | | | - Csaba Galambos
- 3 Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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