Postnatal dilatation of umbilical cord vessels and its impact on wall integrity: Prerequisite for the artificial placenta
| Autor: | Ponnambalam Ravi Selvaganapathy, Dragos Predescu, Niels Rochow, Mohammadhossein Dabaghi, Jenny Peng, Gerhard Fusch, Radenka Bozanovic, Jan Willem Jansen, Sau-Young Lee, Bryon DeFrance, Christoph Fusch |
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| Rok vydání: | 2018 |
| Předmět: |
Umbilical Veins
medicine.medical_specialty Placenta 0206 medical engineering Biomedical Engineering Medicine (miscellaneous) Bioengineering 02 engineering and technology 030204 cardiovascular system & hematology Umbilical cord Catheterization Umbilical Cord Biomaterials 03 medical and health sciences 0302 clinical medicine Pregnancy Internal medicine medicine Humans Vein Lung Respiratory distress business.industry Infant Newborn General Medicine medicine.disease Dilatation 020601 biomedical engineering medicine.anatomical_structure Respiratory failure Cardiology Female Artificial Organs Respiratory Insufficiency business Artery |
| Zdroj: | The International Journal of Artificial Organs. 41:393-399 |
| ISSN: | 1724-6040 0391-3988 |
| DOI: | 10.1177/0391398818763663 |
| Popis: | Introduction: A lung assist device, which acts as an artificial placenta, can provide additional gas exchange for preterm and term newborns with respiratory failure. The concept of the lung assist device requires a large bore access via umbilical vessels to allow pumpless extracorporeal blood flow rates up to 30 mL/kg/min. After birth, constricted umbilical vessels need to be reopened for vascular access. The objective is to study the impact of umbilical vessel expansion on vessel integrity for achieving large bore access. Methods: Umbilical cords from healthy term deliveries were cannulated and dilatated with percutaneous transluminal angioplasty catheters in 1 mm increments from 4 to 8 mm for umbilical artery and from 4 to 15 mm for umbilical vein, n = 6 per expansion diameter. Paraffin-embedded transverse sections of dilated and control samples were HE & Van Gieson stained. Effects of dilatation, shown by splitting, were measured. Results: Umbilical vessel expansion led to concentric splitting, shown by areas devoid of extracellular matrix and nuclei in the tunica intima and media. No radial splitting was observed. Results suggest an expansion threshold of umbilical artery at 6 mm and umbilical vein at 7 mm, while maximal splitting was observed above this threshold (3.6 ± 0.8%, p = 0.043 for umbilical artery 7 mm and 6.3 ± 1.8%, p = 0.048 for umbilical vein 8 mm). Endothelial cell sloughing was present in all dilated samples but not in the control samples. Conclusion: The suggested thresholds for safe expansions are similar to in utero umbilical vessel diameters and demonstrate a proof of concept for attaining large bore access for the lung assist device. |
| Databáze: | OpenAIRE |
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