new approaches to pulmonary arteryial hypertension--padn 陈绍良 周 陵 南京市第一医院
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New Approaches To Pulmonary Arteryial Hypertension--PADN
陈绍良 周 陵南京市第一医院
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Current medications
04/21/23
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Direct evidences of sympathetic nerves in PAH
04/21/23
First description of PA denervation
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Study design
04/21/23
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Surgical denervation on PAP
04/21/23
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Effect of 6-OHDA on PAP
04/21/23
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Evidence of sympathetic nerves in PAH
anterior
lateral
posterior
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Electron microscope
HT staining
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Experimental studies
Acute study: 20 Mongolia dogs
Group 1IA
occlusion
During 10-minute occlusion:Hemodynamics measurement was performed at each minute
Chen SL, et al, Eurointervention March 2013
Group 2BT
occlusion
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Segments of left pulmonary artery
IA
BT
Reprint with permission from Virginia university Chen SL, et al. Eurointervention ,March 2013
Occlusion at BT
Occlusion at IA
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Group 1: interlobar occlusion Group 2: basal occlusion
Before PADN
Chen SL, et al. Eurointervention, March 2013
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Experimental studies
Acute study: 20 Mongolia dogs
During 10-minute occlusion:Hemodynamics measurement was performed at each minute
Chen SL, et al, Eurointervention March 2013
Group 3PADN at level1-3,
Group 4PADN at level 4,5
IA occlusion IA occlusion
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PADN levels
Level 1
2
3
4
5
Level 1:distal MP
Level 2: ostial LPA
Level 3: ostial RPA
Level 4: 5mm distal to ostial LPA
Level 5: 5 mm distal to ostial RPA
Chen SL, et al. Eurointervention , March 2013 Chen SL, et al. JACC September 2013
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Group 3:PADN at level 1-3 Group 4:PADN at level 4,5
distal MPA, ostial LPA and RPA 5mm distal to ostial RPA or LPA
Chen SL, et al. Eurointervention, March 2013
During IA occlusion
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First-In-Man: PADN-1 study22 patients unresponsive to medication between March and May 2012
1 patient excluded: (+) adenosine test
21 patients
Control group(N=8)PADN group(N=13)
Clinical follow-up at 3-month in all patientsHemodynamic measurements: post, 24h,1w,3-m
8 ptients refused PADN
Chen SL,et al. JACC September 2013
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PADN system
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Baseline characteristics of all patients
04/21/23
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Hemodynamic Measurements by RHC
04/21/23
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Assessment of Functional Capacity
04/21/23
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Final results
◇ Reduction of mean PAP >15%
◇ PVR/NT-BNP ↓
◇ 6MWD ↑ by 100 m
◇ Less rehospitalization/death
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Before PADN: PAPs=91 mmHgPAPm=52 mmHg
10-month after PADN: PAPs=79 mmHg PAPm=41 mmHg
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Baseline:PAPm=42mmHg
Post-PADN:PAPm=30.48mmHg
10-month:PAPm=31.33mmHg
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Study on PAH-model
• Dehydromonocrotaline , 3mg/kg• After 8 weeks
– RHC confirmed PAH: mPAP ≥25mmHg
• PADN at level 1• 6 weeks after PADN
– Repeat RHC– Pathologic study– Gene-molecular study– Conduction velocity
04/21/23
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PAH after PADN
04/21/23
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*PADN has been testified in animal model
PADN-I, a FIM study, showed the potential of PADN for IPAH
• PH patients with varying etiologies of
PAH• Further RCTs are required
In conclusion
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Thanks for your attention!