Key result
In utero systemic-to-pulmonary shunts in lambs alter NO and endothelin signaling before severe anatomic changes.
Early endothelial damage and alterations in NO and endothelin signaling pathways may contribute to the development of pulmonary hypertension in congenital heart disease.
May support early endothelial pathway targeting in congenital shunts; extends lamb data but leaves open human translation.
Congenital heart disease with increased pulmonary blood flow commonly leads to the development of pulmonary hypertension and increased vascular reactivity. These serious sequelae are associated with the following two major categories of congenital heart defects: those resulting in increased pulmonary blood flow and increased pulmonary arterial pressure and those resulting in increased pulmonary venous pressure. Recent evidence that the pulmonary vascular endothelium is an important determinant of vascular tone has led to the hypothesis that endothelial injury, secondary to congenital heart disease with increased pulmonary blood flow, disrupts these regulatory mechanisms and thereby plays a role in the development of pulmonary hypertension and its associated increased vascular reactivity. In many animal models, endothelial dysfunction is a precursor for smooth muscle dysfunction, and there is an apparent progression from endothelial dysfunction to smooth muscle dysfunction as vascular changes progress. We established a chronic model of pulmonary hypertension with increased pulmonary blood flow in young lambs by placing a systemic-to-pulmonary shunt in utero. In this model, we found significant physiologic and molecular alternations of both the nitric oxide (NO) and endothelin signaling pathways, two important mechanisms by which the endothelium regulates pulmonary vascular tone. These alterations occur extremely early and precede severe anatomic changes. Early endothelial damage may contribute to the development of pulmonary hypertension and its associated enhanced pulmonary vascular reactivity.
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Steinhorn et al. (1999) studied Pulmonary hypertension in congenital heart disease. Systemic-to-pulmonary shunt in utero was evaluated on Physiologic and molecular alterations of nitric oxide and endothelin signaling pathways. In a young lamb model, a systemic-to-pulmonary shunt in utero caused early physiologic and molecular alterations in nitric oxide and endothelin signaling pathways preceding severe anatomic changes.
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