Removal of"ruptured"pulmonary artery infusion port catheter by pigtail catheter combined with gooseneck trap:A case report

BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.

Pulmonary artery catheterization in acute myocardial infarction complicated by cardiogenic shock:A review of contemporary literature

Acute myocardial infarction(AMI)with left ventricular(LV)dysfunction patients,the most common cause of cardiogenic shock(CS),have acutely deteriorating hemodynamic status.The frequent use of vasopressor and inotropic pharmacologic interventions along with mechanical circulatory support(MCS)in these patients necessitates invasive hemodynamic monitoring.After the pivotal Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial failed to show a significant improvement in clinical outcomes in shock patients managed with a pulmonary artery catheter(PAC),the use of PAC has become less popular in clinical practice.In this review,we summarize currently available literature to summarize the indications,clinical relevance,and recommendations for use of PAC in the setting of AMI-CS.

Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

It was a 36-year-old patient, 5th Pregnancy, 5th Delivery, 4 live children, and I deceased, had a consultation in the department for the removal of implants. Questioning revealed that she had had the implant three years ago without medical follow-up. It was in view of the difficulties in extracting the capsule that the chest X-ray and CT scan carried out concluded that the implant had migrated into a branch of the left pulmonary artery. Therapeutic abstention has been the attitude of cardiovascular surgeons.

Transthoracic echocardiography assists appropriate pulmonary artery catheter placement: An observational study

AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to confirm PAC position in 103 patients undergoing elective cardiac surgery- the parasternal short axis right ventricular inflow-outflow view; the subcostal short axis right ventricular inflow-outflow view; and the parasternal short axis ascending aortic view. All PACs were inserted by the managing anesthesiologist under pressure waveform guidance alone, who was blinded to all sonographic information. A sonographer blinded to all pressure waveform information confirmed visualisation of an "empty" PA before PAC insertion, and visualisation of the PAC balloon in the main PA(MPA) or right PA(RPA) after attempts at placement were complete. Agreement, sensitivity and specificity of TTE in confirming appropriate PAC placement was compared against pressure waveformguidance as the "gold standard". The successful view used was compared against patients' anthropomorphic indices, presence of lung hyperinflation, and insertion of PAC during positive pressure ventilation. Agreement between TTE and pressure waveform guidance was analysed using Cohen's Kappa statistic. The relative proportion of total RPA seen by subcostal vs parasternal TTE views was also compared with a further 20 patients' computed tomography(CT) pulmonary angiograms(CTPA), to determine efficacy in detection of distal RPA PAC placement. RESULTS: Appropriate positioning of the PAC balloon, and its to-and-fro movement consistent with a nonwedged state, within the MPA or RPA was confirmed by TTE in 98 of the 103 patients [sensitivity 95%(95%CI: 89%-98%)], and absence of the PAC balloon before insertion correctly established in 100 patients [specificity 97%(92%-99%)]. This was in very good agreement with pressure waveform guidance [Cohen's Kappa 0.92,(0.87-0.98)]. The subcostal view was the best view to visualise the PAC tip when it was placed in the right pulmonary artery(OR 70, P < 0.0001), was more successful in patients with COAD(OR 9.5, P = 0.001), and visualized 61%(vs 44% by parasternal views, P < 0.001) of mean RPA lengths compared with CTPA; however the parasternal views were more successful in patients with higher body mass indexs(OR 0.78 for success with subcostal views, P < 0.001). There was a trend towards insertion during intermittent positive pressure ventilation favoring visualisation by subcostal views(OR 3.9, P = 0.08). The subcostal view visualized a greater length of the RPA than parasternal views(3.9 cm vs 2.9 cm, P < 0.0001). PACs were more often placed in the MPA than RPA(80 vs 18 patients). Three patient's pulmonary arteries were not visible by any TTE view; in a further 2 patients, despite preinsertion visualisation of their pulmonary arteries, the PAC balloon was not visible by any view with TTE where correct placement by pressure waveform was unequivocal.

“Guidezilla”extension catheter combined with balloon technique for treating pulmonary artery stenosis caused by Takayasu arteritis

Takayasu arteritis(TA)is a rare systemic vasculitis of the aorta and its primary branches,which usually occurs in young women.Due to its insidious onset and lack of specific symptoms,this disease can be easily misdiagnosed or missed.Approximately 50%of the patients having TA with pulmonary artery involvement develop pulmonary hypertension(PH).The 3-year survival rate among patients with TA-related PH is lower than that among patients with TA alone.Early balloon pulmonary angioplasty(BPA)can improve the clinical symptoms and survival of patients with stable TA.To the best of our knowledge,this is the first case reported in the English literature in which a“Guidezilla”catheter was used during BPA to treat stenosis and occlusion of the pulmonary artery caused by Takayasu arteritis(TA).

Qualitative estimation of pulmonary artery systolic pressure:could right heart catheterization be replaced by transthoracic Doppler echocardiography?

Background Transthoracic Doppler echocardiography is recommended for screening the presence of pulmonary hypertension(PH).However,the accuracy of pulmonary artery systolic pressure(PASP) estimated by Doppler echocardiographic is still unknown.Methods We conducted a retrospective study on 102 patients with idiopathic pulmonary arterial hypertension who underwent Doppler echocar-diography within 72 hours before right heart catheterization. During this time,all patients were stable without any specific drug therapy.Results There was moderate correlation between Doppler echocardiographic and right heart catheteriza- tion measurements of PASP(r =0.642,P【0.001).Using Bland-Altman analytic methods,the bias for the echocardio-graphic estimates of PASP was 6.65 mm Hg with 95%limits of agreement ranging from -47.62 to 34.30 mm Hg.There were 58.8%cases with absolute differences over 10 mm Hg between the two methods.Overestimation and underestimation of PASP by Doppler echocardiography occurred in 15.7% (16/102) and 43.1%(44),respectively.The magnitude of pressure underestimation and overestimation was insignificant (24.52±12.15 vs.25.69±16.09,P=0.765),while the corresponding diagnostic categories of severity that each subject would fall into for each technique are not in good agreement. The diagnostic categories of 16 overestimated patients were in accordance.During 44 underestimated patients,20.5%of patients had their pressure underestimated within one diagnostic category(minor error);4.5%of the underestimates were with two diagnostic categories(major error).Conclusions Transthoracic Doppler echocardiography may frequently be inaccurate in estimating PASP and could not replace the right heart catheterization.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma(PAS)is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy.Early diagnosis and radical surgical resection offer the only chance for survival.However,making a preoperative histopathological diagnosis is quite difficult.We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism.After confirming a definitive diagnosis using a catheter suction biopsy,we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass.Eighteen months after surgery,no recurrence was observed.

Evaluation of computed tomography obstruction index in guiding therapeutic decisions and monitoring percutanous catheter fragmentation in massive pulmonary embolism

In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA （TO） and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index （Qanadli index） and compared with Miller index. CTPA, oxygen saturation （SaO2） and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was （55 ± 13）% （range, 40%- 75%）, and Miller index was （62 ± 15）% （range, 45%-85%）. Correlations between them were statistically significant （r = 0.867, P 〈 0.0001）. The Qanadli index showed significant reduction [TO： （55±13）%; TI： （12±10）%; P 〈 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO2 （r = 0.934）, and pulmonary artery pressure （r = 0.813）. The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.

New generation aspiration catheter: Feasibility in the treatment of pulmonary embolism

AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto.035' and XL extraction catheter(Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto.035' or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography(CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle(RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients(n = 8), the mean pulmonary pressures declined from a median(range) of 35.5(19-46) to 23(10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE(n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting(n = 2). CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.

Pulmonary and cerebral lipiodol embolism after transcatheter arterial hemoembolization in hepatocellular carcinoma

Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.

ERK1/2 Promotes Cigarette Smoke-induced Rat Pulmonary Artery Smooth Muscle Cells Proliferation and Pulmonary Vascular Remodeling via Up-regulating CyclinE1 Expression

Summary： This study iflvestigated the potential role of ERK1/2-cyclinE1 signaling pathway in rat pulmonary artery smooth muscle cells （rPASMCs） proliferation and pulmonary vascular remodeling induced by cigarette smoke exposure. A total of 24 male Wistar rats were randomly divided into 4 groups： control group （C group）, S-1M, S-3M and S-6M groups （animals in the groups were exposed to smoke for 1, 3, and 6 months, respectively）. HE staining and anti-u-smooth muscle actin antibody staining were performed to observe the degree of pulmonary vascular remodeling. Imrnunohistochemis- try and Western blotting were performed to evaluate ERK1/2 and cyclinE1 expression in pulmonary vessels. Primary cultured rat pulmonary artery smooth muscle cells （rPASMCs） were exposed to ciga- rette smoke extract （CSE）. ERK inhibitor （PD98059） and cyclinE1 siRNA were used to verify the role of ERK1/2 and cyclinE 1 in CSE-induced rPASMCs proliferation. Cell proliferation was assessed by cell counting and 5-bromo-2-deoxyuridine （BrdU） incorporation. Our results showed that abnormal pulmo- nary vascular remodeling was found in cigarette smoked rats. Compared to C group, activated ERK1/2 and cyclinE1 expression was significantly increased in smoke-exposure groups. This up-regulated ex- pression was positively correlated with the severity of pulmonary vascular remodeling, and there was positive correlation between the expression of ERK1/2 and cyclinE1. PD98059 and cyclinE1 siRNA in- hibited the proliferation of rPASMCs. The expression of cyclinE1 could be down-regulated by PD98059. Our data demonstrated that increased expression of ERK1/2 and cyclinE1 might be involved in the pathogenesis of abnormal rPASMCs proliferation and rat pulmonary vascular remodelling induced by cigarette smoke exposure.

THE ROLES OF bcl-2 GENE FAMILY IN THE PULMONARY ARTERY REMODELING OF HYPOXIA PULMONARY HYPERTENSION IN RATS

Objective. To investigate the roles of apoptosis in the pulmonary artery remodeling of pulmonary hypertension secondary to hypoxia and illustrate the relative genes expression. Methods. Thirty rats were divided into hypoxia group（ 10％ O2, 8h/d） and normal control group. On the 15th day of hypoxia, pulmonary artery pressure and right ventricular hypertrophy index were measured and pulmonary artery vessels were studied by light microscope. Then terminal deoxynucleotidyl transferase- mediated dUTP nick- end labeling（ TUNEL） technique was used to detect nucleosomal DNA fragmentation of apoptotic cells. In situ hybridization and RT- PCR were used to detect the expression level of bcl- 2 and bax. Results. The pulmonary artery pressure and right ventricular hypertrophy index of hypoxia group were increased significantly, the pulmonary artery wall of hypoxic group become incrassate than control group. Apoptotic cells can be found in lung with hypoxia or without hypoxia. Compared with control group, apoptotic index of hypoxic group decreased significantly. Through the methods of in situ hybridization and RT- PCR, we found the expression of bcl- 2 increased whereas bax decreased significantly in the hypoxic group. Conclusion. The alternation in bcl- 2 and bax expression induced by hypoxia play an important role in the pulmonary artery remodeling which is the main pathologic change of pulmonary hypertension secondary to hypoxia.

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting： which is better in patients with chronic obstructive pulmonary disease？

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

Relationship of Intracellular Free Ca^(2+) Concentration and Calcium-activated Chloride Channels of Pulmonary Artery Smooth Muscle Cells in Rats under Hypoxic Conditions

To investigate the relationship between intracellular free Ca^2＋ concentration （[Ca^2＋ ]i ） and calcium-activated chloride （Clca） channels of pulmonary artery smooth muscle cells （PASMCs） in rats under acute and chronic hypoxic conditions, acute hypoxia-induced contraction was observed in rat pulmonary artery by using routine blood vascular perfusion in vitro. The fluorescence Ca^2＋ indicator Fura-2/AM was used to observe [Ca^2＋ ]i of rat PASMCs under normal and chronic hypoxic condition. The effect of Clca channels on PASMCs proliferation was assessed by MTT assay. The Clca channel blockers niflumic acid （NFA） and indaryloxyacetic acid （IAA-94） exerted inhibitory effects on acute hypoxia-evoked contractions in the pulmonary artery. Under chronic hypoxic condition, [Ca^2＋ ]i was increased. Under normoxic condition, [Ca^2＋ If was （123.634-18.98） nmol/ L, and in hypoxic condition, [Ca^2＋]i wag （281. 754-16.48） nmol/L （P〈0. 01）. Under normoxic condition, [Ca^2＋ ]i showed no significant change and no effect on Clca channels was observed （P〉 0. 05）. Chronic hypoxia increased [Ca^2＋ ]i which opened Clca channels. The NFA and IAA-94 blocked the channels and decreased [Ca^2＋ ]i from （281.75± 16.48） nmot/L to （117.66 ±15.36） nmol/L （P〈0.01）. MTT assay showed that under chronic hypoxic condition NFA and IAA-94 decreased the value of absorbency （A value） from 0. 459±0. 058 to 0. 224±0. 025 （P〈0. 01）. Hypoxia increased [Ca^2＋ ]i which opened Cl~ channels and had a positive-feedback in [Ca^2＋ ]i. This may play an important role in hypoxic pulmonary hypertension. Under chronic hypoxic condition, Clca channel may play a part in the regulation of proliferation of PASMCs.

The Effect of Erigeron Breviscapus on Proliferation of Pulmonary Artery Smooth Muscle Cells in Hypoxic Porcines

In order to study the effect of Erigeron Breviscapus (EB) on proliferation of pulmonary artery smooth muscle cells (PASMC) in hypoxic porcines, immunohistochemical and MTT methods were employed to measure the proliferation of PASMC. It was found that the proliferation of PASMC in porcines was obvious, and the expression of proliferating cell nuclear antigen (PCNA) was significantly high within 48 h after exposure to hypoxia. The EB could inhibit the proliferation and the expression of PCNA in PASMC under hypoxia, but it had no effect on the proliferation and expression of PCNA in PASMC under normal condition. The EB could inhibit the proliferation and the expression of PCNA in PASMC induced by phorbol 12-myristate 13-acetate (PMA), an agonist of PKC in normal and hypoxic conditions. It was concluded that the hypoxia could enhance the proliferation and expression of PCNA in PASMC. The EB can inhibit the proliferation and expression of PCNA in PASMC under hypoxia through PKC-signal way. The EB may be used in treating the pulmonary hypertension by inhibiting the proliferation of PASMC and the pulmonary vascular remodeling.

Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Misdiagnosis of primary intimal sarcoma of the pulmonary artery as chronic pulmonary embolism: A case report

BACKGROUND Primary intimal sarcoma of the pulmonary artery is a rare malignant tumor originating from the pulmonary artery,which has a low incidence rate and is easily misdiagnosed as pulmonary embolism.There is no standard protocol for the treatment of primary intimal sarcoma of the pulmonary artery.CASE SUMMARY This study reports a patient with primary intimal sarcoma of the pulmonary artery who was admitted to our hospital in 2017.The clinical characteristics,diagnosis,treatment and outcome of the patient were retrospectively analyzed.The patient was a Chinese Han male aged 44 years.He had three consecutive episodes of syncope,and was thus admitted to a local hospital.Computed tomography pulmonary angiography showed multiple lesions with abnormal densities in the pulmonary trunk,left pulmonary artery,mediastinum and pericardium,which were consistent with recurrence after tumor resection.He underwent surgery,and was pathologically diagnosed with intimal sarcoma of the pulmonary artery.He relapsed 3 mo after surgery,and apatinib was administered.His condition was stable after 4 mo,with tolerable and controllable adverse reactions.He subsequently died 19 mo after surgery.CONCLUSION Primary intimal sarcoma of the pulmonary artery has no specific clinical or imaging manifestations.The diagnosis of this disease depends on histopathology and immunohistochemistry,and has a poor clinical prognosis.Surgical treatment is currently a favorable option for primary intimal sarcoma of the pulmonary artery,and targeted therapy may provide new insights for the development of effective treatment methods.

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery （VATS） currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery （VATS） procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer （NSCLC） received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Anomalous origin of left pulmonary artery branch from the aorta with Fallot's tetralogy:one case report

We report the case of a ten-year-old boy who had often presented with respiratory distress since born. Chest X-ray showed an enlarged right ventricle. Echocardiography demonstrated characteristic features of Fallot＇s tetralogy and the left pulmonary artery could not be visualized. However, cardiac catheterization disclosed that the left pulmonary artery had an anomalous origin in the ascending aorta. The patient underwent total surgical correction of the defects. Nine days later, he was discharged. We present the results of a literature review of the incidence, physiopathological, clinical, diagnostic, and surgical characteristics of this rare disease.

Hypoxia Down-regulates Secretion of MMP-2, MMP-9 in Porcine Pulmonary Artery Endothelial and Smooth Muscle Cells and the Role of HIF-1

Summary： Primary cell culture, techniques of gene transfection, gelatin zymography, and Western blot were used to investigate the effect of hypoxia on the secretion of MMP 2 and MMP-9 in pulmonary artery endothelial cells （PAEC） and smooth muscle cells （PASMC）, and the role of HIF-1. Our results showed that （1） after exposure to hypoxia for 24 h, the protein content and activity of MMP-2 in the PAEC medium as well as these of MMP-2 and MMP-9 in PASMC medium （P〈0. 01 ） decreased significantly in contrast to those in normoxic group （P（0.05） ; （2） after transfection of wild type EPO3＇ enhancer, a HIF-1 decoy, the content and activity of MMP 2 and MMP-9 in hypoxic mediums became higher than those in normoxic group （P〈0. 01）, while transfection of mutant EPO3＇-enhancer didn＇t affect the hypoxia-induced down-regulation. It is concluded that hypoxia could inhibit the secretion and activity of MMP 2 and MMP-9 in PAEC and PASMC, which could he mitigated by the transfection of EPO3 ＇-enhancer and that H1F-1 pathway might contribute to hypoxia-induced down regulation of MMP-2 and MMP-9.