Multiple cardiac myxomas with pulmonary arterial obstruction and acute right heart failure

[No abstract. Showing first paragraph of article]Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary vasculature characterized by progressive narrowing of the pulmonary arteries leading to increased pulmonary vascular resistance, right heart failure, and ultimately premature death.There has been a significant improvement in the available medical therapeutic options in this field that have impacted the short-term survival and morbidity in these patients. However, the median survival post-diagnosis remains unacceptable at 7 years.Physicians’ ability to predict PAH disease progression and risk allows them to determine the patient’s prognosis, make informed adjustments to therapy, and monitor his or her response to therapy . If widely adopted, risk prediction can enhance the consistency of treatment approaches and improve the timeliness of referral for lung transplantation. This approach should lead optimal, directed care that ultimately reduces morbidity and improves mortality in patients with PAH.

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Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

The Journal of Critical Care Medicine ◽

10.2478/jccm-2021-0020 ◽

2021 ◽

Vol 7 (3) ◽

pp. 170-183

Author(s):

Ioan Tilea ◽

Andreea Varga ◽

Anca-Meda Georgescu ◽

Bianca-Liana Grigorescu

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Intensive Care ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Care Management ◽

Right Heart Failure ◽

Right Heart ◽

Continuous Increase ◽

Pulmonary Arterial

Abstract Despite substantial advancements in diagnosis and specific medical therapy in pulmonary arterial hypertension patients’ management, this condition continues to represent a major cause of mortality worldwide. In pulmonary arterial hypertension, the continuous increase of pulmonary vascular resistance and rapid development of right heart failure determine a poor prognosis. Against targeted therapy, patients inexorable deteriorate over time. Pulmonary arterial hypertension patients with acute right heart failure who need intensive care unit admission present a complexity of the disease pathophysiology. Intensive care management challenges are multifaceted. Awareness of algorithms of right-sided heart failure monitoring in intensive care units, targeted pulmonary hypertension therapies, and recognition of precipitating factors, hemodynamic instability and progressive multisystem organ failure requires a multidisciplinary pulmonary hypertension team. This paper summarizes the management strategies of acute right-sided heart failure in pulmonary arterial hypertension adult cases based on recently available data.

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Therapeutic Targeting of Vascular Remodeling and Right Heart Failure in Pulmonary Arterial Hypertension with a HIF-2α Inhibitor

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201710-2079oc ◽

2018 ◽

Vol 198 (11) ◽

pp. 1423-1434 ◽

Cited By ~ 25

Author(s):

Zhiyu Dai ◽

Maggie M. Zhu ◽

Yi Peng ◽

Narsa Machireddy ◽

Colin E. Evans ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Vascular Remodeling ◽

Right Heart Failure ◽

Right Heart ◽

Therapeutic Targeting ◽

Pulmonary Arterial

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The Hemodynamic Characteristics of Right Ventricle After Gradient Pulmonary Artery Banding in Rats

10.21203/rs.3.rs-49641/v1 ◽

2020 ◽

Author(s):

Song Jiyang ◽

Wan Nan ◽

Shen Shutong ◽

Wei Ying ◽

Cao Yunshan

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Right Heart Failure ◽

Therapeutic Strategies ◽

Pulmonary Artery Banding ◽

Right Heart ◽

Pulmonary Arterial ◽

The Right

Abstract Background: Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary disorders. Reliable and reproducible animal models of RV failure are important in order to investigate disease mechanisms and effects of potential therapeutic strategies. To establish a rat model of RV failure perfectly, we observed the right ventricle and carotid artery hemodynamics characteristics in different degrees of pulmonary artery banding of rats of different body weights. Methods: Rats were subjected to 6 groups：control(0%, n=5)(pulmonary arterial banding 0%), PAB(1-30%, n=4)(pulmonary arterial banding1-30%), PAB(31-60%, n=6)(pulmonary arterial banding31-60%),PAB(61-70%, n=5)(pulmonary arterial bandin61-70%), PAB(71-80%,n=4)(pulmonary arterial banding71-80%), PAB(100%, n=3)(pulmonary arterial banding 100%). We measured the right ventricular pressure(RVP) by right heart catheterization when the pulmonary arterial was ligated. Results: The RVP gradually increased with increasing degree of banding, but when occlusion level exceeding 70%, high pressure state can be only maintained for a few minutes or seconds, and then the RVP drops rapidly until it falls below the normal pressure, which in Group F particularly evident.Conclusions: RVP have different reactions when the occlusion level is not the same, and the extent of more than 70% ligation is a successful model of acute right heart failure. These results may have important consequences for therapeutic strategies to prevent acute right heart failure.

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Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa052 ◽

2020 ◽

Vol 4 (3) ◽

pp. 1-5

Author(s):

Kae-Woei Liang ◽

Kuo-Yang Wang

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Right Heart Failure ◽

Idiopathic Pulmonary Arterial Hypertension ◽

Right Heart ◽

Balloon Atrial Septostomy ◽

Atrial Septostomy ◽

Pulmonary Arterial ◽

Prostacyclin Analogues

Abstract Background Intravenous (IV) prostacyclin analogues infusion and balloon atrial septostomy (BAS) are two important treatment options for managing advanced right heart failure in patients with idiopathic pulmonary arterial hypertension (IPAH). References and protocols are rare for dose titrations and transitions between subcutaneous and IV prostacyclin in functional Class IV IPAH patients. Balloon atrial septostomy is rarely done in very few expert centres. Case summary A young female with IPAH who had received maximal medication including subcutaneous prostacyclin analogues injection was admitted due to advanced right heart failure. She received ascites drainage twice. Later, we directly switched the administration route of prostacyclin from subcutaneous to IV at a ratio of 1:1 instantly. Such rapid conversion led her into a state of profound hypotension and drowsy consciousness, which was resolved after escalating IV inotropics and reducing prostacyclin dosage. Five days later, she received BAS under the guidance of intracardiac echocardiography. Her urine output increased and dyspnoea improved gradually. Six months later, clinical worsening happened again with increase of ascites and dyspnoea. She underwent 2nd and 3rd session of graded BAS with relief of symptoms again. She received permanent transition to IV prostacyclin analogues infusions via a peripherally inserted central catheter after three sessions of BAS. Discussion Balloon atrial septostomy is effective in stabilizing the critical right heart failure in IPAH patients but should be intended as a bridge to lung transplant procedure. Transition from subcutaneous to IV prostacyclin is helpful but needs to be titrated in proper aliquots and time intervals to avoid abrupt haemodynamic changes.

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