The relationship between functional class, pulmonary artery pressure and size in left atrial myxoma

Introduction Access to the vascular system is necessary in patients with chronic renal failure planned to undergo dialysis. One of the complications of end-stage renal disease patients is pulmonary hypertension (PHT). Temporary arterio-venous access closure and successful kidney transplantation causes a significant fall in cardiac output and pulmonary artery pressure (PAP), indicating the possibility that excessive pulmonary blood flow is involved in the pathogenesis of the disease. We attempted to study the relationship of PHT with arteriovenous fistula (AVF) creation, as well as to assess the relationship between AVF flow and fistula characteristics. Methods Fifty patients were included in the study. Echocardiography was used to evaluate systolic PAP, cardiac output (CO), and ejection fraction (EF) before creating the AVF. After a follow-up interval of at least 6 months, a second echocardiographic assessment and a Doppler sonographic assessment of their fistula flow were carried out. Complete data were available for 34 patients. Results Study data were collected from 34 patients, 28 males and 6 females with a mean age of 52 yrs ranging from 15–78 yrs. The data showed a statistically significant positive correlation between fistula flow and PAP2 and PAP changes (p<0.05). Mean fistula flow was 1322 ml/min in patients without PHt and 2750 ml/min in patients with PHT. this difference (1428 ml/ min) was statistically significant (p=0.03). We found a significant negative correlation between PAP1 and EF1 and PAP2 and EF2 (p<0.05). In addition, the mean EF2 in patients without PHT was 57% in contrast to 46% in patients with PHT. Mean fistula flow in radial fistulae (mean=422 ml/min, range: 370–474 ml/min) was significantly less than brachial fistulae (mean=1463 ml, range: 270–3300 ml/min) (p=0.03). Mean systolic PAP2 of 14.8 mmHg in transplanted patients was 5.9 mmHg less than those who were not transplanted (20.7 mmHg). Diabetes was the most common cause of renal failure and diabetics had a significant reduction in their EF (15.5%) compared with non-diabetic patients (1% reduction) (p=0.016). Conclusion Fistula flow, PAP and EF of all patients should be checked at least 6 months after fistula creation. Patients with higher fistula flow rates and patients with diabetes mellitus need to be more closely observed. In addition, elderly patients with significant cardiac and other comorbidities may be more prone to develop symptoms after AVF creation

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Intraoperative Flow Study Predicted the Postoperative Pulmonary Artery Pressure in the Bidirectional Glenn Operation

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119884918 ◽

2019 ◽

Vol 11 (1) ◽

pp. 29-33

Author(s):

Oktay Korun ◽

İlker Kemal Yücel ◽

Murat Çiçek ◽

Hüsnü Fırat Altın ◽

Okan Yurdakök ◽

...

Keyword(s):

Decision Making ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Venous Hypertension ◽

Pulmonary Resistance ◽

Artery Pressure ◽

Bidirectional Glenn ◽

The Relationship ◽

Glenn Procedure ◽

Flow Study

Background: The aim of this study was to evaluate the predictability of postoperative pulmonary artery pressure (PAP) using intraoperative flow study in patients undergoing bidirectional Glenn operation. Methods: Patients who underwent Glenn operation under cardiopulmonary bypass (CPB) were included in the study. During the operation, after the completion of additional procedures under CPB, an intraoperative flow study was performed prior to Glenn anastomosis. After the completion of bidirectional Glenn, the patient was separated from the CPB and PAP was measured. The relationship between this pressure and flow study measurement was analyzed. Results: Nine patients who underwent bidirectional Glenn operation with additional procedures under CPB between July 2018 and January 2019 were included in the study. The median PAP was 9 mm Hg (interquartile range [IQR]: 7-10 mm Hg) in the flow study and 10 mm Hg (IQR: 8-11 mm Hg) after CPB, and the median difference between these pressures was 1 mm Hg (IQR: 1-3 mm Hg). There was a strong correlation between these two measurements ( r = 0.732; P = .025). Conclusion: The results of this study show that PAP after the Glenn procedure can be estimated using an intraoperative flow study. We believe that this method may be useful in intraoperative decision-making for Glenn operation in single ventricular patients who require extensive pulmonary artery (PA) reconstruction due to limited PA development, branch PA stenosis, or nonconfluent PAs. Also, this method can be used as a sort of intraoperative pulmonary resistance reversibility study in patients with high preoperative pulmonary vascular resistance due to surgically correctable pulmonary venous hypertension.

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Per-operative Changes of Pulmonary Artery Pressure following Closed Mitral Commissurotomy

Cardiovascular Journal ◽

10.3329/cardio.v11i2.40415 ◽

2019 ◽

Vol 11 (2) ◽

pp. 147-151

Author(s):

Muhammed Abdul Quaium Chowdhury ◽

Mohammad Fazle Maruf ◽

Minhazur Rahman ◽

Subir Barua ◽

Mamunur Rahman ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Stenosis ◽

Left Atrial ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Artery Pressure ◽

Mitral Commissurotomy ◽

Closed Mitral Commissurotomy

Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery pressure following opening of stenosed mitral valve. Methods: All these CMCs were performed routinely through the left antero-lateral thoracotomy (4th intercostal space) and dilatation was done by metallic Tubb’s Dilator. Peroperative left atrial and Pulminary Arterial pressures were measured before and after dilatation. Results: 15 patients had undergone CMC. Following CMC, per-operative mean Pulmonary artery pressure was reduced from 45.5±7.1 mm of Hg to 39.0±8.8 mm of Hg (p=0.043). Mean left atrial pressure reduced from 35.9±5.6 mm of Hg to 30.0±9.1 mm of Hg (p = 0.049). At three months follow up after closed mitral commissurotomy mitral valve area at echocardiography was found 2.29±0.18 cm2. There was no case of death after closed mitral commissurotomy. Mild mitral regurgitation occurred in 1 patient. Conclusion: We conclude that there is immediate significant reduction of pulmonary Artery pressure following closed mitral commissurotomy. This reduction is apparently comparable with a similar reduction of left atrial pressure. Cardiovasc. j. 2019; 11(2): 147-151

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Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.009047 ◽

2019 ◽

Vol 12 (9) ◽

Cited By ~ 9

Author(s):

Khodr Tello ◽

Jun Wan ◽

Antonia Dalmer ◽

Rebecca Vanderpool ◽

Hossein A. Ghofrani ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Operating Characteristic ◽

Systolic Pulmonary Artery Pressure ◽

Area Change ◽

Artery Pressure ◽

Diastolic Stiffness ◽

Relationship Of ◽

The Relationship

Background: The ratios of tricuspid annular plane systolic excursion (TAPSE)/echocardiographically measured systolic pulmonary artery pressure (PASP), fractional area change/invasively measured mean pulmonary artery pressure, right ventricular (RV) area change/end-systolic area, TAPSE/pulmonary artery acceleration time, and stroke volume/end-systolic area have been proposed as surrogates of RV-arterial coupling. The relationship of these surrogates with the gold standard measure of RV-arterial coupling (invasive pressure-volume loop-derived end-systolic/arterial elastance [Ees/Ea] ratio) and RV diastolic stiffness (end-diastolic elastance) in pulmonary hypertension remains incompletely understood. We evaluated the relationship of these surrogates with invasive pressure-volume loop-derived Ees/Ea and end-diastolic elastance in pulmonary hypertension. Methods: We performed right heart echocardiography and cardiac magnetic resonance imaging 1 day before invasive measurement of pulmonary hemodynamics and single-beat RV pressure-volume loops in 52 patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. The relationships of the proposed surrogates with Ees/Ea and end-diastolic elastance were evaluated by Spearman correlation, multivariate logistic regression, and receiver operating characteristic analyses. Associations with prognosis were evaluated by Kaplan-Meier analysis. Results: TAPSE/PASP, fractional area change/mean pulmonary artery pressure, RV area change/end-systolic area, and stroke volume/end-systolic area but not TAPSE/pulmonary artery acceleration time were correlated with Ees/Ea and end-diastolic elastance. Of the surrogates, only TAPSE/PASP emerged as an independent predictor of Ees/Ea (multivariate odds ratio: 18.6; 95% CI, 0.8–96.1; P =0.08). In receiver operating characteristic analysis, a TAPSE/PASP cutoff of 0.31 mm/mm Hg (sensitivity: 87.5% and specificity: 75.9%) discriminated RV-arterial uncoupling (Ees/Ea <0.805). Patients with TAPSE/PASP <0.31 mm/mm Hg had a significantly worse prognosis than those with higher TAPSE/PASP. Conclusions: Echocardiographically determined TAPSE/PASP is a straightforward noninvasive measure of RV-arterial coupling and is affected by RV diastolic stiffness in severe pulmonary hypertension. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03403868.

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