Use of pressure wire for measurement of pulmonary artery pressure across BT shunt in a child with pulmonary atresia

The modified Fontan procedure may be complicated by prolonged pleural drainage. Predisposing factors are not fully understood. This study examines perioperative variables associated with prolonged effusions. We examined the Fontan procedure in 41 patients. Mean age was 45 months (range, 9 to 113 months). Mean weight was 14.7 kg (range, 6.9 to 30.4 kg). Diagnoses included tricuspid atresia in 29 per cent, pulmonary atresia in 12 per cent, and double-outlet right ventricle in 12 per cent. Fontan revisions were excluded. The extracardiac Fontan was performed in 22 patients (54%) and the lateral tunnel (LT) in 18 (44%). Fenestration was performed in 56 per cent. Ten patients (24%) had prolonged pleural effusions. Mean chest tube output (24.2 vs 14.1 mL/kg/d, P < 0.01), days with chest tubes (10.2 vs 5.8 days, P < 0.01), and length of stay (20.8 vs 8.13 days, P < 0.01) were significantly greater in those with effusions. Preoperative mean pulmonary artery pressure was higher in patients with prolonged effusions (12.7 vs 9.90 mmHg, P = 0.001). No other factors were identified as risk factors. Prolonged pleural effusions (greater than 14 days) are common after the modified Fontan procedure. A higher preoperative mean pulmonary artery pressure may be predictive of these effusions. Fenestration, type of Fontan reconstruction, and size of extracardiac conduit did not predispose to postoperative effusions.

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Inflammation and Congenital Heart Disease Associated Pulmonary Hypertension

The Heart Surgery Forum ◽

10.1532/hsf.1228 ◽

2015 ◽

Vol 18 (1) ◽

pp. 038 ◽

Cited By ~ 2

Author(s):

Mete Gursoy ◽

Ece Salihoglu ◽

Ali Can Hatemi ◽

A. Faruk Hokenek ◽

Suleyman Ozkan ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Neutrophil To Lymphocyte Ratio ◽

Cell Distribution ◽

Inflammation Markers ◽

Distribution Width ◽

Artery Pressure ◽

Lymphocyte Ratio ◽

Mean Pulmonary Artery Pressure ◽

Pulmonary Arterial

Background: Increased blood flow may trigger pulmonary arterial wall inflammation, which may influence progression of pulmonary artery hypertension in patients with congenital heart disease. In this study, we aimed to investigate the correlation between preoperative inflammation markers and pulmonary arterial hypertension. Methods: A total of 201 patients with pulmonary hypertension were enrolled in this study retrospectively; they had undergone open heart surgery between January 2012 and December 2013. Patients’ preoperative C-reactive protein (CRP), neutrophil to lymphocyte ratio, red blood cell distribution width, pulmonary pressures, and postoperative outcomes were evaluated. Results: Patient age, neutrophil to lymphocyte ratio, red blood cell distribution width, and CRP were found to be significantly correlated with both preoperative peak and mean pulmonary artery pressures. These data were entered into a linear logistic regression analysis. Patient age, neutrophil to lymphocyte ratio, and CRP were found to be independently correlated with peak pulmonary pressure (P < .001, P < .001, and P = .004) and mean pulmonary artery pressure (P < .001, P < .001, and P = .001), whereas preoperative mean pulmonary artery pressure was found to be independently correlated with intensive care unit stay (P < .001). No parameter was found to be significantly correlated with extubation time and mortality. Eighteen patients had experienced pulmonary hypertensive crisis; in this subgroup, patients’ mean pulmonary artery pressure and neutrophil to lymphocyte ratio were found to be significant (P = .047, P = .003). Conclusion: Preoperative inflammation markers may be correlated with the progression of pulmonary hypertensive disease, but further studies with larger sample size are needed to determine the predictive role of these markers for postoperative outcomes.

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Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism

Internal Medicine ◽

10.2169/internalmedicine.9473-17 ◽

2018 ◽

Vol 57 (5) ◽

pp. 647-654

Author(s):

Masaomi Gohbara ◽

Keigo Hayakawa ◽

Azusa Hayakawa ◽

Yusuke Akazawa ◽

Yukihiro Yamaguchi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Glucose Level ◽

Acute Pulmonary Embolism ◽

Artery Pressure ◽

Admission Glucose

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Measures of Right Ventricular Afterload Predict Exercise Pulmonary Hypertension beyond Mean Pulmonary Artery Pressure

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.550 ◽

2021 ◽

Vol 40 (4) ◽

pp. S189

Author(s):

S. Osman ◽

R.F. Bentley ◽

S. Mak

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Right Ventricular ◽

Pulmonary Artery Pressure ◽

Artery Pressure ◽

Right Ventricular Afterload ◽

Mean Pulmonary Artery Pressure ◽

Ventricular Afterload

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CHANGES IN PULMONARY ARTERY PRESSURE DURING CARDIOPULMONARY BYPASS

Journal of Thoracic Surgery ◽

10.1016/s0096-5588(20)30137-9 ◽

1958 ◽

Vol 36 (4) ◽

pp. 604-620

Author(s):

James B. Littlefield ◽

J. Francis Dammann ◽

Phyllis R. Ingram ◽

William H. Muller

Keyword(s):

Cardiopulmonary Bypass ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Artery Pressure

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Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt

Cardiology in the Young ◽

10.1017/s1047951120004734 ◽

2021 ◽

pp. 1-5

Author(s):

Sakshi Sachdeva ◽

Shyam S. Kothari ◽

Saurabh K. Gupta ◽

Sivasubramanian Ramakrishnan ◽

Anita Saxena

Keyword(s):

Tract Infection ◽

Pulmonary Artery ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Pulmonary Artery Pressure ◽

Lower Respiratory Tract ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Artery Pressure

Abstract We sought to examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications. In a prospective single-centre observational study, 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated non-invasively using shunt gradient by echocardiography and systolic blood pressure measured non-invasively. Median pulmonary artery systolic pressure during lower respiratory tract infection was only mildly (although statistically significantly) elevated during lower respiratory tract infection [60 (42–74) versus 53 (40–73) mmHg, (p < 0.0001)]. However, clinically significant change in pulmonary artery systolic pressure defined as the increase of >10 mmHg was present in only 9 (20%) patients. In the absence of hypoxia or acidosis, only a small minority (9%, n = 4) showed significant pulmonary artery systolic pressure rise >10 mmHg. In the absence of hypoxia or acidosis, severe lower respiratory tract infection in patients with acyanotic CHD results in only mild elevation of pulmonary artery systolic pressure in most of the patients.

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Prognostic importance of mitral e′ velocity in constrictive pericarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa133 ◽

2020 ◽

Author(s):

Jeong Hoon Yang ◽

William R Miranda ◽

Rick A Nishimura ◽

Kevin L Greason ◽

Hartzell V Schaff ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Constrictive Pericarditis ◽

Multivariable Analysis ◽

Artery Pressure ◽

Myocardial Disease ◽

Mean Pulmonary Artery Pressure ◽

Diastolic Velocity ◽

Long Term Mortality

Abstract Aims Increased medial mitral annulus early diastolic velocity (e′) plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e′ velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e′ for long-term mortality after pericardiectomy in patients with CP. Methods and results We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e′ velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e′ and mean pulmonary artery pressure, respectively (both P < 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e′ and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e′ <15 as opposed to 34 patients (57.6%) in the mixed CP group (P < 0.001). Conclusion Increased mitral e′ velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e′ and PAWP is present in these patients but there is no direct inverse correlation between them.

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Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.130 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

KIRILL Malikov ◽

MARINA Kirichkova ◽

MARIA Simakova ◽

NARECK Marukyan ◽

OLGA Moiseeva

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Pulmonary Artery Pressure ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Reverse Remodeling ◽

Free Wall ◽

Artery Pressure ◽

Balloon Pulmonary Angioplasty ◽

Before And After ◽

The Right

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

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