Post-operative course of pulmonary artery pressure after complete atrioventricular canal defect repair

2021 ◽  
pp. 1-7
Author(s):  
Marie Emeline Pierre Louis ◽  
Adnan Bhutta ◽  
Adrian Holloway ◽  
Peter Gaskin
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Trisomy 21 ◽  
Pulmonary Artery Hypertension ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
The Right ◽  
Complete Atrioventricular

Abstract Complete atrioventricular canal defect is a CHD associated with intra-cardiac shunting of blood, which can lead to irreversible changes in pulmonary vascular resistance and pulmonary artery hypertension if unrepaired. Patients with Trisomy 21 are at risk for early development of pulmonary artery hypertension if left uncorrected.1,2 Objectives: The purpose of this study is to describe the evolution of pulmonary artery hypertension after repair of complete atrioventricular canal defect and to determine the time to normalisation of pulmonary artery pressure in both patients with and without Trisomy 21. Methods: This is a single centre, retrospective analysis of patients with complete atrioventricular canal defect admitted for surgical repair at the University of Maryland Medical Center from 2005 to 2015. T-test or Mann–Whitney test and Chi-Square or Fisher’s exact tests were used to compare the two groups (patients with Trisomy 21 and those without). Repeated measures of analysis of variance and serial measurement analysis were performed. Results: Twenty-nine patients meeting the inclusion criteria underwent repair of complete atrioventricular defects during the study period. The right ventricular pressure estimate remained elevated over time and did not show a significant difference between the two groups. Right ventricular to systolic blood pressure ratios for all patients remained > 0.5 over the time periods assessed. Conclusions: Our study suggests that in patients with complete atrioventricular canal defects, the right ventricular pressure remains elevated and does not normalise on echocardiograms performed up to one year after surgery, suggesting a sustained elevation in pulmonary vascular resistance.

scholarly journals Pulmonary hypertension or cardiology aerobatics

2020 ◽  
Vol 17 (2) ◽  
pp. 66-68
Author(s):  
I. E. Chazova ◽  
T. V. Martynyuk ◽  
N. M. Danilov
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Progressive Increase ◽  
Hemodynamic Pattern

Pulmonary hypertension (PH) is a group of diseases with a hemodynamic pattern of progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP), which leads to right ventricular dysfunction and the development of right ventricular heart failure.

scholarly journals Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Hidenori Moriyama ◽  
Takashi Kawakami ◽  
Masaharu Kataoka ◽  
Takahiro Hiraide ◽  
Mai Kimura ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Vascular Resistance ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Area Change ◽  
Thromboembolic Pulmonary Hypertension ◽  
Rv Function

Background Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV‐specific 3‐dimensional (3D)‐speckle‐tracking echocardiography (STE) in patients with chronic thromboembolic pulmonary hypertension. We also assessed regional wall motion abnormalities in the RV and chronological changes during balloon pulmonary angioplasty (BPA). Methods and Results Twenty‐nine patients with chronic thromboembolic pulmonary hypertension who underwent BPA were enrolled and underwent right heart catheterization and echocardiography before, immediately after, and 6 months after BPA. Echocardiographic assessment of RV function included both 2‐dimensional‐STE and RV‐specific 3D‐STE. Before BPA, global area change ratio measured by 3D‐STE was significantly associated with invasively measured mean pulmonary artery pressure and pulmonary vascular resistance ( r =0.671 and r =0.700, respectively). Dividing the RV into the inlet, apex, and outlet, inlet area change ratio showed strong correlation with mean pulmonary artery pressure and pulmonary vascular resistance before BPA ( r =0.573 and r =0.666, respectively). Only outlet area change ratio was significantly correlated with troponin T values at 6 months after BPA ( r =0.470), and its improvement after BPA was delayed compared with the inlet and apex regions. Patients with poor outlet area change ratio were associated with a delay in RV reverse remodeling after treatment. Conclusions RV‐specific 3D‐STE analysis revealed that 3D RV parameters were novel useful indicators for assessing RV function and hemodynamics in pulmonary hypertension and that each regional RV portion presents a unique response to hemodynamic changes during treatment, implicating that evaluation of RV regional functions might lead to a new guide for treatment strategies.

scholarly journals Diagnostic and prognostic value of right ventricular eccentricity index in pulmonary artery hypertension

2020 ◽  
Vol 10 (2) ◽  
pp. 204589401989977 ◽  
Author(s):  
Lili Wang ◽  
Xiaoling Chen ◽  
Ke Wan ◽  
Chao Gong ◽  
Weihao Li ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Healthy Volunteers ◽  
Prognostic Value ◽  
Pulmonary Artery Hypertension ◽  
Volume Index ◽  
Eccentricity Index ◽  
The Right ◽  
Diagnostic And Prognostic Value

The right ventricle experiences dynamic changes under pressure overload in pulmonary artery hypertension. This study aimed to evaluate the diagnostic and prognostic value of right ventricular eccentricity index (RVEI) in pulmonary artery hypertension. A total of 100 pulmonary artery hypertension patients (mean age, 36.85 (SD, 13.60) years; males, 30.0%) confirmed by right heart catheterization and 147 healthy volunteers (mean age 45.58 (SD, 17.58) years; males, 42.50%) were enrolled in this prospective study. All participants underwent cardiac magnetic resonance imaging (MRI) examination, and balanced steady-state free precession (bSSFP) cine sequences were acquired. RVEI was measured on short-axis cine images at the mid-ventricular level of the right ventricle in end systole. The study found that RVEI was significantly lower in pulmonary artery hypertension patients than in healthy volunteers (1.84 (SD, 0.40) vs. 2.46 (SD, 0.40); p < 0.001). In pulmonary artery hypertension patients, RVEI was correlated with log(NT-proBNP) (r = −0.388; p < 0.001), right ventricular end-diastolic volume index (r = −0.452; p < 0.001), right ventricular end-systolic volume index (r = −0.518; p < 0.001), and right ventricular ejection fraction (r = 0.552; p < 0.001). RVEI could discriminate pulmonary artery hypertension patients from healthy volunteers with 91.8% sensitivity and 68.0% specificity. Over median follow-up of 14.8 months (interquartile range: 6.7–26.9 months), RVEI was demonstrated to be an independent predictor for adverse outcome (HR = 0.076; 95% CI, 0.013-0.458; p = 0.005). In conclusion, MRI-derived RVEI appears to be a useful diagnostic and prognostic value in pulmonary artery hypertension, and it provides incremental value to risk stratification strategy.

scholarly journals Noninvasive Assessment of Right Ventricle function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women with Pre-eclampsia. An Exploratory Study

2020 ◽  
Author(s):  
Ahmed Zaky ◽  
Michael Froelich ◽  
Jacob Meers ◽  
Adam Sturdivant ◽  
Ryan Densmore ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Transthoracic Echocardiography ◽  
Tertiary Care ◽  
Peak Systolic Velocity ◽  
Systemic Circulation ◽  
Artery Pressure ◽  
Academic Center ◽  
The Right

Objectives: Much less attention has been given to the right heart and pulmonary circulation compared to the left heart and systemic circulation in patients with pre-eclampsia (PEC). We used transthoracic echocardiography (TTE) to estimate pulmonary artery pressure and right ventricular function in women with PEC. Methods: A case-control study at a tertiary care academic center. Ten early PEC (<34 week gestation) and nine late PEC (≥34 weeks gestation) patients with eleven early and ten late gestational age-matched controls. Two dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on pulmonary artery acceleration time (PAAT). Pulmonary vascular resistance (ePVR) was estimated from eMPAP and right ventricular (RV) cardiac output. RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD) and lateral tricuspid annular tissue peak systolic velocity (S’) were measured. Results Compared to early controls, in early PEC the eMPAP and ePVR were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, estimated MPAP and estimated PVR were elevated, PAAT was reduced and RVMPI was increased, while TAPSE, TTAD and TV S’ were unchanged. Conclusions: Early PEC is associated with increased eMPAP and ePVR. A subclinical decrement of RV function is noticed. TTE is a useful screening tool for early detection of PH and RV dysfunction in PEC.

Effect of increased pulmonary vascular resistance on right ventricular systolic performance in dogs

1984 ◽  
Vol 246 (3) ◽  
pp. H339-H343 ◽  
Author(s):  
M. Ghignone ◽  
L. Girling ◽  
R. M. Prewitt
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Glass Beads ◽  
Ventricular Systolic Pressure ◽  
Bead Injection ◽  
The Right

We tested the possibility that for a given contractile state and right ventricular systolic pressure (RVSP), rate and extent of ventricular shortening would be reduced as resistance to ejection increased. In eight anesthetized, ventilated dogs, we measured RV and pulmonary artery pressure (Ppa), blood pressure, heart rate, cardiac output (CO), and RV dP/dt before (condition 1) and after (condition 2) pulmonary vascular resistance (PVR) was increased by injection of small (80 micron) glass beads. Glass beads caused a large increase (P less than 0.001) in Ppa and in RVSP and, despite increased RV end-diastolic pressure (EDP), CO and stroke volume (SV) were reduced. A third set of measurements was obtained following a further increase in resistance (condition 3). A comparison of condition 2 with condition 3, despite constant RVSP, constant mean Ppa, and increased EDP, showed a marked fall in CO and SV (P less than 0.001) when glass bead injection increased calculated resistance from 21 (condition 2) to 34 (condition 3) mmHg X 1(-1) X min. RV contractility, as assessed by Vmax and peak dP/dt was similar in both conditions. In five additional dogs, we measured the same parameters as before plus instantaneous pulmonary artery flow in all conditions. In a comparison of conditions 2 and 3, despite constant RVSP and increased EDP, peak and total flow (P less than 0.05) were reduced as resistance to RV ejection increased. We conclude that the right ventricle shortens more slowly and to a smaller extent against the same systolic pressure when its resistive afterload increases.

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