scholarly journals P954 Paps / Actpo ratio indicator of pulmonary arterial ventricle coupling in normal subjects and in pulmonary hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
W Serra ◽  
L M Marangoni ◽  
M G Goldoni ◽  
A C Chetta
Keyword(s):  
Pulmonary Hypertension ◽  
Statistical Analysis ◽  
Right Ventricular ◽  
Interobserver Variability ◽  
Normal Subjects ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Indirect Measure ◽  
Increased Risk ◽  
Pulmonary Arterial

Abstract In Pulmonary Hypertension (PH), the development of dilatation and right ventricular failure (RV) are signs of accelerated progression of the disease resulting in an increased risk of cardiac death, and right ventricular failure. Even the non-invasive assessment of the systolic blood pressure pulmonary artery (PAPs) by well-established doppler echocardiography, this does not give us a measure of ventriculo-pulmonary interaction. Some studies have shown the potential use of echocardiography to indirectly evaluate the PVR and the pulmonary outflow acceleration time (ACTPO), it should be a good correlated indirect measure. To have a measure of the ventriculo-pulmonary interaction, we used a parameter that contained information related to pulmonary pressure and a parameter that was an indicator of pulmonary vascular resistance. We have therefore called it PAPS / ACTPO ratio [strength / surface unit] / [time]. We wanted to study this parameter in apparently healthy subjects to code the normal range. From January 2017 to December 2017, we have studied 60 normal patients subjecting them to a complete two-dimensional echocardiographic / Doppler evaluation of the right function and hemodynamics. Echocardiographic imaging was performed using a Philips IE33 and a 3.5 MHz transducer (Philips Medical Systems, Andover, MA). We planned to evaluate this parameter in patients with Pulmonary Hypertension associated with systemic sclerosis. Statistical analysis. To test the diagnostic power of variables, ROC curves were extrapolated. AUC and cut-off point (max sensitivity + specificity) were also calculated. Pair of variables were correlated by using Pearson’s test. Significance was always set at 0.05. IBM SPSS 25.0 (IBM, Amork, NY) was always used for all the statistical tests. PAPs/ACTpo ratio was measured by two echocardiographers blinded to the clinical data in order to assess interobserver variability Results In normal subjects we found a mean PAPS / ACTPO ratio of 0.26, indicator of an optimal pulmonary arterial ventricle coupling. The first data derived from the only 19 patient analysis shows that those presenting pre-capillary pulmonary hypertension to cardiac catheterization have a PAPS/ACTPO ratio of 0.40 ± 0.05 . Interobserver variability was lower than 5% Conclusion PAPS / ACTPO ratio may be an indicator of pulmonary arterial ventricle coupling. Table 1 PAPs/Act PAPs NYHA 24m Tapse (mm) Act (msc) PVR WUmm/Hg.min.L CAT dx PAPs PAPs/Act R value ,877 ,491 -,076 -,901 ,820 ,795 Sig ,000 ,033 ,757 ,000 ,000 ,000 19 19 19 19 19 19 18 Statistical analysis

scholarly journals New Insights into Pulmonary Hypertension: A Role for Connexin-Mediated Signalling

2021 ◽  
Vol 23 (1) ◽  
pp. 379
Author(s):  
Myo Htet ◽  
Jane. E. Nally ◽  
Patricia. E. Martin ◽  
Yvonne Dempsie
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Pressure ◽  
Right Ventricular ◽  
Small Molecules ◽  
Clinical Condition ◽  
Pulmonary Arterial Pressure ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Paracrine Signalling ◽  
Pulmonary Arterial

Pulmonary hypertension is a serious clinical condition characterised by increased pulmonary arterial pressure. This can lead to right ventricular failure which can be fatal. Connexins are gap junction-forming membrane proteins which serve to exchange small molecules of less than 1 kD between cells. Connexins can also form hemi-channels connecting the intracellular and extracellular environments. Hemi-channels can mediate adenosine triphosphate release and are involved in autocrine and paracrine signalling. Recently, our group and others have identified evidence that connexin-mediated signalling may be involved in the pathogenesis of pulmonary hypertension. In this review, we discuss the evidence that dysregulated connexin-mediated signalling is associated with pulmonary hypertension.

scholarly journals Supra-systemic pulmonary hypertension after complicated percutaneous mitral balloon valvuloplasty: a case report and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jose R. Navas-Blanco ◽  
Justin Miranda ◽  
Victor Gonzalez ◽  
Asif Mohammed ◽  
Oscar D. Aljure
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tissue Perfusion ◽  
Venous Hypertension ◽  
Right Ventricular Failure ◽  
Balloon Valvuloplasty ◽  
Ventricular Failure ◽  
The Moment

Abstract Background The World Symposium of Pulmonary Hypertension in 2018, updated the definition of pulmonary hypertension (PH) as mean pulmonary artery pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to left-heart disease, constitutes the most common cause of PH, and the determination of a co-existent pre-capillary (primary) PH becomes paramount, particularly at the moment of evaluating and managing patients with heart failure. Pulmonary artery pressures above the systemic pressures define supra-systemic PH and generally leads to frank right ventricular failure and high mortality. Case presentation We present the perioperative management of a patient with rheumatic mitral valve disease, initially found to have severe PH due to pulmonary venous hypertension, who underwent percutaneous mitral balloon valvuloplasty complicated with mitral chordae rupture, severe mitral regurgitation and supra-systemic PH. Multiple medical therapies and an intra-aortic balloon pump were used as means of non-surgical management of this complication. Conclusions This case report illustrates the perioperative implications of combined pre- and post-capillary PH and supra-systemic PH, as this has not been widely discussed in previous literature. A thorough literature review of the clinical characteristics of PH, methods to determine co-existent pre- and post-capillary PH components, as well as concomitant right ventricular failure is presented. Severe PH has known detrimental effects on the hemodynamic status of patients, which can ultimately lead to a decrease in effective cardiac output and poor tissue perfusion.

scholarly journals Pulmonary Hypertension in Pregnancy: Critical Care Management

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Adel M. Bassily-Marcus ◽  
Carol Yuan ◽  
John Oropello ◽  
Anthony Manasia ◽  
Roopa Kohli-Seth ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Critical Care ◽  
Right Ventricular ◽  
Pregnant Women ◽  
Signs And Symptoms ◽  
Right Ventricular Failure ◽  
Team Approach ◽  
Ventricular Failure ◽  
Critical Care Management ◽  
New Treatments

Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

Mechanisms of right ventricular failure

ESC CardioMed ◽  
2018 ◽  
pp. 2493-2495
Author(s):  
Joanne A. Groeneveldt ◽  
Anton Vonk Noordegraaf ◽  
Frances S. de Man
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Dysfunction ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Adaptive Mechanisms ◽  
Patient Will ◽  
Pulmonary Arterial ◽  
The Right

In pulmonary arterial hypertension, afterload on the right ventricle is increased. Due to several adaptive mechanisms, the right ventricle is able to cope with a three- to fivefold increase in afterload. However, when adaptive mechanisms are no longer sufficient to compensate for this increase, the patient will develop right ventricular dysfunction and failure. This chapter provides an overview of mechanisms currently considered as having important roles in right ventricular adaptation and right ventricular failure.

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