Pulmonary Hypertension

2019 ◽  
pp. 238-243
Author(s):  
Renata G. Ferreira ◽  
Andreas Schuler
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Preoperative Evaluation ◽  
Disease Process ◽  
Underlying Disease ◽  
Noncardiac Surgery ◽  
Heart Catheterization ◽  
Perioperative Morbidity ◽  
Artery Pressure

Pulmonary hypertension (PHTN) is a rare yet devastating disease. PHTN is defined as a mean pulmonary artery pressure of 25 mm Hg or greater at rest, measured during right heart catheterization. The survival without therapy is only 2.8 years. Its estimated prevalence ranges from 0.001 to 0.01. In noncardiac surgery, PHTN is considered to be an important predictor of complications, with perioperative morbidity ranging from 14% to 24%. Given this potential morbidity, careful preoperative evaluation and understanding of risks and management of these patients is strongly encouraged as it may improve outcomes after surgery. The perioperative risk and management among patients with PHTN undergoing noncardiac surgery may differ. Therefore, it is important for the anesthesiologist to understand the underlying disease process causing elevation of the pulmonary artery pressure when evaluating the risks and benefits of the proposed procedure.

Pulmonary Hypertension

2013 ◽  
Author(s):  
George K Istaphanous ◽  
Andreas W Loepke
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Pulmonary Artery ◽  
Arterial Hypertension ◽  
Pulmonary Artery Pressure ◽  
Disease Process ◽  
Underlying Disease ◽  
Artery Pressure ◽  
Pulmonary Arterial ◽  
Made In

Pediatric pulmonary arterial hypertension (PAH) is characterized by a pathologically elevated pulmonary artery pressure in children. The etiology of PAH is multifactorial, and while its prognosis is closely related to the reversibility of the underlying disease process, much progress has recently been made in its diagnosis and treatment, significantly decreasing the associated morbidity and mortality.

scholarly journals Effect of Ketamine in Pulmonary Hypertensive Children

2017 ◽  
Vol 6 (1) ◽  
pp. 23-26
Author(s):  
Jeju N Pokharel ◽  
M R Upreti ◽  
D R Shakya ◽  
Shyam Raj Regmi ◽  
Urmila Shakya ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Artery Pressure ◽  
Before And After ◽  
Uncommon Condition

Pulmonary hypertension is not an uncommon condition in clinical setting. Pulmonary artery (PA) pressure may increase during anesthesia because of the hypoxia, hypoventilation and acidosis. Keeping these factors constant there are also other possibilities which can increase the PA pressure, for example drugs. Among them ketamine is known to increase PA pressure in adults especially when they have baseline increased PA pressure. In few literatures it is claimed that in children ketamine may be safe even in those with pulmonary hypertension. We are using ketamine as a component of intravenous anesthesia in catheterization lab during right heart catheterization, pressure measurement and saturation evaluation. We thought it was necessary to evaluate the effect to ketamine on pulmonary artery pressure in pediatric patients in our setting. Altogether fifteen children diagnosed with pulmonary hypertension wer anesthetized with ketamine based anesthesia and the pulmonary artery pressure was evaluated in cardiac catheterization laboratory before and after 5, 10 and 15 min of injection of the ketamine (2mg/kg body weight) intravenously. We found in our study only about 6.2% increment in pulmonary artery pressure after 5 minutes of the injection of the ketamine and the pressure came to the pre-injection level at 10 to 15 minutes of the injection In conclusion of this preliminary study with limited number of the cases, ketamine can be used safely without much problems in pulmonary hypertensive children secondary to the increased blood flow to the lungs.

scholarly journals Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure

2020 ◽  
Vol 9 ◽  
pp. 204800402097383
Author(s):  
Simon Wernhart ◽  
Jürgen Hedderich
Keyword(s):  
Older Adults ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Vital Capacity ◽  
Heart Catheterization ◽  
Systolic Pulmonary Artery Pressure ◽  
Operating Characteristics ◽  
Artery Pressure ◽  
Non Invasive

Objective Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH. Methods and design We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC. Main outcome measures In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PAmean, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis. Results We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VCmax), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08–4.65) and 1.86 (1.11–3.21) for a 1 l decrease in VCmax. On their own, VCmax proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH. Conclusions We provide a combinatorial model to predict PH from sPAP and VCmax in older adults, which may help to avoid invasive procedures.

scholarly journals Advances in nutritional status of patients with connective tissue-associated pulmonary hypertension

2021 ◽  
Vol 233 ◽  
pp. 02002
Author(s):  
Jiang Jinyan ◽  
Li Jin ling ◽  
Chengjie
Keyword(s):  
Pulmonary Hypertension ◽  
Connective Tissue ◽  
Pulmonary Artery ◽  
Connective Tissue Disease ◽  
Pulmonary Artery Pressure ◽  
Pathological Condition ◽  
Rare Complication ◽  
Heart Catheterization ◽  
Right Heart ◽  
Artery Pressure

Connective Tissue Disease (CTD) is an autoimmune disease involving connective tissues, including sjogren syndrome (pSS), rheumatoid arthritis (RA), systemic sclerosis (SSc), mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), etc. [1,2]. Pulmonary Arterial Hypertension (PAH) refers to a pathological condition in which the pulmonary artery pressure rises above a certain threshold, causing right heart failure and death [3]. PAH refers to the mean Pulmonary Artery Pressure (mPAP) of greater than 25 mmHg and the pulmonary wedge pressure (PAWP) of less than 15mmhg under right heart catheterization (RHC) at rest [4,5]. The only criterion for examining pulmonary hypertension is right cardiac catheterization. Connective tissue disease-associated pulmonary hypertension (CTD-PAH) is a rare complication of PAH, characterized by high mortality, venous and cardiac involvement and poor prognosis [6-8].

scholarly journals Pulmonary artery ganglionic plexi radiofrequency ablation using non-fluoroscopic navigation for the treatment of pulmonary hypertension: a pilot study

2019 ◽  
Vol 7 (4S) ◽  
pp. 36-46 ◽  
Author(s):  
S. E. Mamchur ◽  
E. V. Tokmakov ◽  
O. A. Nagirniak ◽  
E. A. Khomenko ◽  
T. Y. Chichkova ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Heart Catheterization ◽  
Artery Pressure ◽  
Clinical Forms ◽  
Positive Tendency ◽  
Mean Pulmonary Artery Pressure ◽  
Group I ◽  
Group Ii

Aim. To evaluate the safety of the pulmonary artery radiofrequency catheter denervation in different pulmonary hypertension (PH) clinical forms.Methods. 6 patients with different clinical forms of PH were included in the study with the further randomization into two groups. Group I patient (n = 3) underwent pulmonary denervation and group II patients (n = 3) underwent a placebo procedure. The examination of patients included routine clinical tests, the measurements of N-terminal precursor of the brain natriuretic peptide (NT-proBNP) levels, coagulation blood tests, ECG recordings, echocardiography (with the estimation of mean pulmonary artery pressure), chest X-ray, the assessment of the respiratory function, right heart catheterization (RHC), six-minute walk test (6MWT), the assessment of the quality of life according to the SF-36 questionnaire. Intraoperative measures indicating the safety of the procedure were also studied.Results. There were no statistically significant differences found in the intraoperative data between the groups. None intraoperative and postoperative complications during in the in-hospital period found. Mean pulmonary artery pressure reduced in two patients without any elevations 24 hours following the intervention. A decrease in mean pulmonary arterial pressure from 48 to 41 mm Hg was observed in a patient with primary PH. The second patient with post-embolic pulmonary hypertension demonstrated a reduction in mean pulmonary artery pressure from 43 to 32 mm Hg. The third patient had no changes according to the RHC. All three patients showed a positive tendency according to the 6MWT and echocardiography, while none of these changes were recorded in Group II. The mean NT-pro-BNP level in Group I decreased from 1767±291 to 488±129 vs. 1519±305 and 1594±337 in Group II, respectively (P = 0.013). Conclusion Pulmonary artery denervation is a safe and promising treatment method, but further studies are required to prove its effectiveness.

Sarcoidosis-Associated Pulmonary Hypertension

2017 ◽  
Vol 38 (04) ◽  
pp. 450-462 ◽  
Author(s):  
Oksana Shlobin ◽  
Robert Baughman
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Lung Disease ◽  
Pulmonary Artery Pressure ◽  
Ct Scanning ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Double Blind ◽  
Artery Pressure ◽  
Fibrotic Lung Disease

AbstractSarcoidosis-associated pulmonary hypertension (SAPH) is found in 5 to 20% of sarcoidosis patients. Elevated pulmonary artery pressure may be due to multiple factors, including vasculocentric, parenchymal, and mechanical, as well as comorbidities such as cardiac sarcoidosis and sleep apnea. Most SAPH patients have fibrotic lung disease, but SAPH may be present in those without advanced parenchymal lung disease. Several features have been shown to suggest SAPH, including reduced DLCO, shortened 6-minute walk distance, with or without desaturation, and the presence of increased pulmonary artery to aorta ratio on CT scanning. Echocardiography remains an important tool for the evaluation of SAPH but may both over- or underestimate the severity of pulmonary artery pressure. Right heart catheterization remains the definitive test to make the diagnosis. There have been several reports on the value of different modalities of treating SAPH. These include prospective clinical trials and one double-blind placebo-controlled randomized trial. Evidence-based guidelines for treatment of SAPH are discussed in this review.

scholarly journals Poor Tricuspid Regurgitation Signal on Echocardiogram: How Does It Correlate with Pulmonary Artery Pressure as Measured by Right Heart Catheterization?

2021 ◽  
Author(s):  
Mohammad Aziz ◽  
Steven Romero ◽  
Matthew Price ◽  
Rajeev Mohan
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Artery Pressure ◽  
Upper Limit ◽  
Lower Likelihood ◽  
Rule Out

Abstract BackgroundTricuspid Regurgitation (TR) gradient on echocardiogram is used to approximate pulmonary artery pressure (PAP) on echocardiography. A common dilemma is encountered when PAP measurement is indeterminate due to poor TR signal. We hypothesized that patients with poor TR signal would be unlikely to have pulmonary hypertension (PH) on right heart catheterization (RHC). MethodsWe performed a retrospective analysis of 141 patients who underwent RHC and had a corresponding echocardiogram showing poor TR signal within 2 months of RHC. A cutoff of 25 mm Hg was used as the upper limit of normal to define PH. ResultsFifty percent of patients had mean PAP (mPAP) greater than 25 mm Hg. 82% of values were 35 mm Hg or below. ConclusionsPoor TR signal does not rule out PH but may indicate lower likelihood of severe PH.

scholarly journals Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401876227 ◽  
Author(s):  
Cihangir Kaymaz ◽  
Ozgur Yasar Akbal ◽  
Aykun Hakgor ◽  
Hacer Ceren Tokgoz ◽  
Ibrahim Halil Tanboga ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Normal Population ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Systolic Pulmonary Artery Pressure ◽  
Poor Agreement ◽  
Artery Pressure ◽  
Systematic Biases

Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP − 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech-Hanssen (0.65 × PASP − 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland–Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.

scholarly journals Correlation of Pulse Wave Transit Time with Pulmonary Artery Pressure in a Porcine Model of Pulmonary Hypertension

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1212
Author(s):  
Fabian Mueller-Graf ◽  
Jonas Merz ◽  
Tim Bandorf ◽  
Chiara Albus ◽  
Maike Henkel ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Transit Time ◽  
Pulse Wave ◽  
Correlation Coefficients ◽  
Physiological Basis ◽  
Artery Pressure ◽  
Hypoxic Vasoconstriction ◽  
Pulse Wave Transit Time

For the non-invasive assessment of pulmonary artery pressure (PAP), surrogates like pulse wave transit time (PWTT) have been proposed. The aim of this study was to invasively validate for which kind of PAP (systolic, mean, or diastolic) PWTT is the best surrogate parameter. To assess both PWTT and PAP in six healthy pigs, two pulmonary artery Mikro-Tip™ catheters were inserted into the pulmonary vasculature at a fixed distance: one in the pulmonary artery trunk, and a second one in a distal segment of the pulmonary artery. PAP was raised using the thromboxane A2 analogue U46619 (TXA) and by hypoxic vasoconstriction. There was a negative linear correlation between PWTT and systolic PAP (r = 0.742), mean PAP (r = 0.712) and diastolic PAP (r = 0.609) under TXA. During hypoxic vasoconstriction, the correlation coefficients for systolic, mean, and diastolic PAP were consistently higher than for TXA-induced pulmonary hypertension (r = 0.809, 0.778 and 0.734, respectively). Estimation of sPAP, mPAP, and dPAP using PWTT is feasible, nevertheless slightly better correlation coefficients were detected for sPAP compared to dPAP. In this study we establish the physiological basis for future methods to obtain PAP by non-invasively measured PWTT.

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