The Problem after Lung Transplantation for Idiopathic Pulmonary Artery Hypertension Is not the Right Ventricle - Awake ECMO for LV Remodelling

2012 ◽  
Vol 94 (10S) ◽  
pp. 211
Author(s):  
I. Tudorache ◽  
C. Kuehn ◽  
W. Sommer ◽  
M. Avsar ◽  
O. Wiesner ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Lung Transplantation ◽  
Pulmonary Artery Hypertension ◽  
The Right

scholarly journals Feasibility of oxygen sensitive cardiac magnetic resonance of the right ventricle in pulmonary artery hypertension

2019 ◽  
Vol 9 (5) ◽  
pp. 502-512
Author(s):  
Karthigesh Sree Raman ◽  
Michael Stokes ◽  
Angela Walls ◽  
Rebecca Perry ◽  
Peter M. Steele ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Hypertension ◽  
Oxygen Sensitive ◽  
The Right

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 Epigenetic Regulation of Pulmonary Arterial Hypertension-Induced Vascular and Right Ventricular Remodeling: New Opportunities?

2020 ◽  
Vol 21 (23) ◽  
pp. 8901
Author(s):  
Jordy M. M. Kocken ◽  
Paula A. da Costa Martins
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Ventricular Remodeling ◽  
Pulmonary Artery Hypertension ◽  
Pulmonary Arterial ◽  
And Migration ◽  
Ventricle Hypertrophy ◽  
The Right ◽  
Disease Exposure

Pulmonary artery hypertension (PAH) is a rare chronic disease with high impact on patients’ quality of life and currently no available cure. PAH is characterized by constant remodeling of the pulmonary artery by increased proliferation and migration of pulmonary arterial smooth muscle cells (PASMCs), fibroblasts (FBs) and endothelial cells (ECs). This remodeling eventually leads to increased pressure in the right ventricle (RV) and subsequent right ventricle hypertrophy (RVH) which, when left untreated, progresses into right ventricle failure (RVF). PAH can not only originate from heritable mutations, but also develop as a consequence of congenital heart disease, exposure to drugs or toxins, HIV, connective tissue disease or be idiopathic. While much attention was drawn into investigating and developing therapies related to the most well understood signaling pathways in PAH, in the last decade, a shift towards understanding the epigenetic mechanisms driving the disease occurred. In this review, we reflect on the different epigenetic regulatory factors that are associated with the pathology of RV remodeling, and on their relevance towards a better understanding of the disease and subsequently, the development of new and more efficient therapeutic strategies.

Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

2012 ◽  
Vol 15 (2) ◽  
pp. 119 ◽  
Author(s):  
I. Halil Algin ◽  
Aytekin Yesilay ◽  
N. Murat Akcar
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Symptomatic Disease ◽  
Coronary Artery Fistulas ◽  
The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

scholarly journals Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure

2021 ◽  
Author(s):  
Isaac Wamala ◽  
Christopher J. Payne ◽  
Mossab Y. Saeed ◽  
Daniel Bautista-Salinas ◽  
David Van Story ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Tricuspid Regurgitation ◽  
Diastolic Pressure ◽  
Right Heart Failure ◽  
Lower Grade ◽  
Ventricular Assist ◽  
Valve Function ◽  
Right Ventricular Assist Device ◽  
The Right

Abstract Purpose In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload. Methods In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels. Results Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m2 and 1.26 (IQR 1.05–1.57) L/min/m2 at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m2. Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m2 at 5 min (p = 0.114), 30 min (p = 0.013) and 60 (p = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF (p = 0.046), a lower diastolic pressure at RHF (p = 0.019) and lower mean arterial pressure at RHF (p = 0.024) were significantly associated with higher SRVAD effectiveness. Conclusions Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness.

scholarly journals 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

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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