A patient with pulmonary hypertension waiting for donor lungs during the pandemic: 194 days on extracorporeal life support including 143 days on pulmonary artery to left atrium shunt

2022 ◽  
Author(s):  
M Balik ◽  
J Rulisek ◽  
M Flaksa ◽  
M Porizka ◽  
F Mosna ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Left Atrium ◽  
Life Support ◽  
Extracorporeal Life Support

scholarly journals Veno-Arterial Extracorporeal Life Support (ECLS) After Bilateral Lung and Heart-Lung Transplantations for Pulmonary Hypertension

2016 ◽  
Vol 35 (4) ◽  
pp. S371-S372
Author(s):  
T. Kortchinsky ◽  
S. Mussot ◽  
S. Rezaiguia-Delclaux ◽  
M. Artiguenave ◽  
E. Fadel ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bilateral Lung

scholarly journals The role of extracorporeal life support in the management with severe idiopathic pulmonary artery hypertension undergoing lung transplantation: are those patients referred too late?

2019 ◽  
Vol 11 (S6) ◽  
pp. S929-S937
Author(s):  
Anton Sabashnikov ◽  
Prashant N. Mohite ◽  
Mohamed Zeriouh ◽  
Bartlomiej Zych ◽  
Diana García-Sáez ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Lung Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pulmonary Artery Hypertension

scholarly journals Trans-Aortic or Pulmonary Artery-Based Drainage for Left Ventricular Unloading and Veno-Arterial Extracorporeal Life Support Management in a Porcine Cardiogenic Shock Model.

2020 ◽  
Author(s):  
Paolo Meani ◽  
Mikulas Mlcek ◽  
Mariusz Kowalewski ◽  
Giuseppe Maria Raffa ◽  
Federica Jiritano ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Stasis ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Stroke Work ◽  
Organ Perfusion ◽  
Suction Device

Abstract Background The use of peripheral veno-arterial extracorporeal life support (V-A ECLS) as a mechanical circulatory support in cardiogenic shock has increased dramatically over the last years. However, increased afterload may jeopardize left ventricle (LV) recovery and cause blood stasis and pulmonary edema. Therefore, several LV unloading techniques have been developed and used with limited understanding of the actual difference among them. The aim of the present study was to compare a trans-aortic suction device (Impella) and pulmonary artery (PA) drainage, for LV unloading and V-A ECLS management as well as efficacy in a porcine cardiogenic shock (CS) model Methods A dedicated CS model compared included twelve female swine (21± 1,8-weeks old and weighing 54,3 ± 4,6 kg) supported with V-A ECLS and randomized to Impella or PA-related LV drainage. LV unloading and end-organ perfusion were evaluated through the pulmonary artery catheter and the LV pressure/volume analysis. All the variables were collected at baseline, profound CS, V-A ECLS support with maximum flow and when Impella or PA cannula run on top. Results CS was successfully induced in all twelve animals. Impella resulted in a marked drop of LVEDV compared to a slight decrease in the PA cannula group, resulting in an overall stroke work (SW) and Pressure-Volume Area (PVA) reductions with both techniques. However, SW reduction was significant in the Impella CP group (VA ECMO 3998.82027.6 mmHg x mL vs VAECMO + Impella 1796.9±1033.9 mmHg x ml, p value 0,016), leading to a more consistent PVA reduction (Impella reduction 34,7% vs PA cannula reduction 9,7%) In terms of end organ perfusion, central and mixed O 2 saturation improved with V-A ECLS, and subsequently, remaining unchanged with either Impella or PA cannula as unloading strategy Conclusions Trans-aortic suction and PA drainage provided effective LV unloading during V-A ECLS while maintaining adequate end-organ perfusion. Trans-aortic suction device provides a greater LV unloading effect and reduces more effectively the total LV stroke work.

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Dalya Munves Ferguson ◽  
Vikas S. Gupta ◽  
Pamela A. Lally ◽  
Matias Luco ◽  
KuoJen Tsao ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Systolic Pressure ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Inpatient Outcomes ◽  
Increased Risk

<b><i>Introduction:</i></b> Pulmonary hypertension (PH) is the major pathophysiologic consequence of congenital diaphragmatic hernia (CDH). We aimed to evaluate the association between early CDH-associated PH (CDH-PH) and inpatient outcomes. <b><i>Methods:</i></b> The CDH Study Group registry was queried for infants born 2015–2019 with echocardiograms before 48h of life. PH was categorized using echocardiographic findings: none, mild (right ventricular systolic pressure &#x3c;2/3 systemic), moderate (between 2/3 systemic and systemic), or severe (supra-systemic). Univariate and multivariate analyses were performed. Adjusted Poisson regression was used to assess the primary composite outcome of mortality or oxygen support at 30 days. <b><i>Results:</i></b> Of 1,472 patients, 86.5% had CDH-PH: 13.9% mild (<i>n</i> = 193), 44.4% moderate (<i>n</i> = 631), and 33.2% severe (<i>n</i> = 468). On adjusted analysis, the primary outcome of mortality or oxygen support at 30 days occurred more frequently in infants with moderate (incidence rate ratio [IRR] 1.8, 95% confidence interval [CI], 1.2–2.6) and severe CDH-PH (IRR 2.0, 95% CI, 1.3–2.9). Extracorporeal life support (ECLS) utilization was associated only with severe CDH-PH after adjustment (IRR 1.8, 95% CI, 1.0–3.3). <b><i>Discussion/Conclusion:</i></b> Early, postnatal CDH-PH is independently associated with increased risk for mortality or oxygen support at 30 days and utilization of ECLS. Early echocardiogram is a valuable prognostic tool for early, inpatient outcomes in neonates with CDH.

scholarly journals The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Ying Zhang ◽  
Xiao-Han Ding ◽  
Rongsheng Rao ◽  
Yiqin Wang ◽  
Fang Pang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricle ◽  
Pulmonary Artery ◽  
Left Atrium ◽  
Right Atrium ◽  
Associated Factors ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Maintenance Dialysis ◽  
Esrd Patients

Aim: To determine the prevalence of pulmonary hypertension (PH) and its associated factors among end-stage renal disease (ESRD) patients who underwent maintenance dialysis.Methods: A total of 491 patients received echocardiography examinations and underwent pulmonary artery systolic pressure (PASP) assessments. A subgroup of 283 patients were subjected to plasma creatinine (Cr) and blood urea nitrogen concentration (BUN) tests, routine blood examinations and electrolyte analysis. First, we compared the differences in echocardiographic, Cr and BUN, blood routine and electrolyte parameters between PH and non-PH groups. The correlations between PASP and the parameters mentioned above were also analyzed. Furthermore, univariate and adjusted logistic regression analyses were performed to identify the independent associated factors.Results: The incidence of PH among ESRD patients who were treated with maintenance dialysis was 34.6%. Most of the echocardiographic parameters, including end-diastolic internal diameters of the left atrium, left ventricle, right atrium, and pulmonary artery, as well as interventricular septum mobility, left ventricular posterior wall mobility, fractional shortening, stroke volume and left ventricle ejection fraction (LVEF), were associated with PH. Furthermore, Mg2+ (p = 0.037) and Cl− (p = 0.043) were significantly associated with PASP. However, after adjustments were made in the regression analysis, only internal diameters of the left atrium, right atrium, and LVEF were independently associated with PH.Conclusion: PH is prevalent, with a relatively high incidence among ESRD patients who undergo maintenance dialysis. The sizes of the left and right atria as well as LVEF were independently associated with PH, but further cohort and basic mechanistic studies are needed to confirm this finding.

scholarly journals Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension

2019 ◽  
Vol 8 (1) ◽  
pp. 84-92 ◽  
Author(s):  
Sofia Martin-Suarez ◽  
Gregorio Gliozzi ◽  
Mariafrancesca Fiorentino ◽  
Antonio Loforte ◽  
Valentina Ghigi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thromboembolic Pulmonary Hypertension

The active molecular form of plasma adrenomedullin is extracted in the pulmonary circulation in patients with mitral stenosis: possible role of adrenomedullin in pulmonary hypertension

2000 ◽  
Vol 100 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Toshio NISHIKIMI ◽  
Seiki NAGATA ◽  
Tatsuya SASAKI ◽  
Fumiki YOSHIHARA ◽  
Noritoshi NAGAYA ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Left Atrium ◽  
Pulmonary Circulation ◽  
Mitral Stenosis ◽  
Molecular Form ◽  
Femoral Vein ◽  
Active Form ◽  
Molecular Forms ◽  
Main Site

Adrenomedullin (AM), a novel hypotensive peptide, preferentially dilates pulmonary vessels rather than systemic vessels. This suggests the possibility that AM is a circulating hormone which participates in regulation of the pulmonary circulation. A recent study revealed that two molecular forms of AM, i.e. a mature, active form of AM (AM-m) and an intermediate, inactive, glycine-extended form of AM (AM-Gly), circulate in human plasma. In the present study we investigated the production and clearance sites and pathophysiological significance of the two molecular forms of AM in the pulmonary circulation in patients with mitral stenosis. We measured the plasma levels of AM-m and total AM (AM-T; AM-m+AM-Gly) using a recently developed specific immunoradiometric assay, and thus calculated plasma AM-Gly levels, in blood samples obtained from the femoral vein, pulmonary artery, left atrium and aorta of 28 consecutive patients with mitral stenosis (20 females and eight males; age 53±10 years). Patients with mitral stenosis had significantly higher venous concentrations of AM-T, AM-Gly and AM-m than age-matched normal controls (AM-T, 15.9±2.5 and 10.6±2.1 pmol/l respectively; AM-Gly, 14.0±2.1 and 9.8±1.9 pmol/l respectively; AM-m, 1.9±0.6 and 1.1±0.3 pmol/l respectively; each P < 0.001). There was a significant decrease in the concentrations of AM-m and AM-T between the pulmonary artery and the left atrium (AM-T, 16.1±2.7 and 14.0±2.4 pmol/l respectively; AM-m, 2.0±0.6 and 0.7±0.2 pmol/l respectively; each P < 0.001); however, there were no differences in plasma AM-Gly levels between the pulmonary artery and the left atrium (14.1±2.3 and 13.5±2.3 pmol/l respectively). The venous concentrations of AM-m, AM-Gly and AM-T showed similar correlations with mean pulmonary artery pressure (AM-T, r = 0.67; AM-Gly, r = 0.63; AM-m, r = 0.59; each P < 0.001) and total pulmonary vascular resistance (AM-T, r = 0.77; AM-Gly, r = 0.70; AM-m, r = 0.75; each P < 0.001). These results suggest that the plasma concentration of AM-m is increased in parallel with those of AM-Gly and AM-T, and that the main site for clearance of AM-m from the plasma is the lung; the extracted AM-m in the lungs may help to attenuate the increased pulmonary arterial resistance in secondary pulmonary hypertension due to mitral stenosis.

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