scholarly journals Right ventricular pseudoaneurysm in a young adult following right heart catheterization: a rare case report and review of the literature

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Habib Ahmad Esmat ◽  
Naim Ceylan ◽  
Emre Demir ◽  
Akın Çinkooğlu
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Cardiac Imaging ◽  
Imaging Techniques ◽  
Fatal Outcome ◽  
Right Heart Catheterization ◽  
Cardiac Imaging Techniques ◽  
Heart Catheterization ◽  
Right Heart ◽  
Ct Angiogram

Abstract Background Right ventricular pseudoaneurysm is an extremely rare finding than left ventricular pseudoaneurysm, associated with high mortality. The diagnosis of right ventricle pseudoaneurysm is often challenging because of its rarity and lack of typical clinical features. However, advanced cardiac imaging techniques including CT angiogram and MRI can help a timely diagnosis to avoid a fatal outcome. Case presentation The authors present the imaging findings of a right ventricular pseudoaneurysm in a 33-year-old male, presented with dyspnea and chest pain after exertion for 2 weeks. The gated CT and cardiac MRI showed a small outpouching from the right ventricle apex into the pericardial space, consistent with a pseudoaneurysm. He underwent cardiac surgery and pseudoaneurysm resection with a favorable outcome. Conclusion Right ventricular pseudoaneurysm is a very rare complication following right heart catheterization and a potentially life-threatening condition that requires prompt diagnosis and management. Though the lack of its typical clinical presentation is often a diagnostic challenge, advanced cardiac imaging techniques including CT angiogram and MRI may help a timely diagnosis to avoid a fatal outcome.

scholarly journals Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1110
Author(s):  
Ekkehard Grünig ◽  
Christina A. Eichstaedt ◽  
Rebekka Seeger ◽  
Nicola Benjamin
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Contractile Reserve ◽  
Heart Catheterization ◽  
Right Heart ◽  
Heart Size

Various parameters reflecting right heart size, right ventricular function and capacitance have been shown to be prognostically important in patients with pulmonary hypertension (PH). In the advanced disease, patients suffer from right heart failure, which is a main reason for an impaired prognosis. Right heart size has shown to be associated with right ventricular function and reserve and is correlated with prognosis in patients with PH. Right ventricular reserve, defined as the ability of the ventricle to adjust to exercise or pharmacologic stress, is expressed by various parameters, which may be determined invasively by right heart catheterization or by stress-Doppler-echocardiography as a noninvasive approach. As the term “right ventricular contractile reserve” may be misleading, “right ventricular output reserve” seems desirable as a preferred term of increase in cardiac output during exercise. Both right heart size and right ventricular reserve have been shown to be of prognostic importance and may therefore be useful for risk assessment in patients with pulmonary hypertension. In this article we aim to display different aspects of right heart size and right ventricular reserve and their prognostic role in PH.

scholarly journals Pulmonary hypertension in patients with interstitial pneumonia with autoimmune features

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402094411
Author(s):  
Bashar N. Alzghoul ◽  
Robert Hamburger ◽  
Thomas Lewandowski ◽  
Brandon Janssen ◽  
Daniel Grey ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Interstitial Lung Disease ◽  
Right Ventricular ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Linear Regression Analysis ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart

Pulmonary hypertension in interstitial lung diseases is associated with increased mortality and hospitalizations and reduced exercise capacity. Interstitial pneumonia with autoimmune features (IPAF) is a recently described interstitial lung disease. The characteristics of pulmonary hypertension in IPAF patients are unknown. We sought to characterize patients with IPAF based on their echocardiographic probability of pulmonary hypertension and compare patients with and without pulmonary hypertension identified by right heart catheterization. We conducted a retrospective study of patients seen in the interstitial lung disease clinic from 2015 to 2018. Forty-seven patients with IPAF were identified. Patients were classified into low, intermediate and high echocardiographic pulmonary hypertension probabilities. A sub-group analysis of patients with pulmonary hypertension and without pulmonary hypertension (IPAF-PH vs. IPAF-no PH) identified by right heart catheterization was also performed. Linear regression analysis was performed to study the association between 6-min-walk-distance (6MWD) and pulmonary vascular resistance (PVR) while adjusting for age and body mass index. Right ventricular hypertrophy (>5 mm), right ventricular enlargement (>41 mm) and right ventricular systolic dysfunction defined as fractional area change% ≤35 was present in 76%, 24%, and 39% of patients, respectively. Pulmonary hypertension was identified in 12.7% of patients. IPAF-PH patients had higher mean pulmonary artery pressure and lower cardiac output compared to the IPAF-no PH group (34 mmHg vs. 19 mmHg, p = 0.002 and 4.0 vs. 5.7 L/min, p = 0.023, respectively). Lower 6MWD was associated with higher PVR on regression analysis ( p = 0.002). Pulmonologists should be aware that a significant number of IPAF patients may develop pulmonary hypertension. Reduced 6MWD may suggest the presence of pulmonary hypertension in IPAF patients.

Abstract 16661: Fluid Challenge During Right Heart Catheterization for Evaluation of Pulmonary Hypertension Identifies Patients With Decreased Right Ventricular Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vineet A Agrawal ◽  
Amelia Muhs ◽  
Tufik Assad ◽  
Ivan M Robbins ◽  
John Newman ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Fluid Challenge ◽  
Right Heart Catheterization ◽  
Rank Test ◽  
Heart Catheterization ◽  
Stroke Work ◽  
Right Heart ◽  
Prognostic Implications ◽  
Rv Function

Introduction: Fluid challenge during right heart catheterization (RHC) identifies occult left heart diastolic dysfunction (Occ-DD) in 10-20% of patients initially diagnosed with pre-capillary pulmonary hypertension (PH). The prognostic implications of the response to fluid challenge are not known. Abnormal right ventricular (RV) function is a poor prognostic indicator in all forms of PH. Hypothesis: We hypothesized that fluid challenge during RHC identifies patients with worse RV function and survival. Methods: Consecutive patients referred for RHC with fluid challenge from 2009-2016 were studied. Occ-DD was defined by a resting pulmonary arterial wedge pressure (PAWP) < 15 mmHg, and a PAWP > 18 mmHg after 500cc fluid challenge. Resting DD was defined by resting PAWP > 15 mmHg. RV function was assessed by pulmonary artery pulsatility index (PAPi) or RV stroke work index (RVSWI). Statistical analysis was conducted using Kruskal Wallis test. Survival analysis was conducted by log rank test. Results: Of the 310 patients identified, 83% were female with a mean age of 54 + 14 years. The cohort consisted of 204 (66%) patients without DD, 30 (10%) with Occ-DD, and 76 (24%) with resting DD. Patients with Occ-DD were older (59 + 12 vs 51 + 14, p < 0.0001) with greater BMI (31 + 6 vs 28 + 7, p < 0.0001), but had similar prevalence of obesity, hypertension, diabetes mellitus, and coronary disease to all groups. Patients with Occ-DD had lower PAPi (7.8 + 0.4 vs 8.5 + 0.4, p < 0.0001), lower RVSWI (9.9 + 0.8 vs 17.8 + 0.7 mmHg*ml/m2, p < 0.0001) (Figure), and decreased survival (3.7 + 3.5 vs 4.9 + 3.5 years, p < 0.0001) compared to those without DD. After adjustment for RV function, survival was no longer different between groups. Conclusions: Patients with Occ-DD after fluid challenge during RHC have decreased survival due to worse RV function compared to patients without DD. These findings suggest important prognostic implications for fluid challenge in the evaluation of patients with PH.

scholarly journals Right ventricular dimension index by cardiac magnetic resonance for prognostication in connective tissue diseases and pulmonary hypertension

Rheumatology ◽  
2019 ◽  
Author(s):  
Nobuya Abe ◽  
Masaru Kato ◽  
Michihito Kono ◽  
Yuichiro Fujieda ◽  
Hiroshi Ohira ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
Dimension Index

Abstract Objectives Pulmonary hypertension (PH) in patients with CTD is a heterogeneous condition affected by left heart disease, chronic lung disease and thromboembolism as well as pulmonary vascular disease. Recent studies using cardiac magnetic resonance (CMR) have shown that right ventricular dysfunction is predictive for mortality in patients with PH, but limited to pulmonary arterial hypertension. This study aimed to analyse prognostic factors in PH-CTD. Methods This retrospective analysis comprised 84 CTD patients, including SSc, who underwent both CMR and right heart catheterization from 2008 to 2018. Demographics, laboratory findings, and haemodynamic and morphological parameters were extracted. The prognostic value of each parameter was evaluated by multivariate analysis using covariables derived from propensity score to control confounding factors. Results Of 84 patients, 65 had right heart catheterization-confirmed PH (54 pulmonary arterial hypertension, 11 non-pulmonary arterial hypertension). Nine out of these PH patients died during a median follow-up period of 25 months. In 65 patients with PH, right ventricular end-diastolic dimension index (RVEDDI) evaluated by CMR was independently associated with mortality (hazard ratio 1.24; 95% CI: 1.08–1.46; P = 0.003). In a receiver operating characteristic analysis, RVEDDI highly predicted mortality, with area under the curve of 0.87. The 0.5–2-year follow-up data revealed that RVEDDI in both survivors and non-survivors did not significantly change over the clinical course, leading to the possibility that an early determination of RVEDDI could predict the prognosis. Conclusion RVEDDI simply evaluated by CMR could serve as a significant predictor of mortality in PH-CTD. A further validation cohort study is needed to confirm its usability.

Right ventricular function and right heart catheterization as predictors of ECMO requirement in lung transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Garcia Gomez ◽  
V Monivas ◽  
J Goicolea ◽  
J.F Oteo ◽  
J.L Campo-Canaveral De La Cruz ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Lung Transplantation ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Life Support ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure

Abstract Introduction Lung transplantation (LT) often requires extracorporeal life support with extracorporeal membrane oxygenation (ECMO) because of several complications (included acute heart failure) during the intervention. Data on predictors of intraoperative ECMO use in these patients are scarce but it is an interesting topic because ECMO support has been linked to worse outcomes after LT. Purpose The main aim of our study is to assess which pre-surgical characteristics of right ventricular (RV) function and data from right heart catheterization (RHC) could help us to anticipate the need of ECMO in LT. Methods We conducted a retrospective observational study of all patients who underwent LT at our institution along 2018. We analysed data from echocardiogram (ECO) and RHC. All subjects underwent transthoracic echocardiography (TTE) according to the latest ASE/EACVI guidelines. Strain analysis was carried out by speckle-tracking echocardiography (QLAB 10.7, Philips). Results We included all 47 patients who underwent LT from January to December of 2018. They were middle age patients (52±11.8 years old) 51.1% men, 61.7% smokers (other cardiovascular risks: diabetes mellitus (8.5%), hypertension (23.4%) or dyslipidaemia (27.7%)). 24 (51%) of them needed intraoperative ECMO. 21 patients (45%) were evaluated by RHC before LT and ECO quality was good enough to evaluate different data in 41 patients (87%). Variables related to ECMO requirement vs non-ECMO use were: mean pulmonary artery pressure (23.1±7.3 vs 16.67±4.9 mmHg, p=0.027), mean transpulonary gradient (16.9±6.6 vs 8.9±3.6 mmHg, p=0.027) and diastolic transpulmonary gradient (9.8±8.1 vs 2.3±4.7 mmHg, p=0.002) from RHC and RV mid cavity diameter (3.4±0.8 vs 2.8±0.6 mm, p=0.001) from ECO. Besides this, free-wall RV longitudinal strain (FWRVLS) showed a tendency to be lower in patients who required ECMO (17.3±4.5% in vs 21.4±4.5%, p=0.072). Conclusion According to our results, RV mid cavity diameter measured by ECO and mean pulmonary artery pressure, mean and diastolic pulmonary gradients measured by RHC are useful tools to predict which patients could require ECMO during LT. FWRVLS showed an interesting tendency of lower values of it in LT using ECMO. This exploratory finding opens an important investigation line about a parameter which could help us to identify patients with subclinical right ventricle dysfunction. ROC curve Funding Acknowledgement Type of funding source: None

scholarly journals Crucial role of extra-domain A containing fibronectin for the development of pulmonary hypertension and associated right heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Singerer ◽  
K Gruen ◽  
A Schrepper ◽  
L Baez ◽  
M Schwarzer ◽  
...  
Keyword(s):  
Body Weight ◽  
Right Ventricular ◽  
Lung Tissue ◽  
Therapeutic Target ◽  
Neutralizing Antibodies ◽  
Interstitial Fibrosis ◽  
Right Heart Catheterization ◽  
University Hospital ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background Pulmonary vascular and right ventricular myocardial remodelling are unique phenomena in PH progression. Both processes are accompanied by an abundant re-expression of the extra-domain A of fibronectin (ED-A+ Fn) therefore qualifying as promising biomarker or even therapeutic target. Nevertheless, its functional role in PH pathogenesis remains unclear until now. Objective: The purpose of our study was to analyse the development of PH and RHF in a mouse model of monocrotaline (MCT)-induced PH comparing C57BL/6 ED-A+ Fn knockout (KO) and wild-type (WT) mice. Methods PH was induced by subcutaneous injection of a single dose of MCT (60 mg/kg body weight). Subgroups were additionally treated with the dual endothelin receptor antagonist Macitentan (MAC, 15mg/kg body weight per day from day 14 to 28). There were 6 experimental groups: sham-treated control WT mice (WTco, n=4); MCT induced PH WT mice (WTPH, n=6); MCT induced PH WT mice treated with MAC (WTPH_MAC, n=6); sham-treated control KO mice (KOco, n=4); MCT induced PH KO mice (KOPH, n=6); MCT induced PH KO mice treated with MAC (KOPH_MAC, n=6). Between day 26 and 28, transthoracic echocardiography and right heart catheterization were performed. Both, lung and cardiac tissue samples were subjected to histological analyses. Results Right heart catheterization revealed significantly increased RVPsys values in WTPH (87.0±16.4mmHg) compared to WTco (36.1±9.4mmHg; p=0.034) animals, which showed, at least in trend, a diminution in the WTPH_MAC group (67.1±20.9mmHg; p=n.s.). There was a non-significant increase in RVPsys in the KOPH (55.6±14.9mmHg) compared to KOco mice (37.2±5.6mmHg; p=n.s.) without any differences compared to the KOPH_MAC group (60.9±14.0mmHg; p=n.s.). When comparing the WTPH and the KOPH group, RVPsys was significantly lower in the KO animals (p=0.014), while there were no differences between the WTPH_MAC and the KOPH_MAC group (p=n.s.). Echocardiographic evaluation including surrogate parameters of right ventricular (RV) overload and failure were significantly altered in WTPH compared to WTco animals (p&lt;0.05) and could not be shown to be relevantly improved in the WTPH_MAC group (p=n.s.). The majority of echocardiographic parameters did not significantly differ between the KOPH and the KOco group (p=n.s.). Lung tissue analysis revealed significant alterations in both, the WTPH and the KOPH group, each compared to the corresponding control (p&lt;0.05). The level of lung tissue damage was significantly decreased in KOPH compared to WTPH mice (p&lt;0.05). In RV, the amount of interstitial fibrosis was increased in the WTPH (p=0.009) but not in the KOPH group (p=n.s.), each compared to the corresponding controls. Conclusions The findings of the current study underline the hypothesis that ED-A+ Fn is a key player in the pathogenesis of PH and associated RHF. Thus, it might represent a promising therapeutic target, e.g., by the administration of neutralizing antibodies. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Jena

scholarly journals The Role of Four-Dimensional Automatic Right Ventricular Quantification Technology to Determine RV Function and Hemodynamics in Patients With Pulmonary Hypertension Compared With Right Heart Catheterization

2021 ◽  
Vol 8 ◽  
Author(s):  
Weichun Wu ◽  
Bingyang Liu ◽  
Min Huang ◽  
David H. Hsi ◽  
LiLi Niu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Image Quality ◽  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Healthy Controls ◽  
Right Heart ◽  
Quality Image ◽  
Rv Function

Background: Four-dimensional automatic right ventricular quantification technology (4D auto-RVQ) is a new method that can simultaneously measure right ventricular (RV) structure and strain. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. We assessed the 4D auto-RVQ to measure right heart structure, function, and hemodynamics in patients with pulmonary hypertension (PHTN) correlated with right heart catheterization (RHC).Methods: We enrolled a prospective cohort of 103 patients with PHTN and 25 healthy controls between September 2017 and December 2018. All patients with PHTN underwent echocardiography and RHC. Patients were included if they underwent two-dimensional (2D) and 4D auto-RVQ echocardiographic sequences on the same day as RHC. We analyzed RV functional indices using 2D and 4D auto-RVQ analyses. We divided patients with PHTN into three groups according to echocardiographic image quality as follows: high (n = 24), average (n = 48), and poor (n = 4). Hemodynamic parameters were measured using RHC, including mean right atrial pressure, mean pulmonary arterial pressure, RV cardiac index (RV-CI), and pulmonary vascular resistance.Results: There were significant differences in most 2D and 4D auto-RVQ parameters between patients with PHTN and healthy controls. Interobserver variability showed significant agreement with 4D auto-RVQ for most measurements except for 4D end-diastolic volume. Indices measured by auto 4D-RVQ in the high-quality image group had a good correlation with RHC but not in the average- and poor-quality image group. Mid-RV diameter showed the best predictive power for the right RV-CI [area under the curve (AUC) 0.935; 95% confidence interval (CI), 0.714–0.997; p &lt; 0.001]. RV end-systolic volume &gt;121.50 mL had a 71.43% sensitivity and a 100% specificity to predict right RV-CI (AUC, 0.890; 95% CI, 0.654–0.986; p &lt; 0.001).Conclusions: 4D auto-RVQ may be used to estimate RV function and some hemodynamic changes compared with RHC in PHTN patients with high image quality. Furthermore, a large sample of the study is needed to evaluate RV function by 4D auto-RVQ in PHTN patients with average image quality.

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