scholarly journals Assessing the spectrum of pulmonary hypertension identified at an Egyptian expert referral center

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mostafa Elshazly ◽  
Amira Ismail Mostafa ◽  
Asmaa Ibrahim ◽  
Irene M. Sabry
Keyword(s):  
Pulmonary Hypertension ◽  
Survival Rate ◽  
Treatment Strategies ◽  
Blood Gases ◽  
Pulmonary Artery Hypertension ◽  
Referral Center ◽  
Arterial Blood ◽  
Female Predominance ◽  
Right Heart Catheter ◽  
6 Minute Walk Test

Abstract Background and objective Pulmonary hypertension is an assorted state that encompasses a spectrum of diseases and is categorized into five groups. The registries are necessary for the identification of risk factors, progression of the disease, outcomes, and effect of treatment strategies on the progression of the disease. The aim of this work was to identify different groups of PH identified at an Egyptian referral center and to compare the demographic and clinical characteristics of each group. Patients and methods This study included 132 patients who were diagnosed with a right heart catheter in the Chest Department, Kasr El-Aini Hospital, Faculty of Medicine, Cairo University, in the period from January 2017 to January 2019. Patients were classified into different groups, then received medical treatment accordingly. Demographic and clinical data were documented. Arterial blood gases, spirometry, and 6-minute walk test (6MWT) were performed. Results The mean age of cases was (43.9±13.69) years; the majority of them were females (72.7%). More than half of the patients (57.5%) had pulmonary artery hypertension (PAH), while 22.7% and 18.3% had pulmonary hypertension due to chronic thrombo-embolic cause and lung cause respectively. The 1-year survival rate was 81.8%. Conclusions The results of the study showed female predominance, the PAH type was the commonest, and the overall 1-year survival rate was 81.8%.

Newborns With Acute Respiratory Distress: Diagnosis and Management

1988 ◽  
Vol 9 (9) ◽  
pp. 279-285
Author(s):  
Richard L. Schreiner ◽  
Niceta C. Bradburn
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress ◽  
Newborn Infant ◽  
Blood Gases ◽  
Indirect Measurement ◽  
Chest Roentgenogram ◽  
Inborn Errors ◽  
Severe Respiratory Distress ◽  
Glucose Determination ◽  
Arterial Blood

If respiratory distress develops in the newborn after he or she has been normal for more than a few hours, bacterial sepsis, inborn errors of metabolism, cardiac disorders, and intracranial hemorrhage should be suspected. It is virtually impossible to determine whether an infant with mild respiratory distress in the first few hours of life will have rapid resolution of disease or progress to severe respiratory distress. That is, it is difficult to differentiate among transient tachypnea of the newborn, sepsis, and pulmonary hypertension in the infant with mild respiratory distress in the first few hours of life. Transient tachypnea is a diagnosis that can only be made with certainty after the infant's respiratory distress has resolved. The newborn infant with mild respiratory distress of more than a few hours' duration requires a minimum number of laboratory tests including chest roentgenogram, hematocrit or hemoglobin, blood glucose determination, direct or indirect measurement of arterial blood gases, and blood cultures. The liberal use of oxygen in the near-term, term, or post-term vigorous but cyanotic infant in the delivery room may decrease the incidence and/or severity of respiratory distress due to pulmonary hypertension. A newborn infant with respiratory distress for more than a few hours should be considered a candidate for infection.

Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 295-300
Author(s):  
G. Ganesh Konduri ◽  
Daisy C. Garcia ◽  
Nadya J. Kazzi ◽  
Seetha Shankaran
Keyword(s):  
Pulmonary Hypertension ◽  
Placebo Group ◽  
Extracorporeal Membrane Oxygenation ◽  
Normal Saline ◽  
Medical Center ◽  
Blood Gases ◽  
Adenosine Infusion ◽  
Term Infants ◽  
Membrane Oxygenation ◽  
Arterial Blood

Objective. Adenosine infusion causes selective pulmonary vasodilation in fetal and neonatal lambs with pulmonary hypertension. We investigated the effects of a continuous infusion of adenosine on oxygenation in term infants with persistent pulmonary hypertension of newborn (PPHN). Design. A randomized, placebo-controlled, masked trial comparing the efficacy of intravenous infusion of adenosine to normal saline infusion over a 24-hour period. Setting. Inborn and outborn level III neonatal intensive care units at a university medical center. Participants. Eighteen term infants with PPHN and arterial postductal Po2 of 60 to 100 Torr on inspired O2 concentration of 100% and optimal hyperventilation (PaCo2 <30 Torr) were enrolled into the study. Study infants were randomly assigned to receive a placebo infusion of normal saline, or adenosine infusion in doses of 25 to 50 µg/kg/min over a 24-hour period. Results. Nine infants each received adenosine or placebo. The two groups did not differ in birth weight, gestational age, or blood gases and ventilator requirements at the time of entry into the study. Four of nine infants in the adenosine group and none of the placebo group had a significant improvement in oxygenation, defined as an increase in postductal PaO2 of ≥20 Torr from preinfusion baseline. The mean PaO2 in the adenosine group increased from 69 ± 19 at baseline to 94 ± 15 during 50 µg/kg/min infusion rate of adenosine and did not change significantly in the placebo group. Arterial blood pressure and heart rate did not change during the study in either group. The need for extracorporeal membrane oxygenation, incidence of bronchopulmonary dysplasia, and mortality were not different in the two groups. Conclusion. Data from this pilot study indicate that adenosine infusion at a dose of 50 µg/kg/min improves PaO2 in infants with PPHN without causing hypotension or tachycardia. Larger trials are needed to determine its effects on mortality and/or need for extracorporeal membrane oxygenation in infants with PPHN.

scholarly journals Transient Pulmonary Artery Hypertension in Holstein Neonate Calves

Animals ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 2277
Author(s):  
Melina Marie Yasuoka ◽  
Bruno Moura Monteiro ◽  
Paulo Fantinato-Neto ◽  
Renan Braga Paiano ◽  
Denise Tabacchi Fantoni ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Blood Gases ◽  
Pulmonary Artery Hypertension ◽  
Right Atrial ◽  
Arterial Blood ◽  
Pulmonary Capillary ◽  
Neonatal Adaptation ◽  
Holstein Calves ◽  
Phase Constant ◽  
The Right

The neonatal period is a challenging phase for calves, and during this phase constant adaptations are required. The aim of the present study was to evaluate the invasive hemodynamics with the Swan-Ganz catheter in neonate calves to understand adaptive changes during the first 30 days of life. A prospective and observational study was conducted with 10 Holstein calves. Assessments of the right atrial pressure (RAP), right ventricular pressure (RVP), pulmonary artery pressure (PAP), pulmonary capillary pressure (PW), cardiac output (CO), heart rate (HR), pulmonary vascular resistance (PVR), and blood gas levels were performed. The analyses of PAP, PVR, PW, HR, sO2, and arterial blood gases differed (p < 0.05) between the evaluated periods. Our results indicated transient pulmonary artery hypertension during the process of extrauterine adaptation during the first 30 days of life. This hypertension must be considered as physiological and consequent to the neonatal adaptation process.

The oxygen dissociation curve: quantifying the shift

Perfusion ◽  
2004 ◽  
Vol 19 (3) ◽  
pp. 141-144 ◽  
Author(s):  
Carole Hamilton ◽  
Barbara Steinlechner ◽  
Eva Gruber ◽  
Paul Simon ◽  
Gregor Wollenek
Keyword(s):  
Ph Value ◽  
Venous Blood ◽  
Critical Role ◽  
Treatment Strategies ◽  
Oxygen Affinity ◽  
Blood Gases ◽  
Dissociation Curve ◽  
Oxyhaemoglobin Dissociation Curve ◽  
Arterial Blood ◽  
The Right

An oxyhaemoglobin dissociation curve (ODC) quantifies the most important function of red blood cells and that is the affinity for oxygen and its delivery to the tissues. Oxygen affinity for haemoglobin plays a critical role in the delivery of oxygen to the tissues and is changed by shifting to the left or right. A shift to the left implies an increased oxygen affinity and, hence, tighter binding due to the higher oxygen saturation in relation to the pO2.On the other hand, a shift to the right corresponds to a decreased oxygen affinity and easier release of oxygen to the tissues. It is well known that the ODC shifts in response to changes in pH, pCO2 and 2,3 diphosphoglycerate. However, how much the ODC shifts has never been quantified. Arterial and venous blood gases were taken during cardiopulmonary bypass and two indices were used to quantify the shift of the ODC; the p50 shift and the SO2 difference. Arterial blood shifted to the right by 49-0.1 mmHg at a pH of 7.24 and shifted to the left by -3.59-0.05 mmHg at a pH of 7.51. The change in arterial saturation was minimal, rising by 0.8% and dropping by -5% and did not correlate to p50 shifting and changes in pH, but demonstrated changes dependent on the concentration of dyshaemoglobins. The venous blood exhibited a greater range of p50 shifting at each pH value. At a pH of 7.24, the p50 shifted to the right by 4.89-2 mmHg and at a pH of 7.51 the p50 shifted to the left by -4±1.8 mmHg. Unlike the arterial blood, the change in saturation correlated well to p50 shifting. It is shown here for the first time how much the curve shifts with changes in pH and how this may be used to evaluate treatment strategies.

scholarly journals THE СLINICAL IMPACT OF PULMONARY ARTERY DISTENSIBILITY INDEX IN PATIENTS WITH PULMONARY HYPERTENSION

2013 ◽  
Vol 19 (2) ◽  
pp. 132-138
Author(s):  
A. V. Kazimli ◽  
A. V. Ryzhkov ◽  
N. S. Goncharova ◽  
A. V. Berezina ◽  
A. V. Naymushin ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Cardiopulmonary Exercise Testing ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Hypertension ◽  
Heart Catheterization ◽  
Contrast Magnetic Resonance ◽  
Thromboembolic Pulmonary Hypertension ◽  
6 Minute Walk Test

Objective.Vascular remodeling in patients with pulmonary artery hypertension (PAH) may be assessed by measurement of contrast magnetic-resonance imaging (CMRI) derived pulmonary artery distensibility (PAD) index. The objective of our study was to investigate whether PAD index could be used as a marker for the evaluation of PAH severity.Design and methods.Forty four patients with PAH (mean age — 42,8 ± 14,5 years, males:females = 11:33) were enrolled: 29 patients with idiopathic pulmonary arterial hypertension, 4 subjects with corrected congenital heart disease, 3 subjects with scleroderma PAH and 8 patients with inoperable chronic thromboembolic pulmonary hypertension. All patients underwent 6-minute walk test, right heart catheterization (RHC), heart ultrasound (ECHO), CMRI, cardiopulmonary exercise testing, and serum N-terminal-pro-brain natriuretic peptide (NT-proBNP) level was defined.Results.PAD index was decreased in PAH patients 11,9 % (9,3-19,7). Patients with decreased PAD index < 20 % had higher NT-proBNP level, lower tricuspid annular systolic velocity and right ventricle/left ventricle ratio by ECHO. Patients with PAD index < 20 % had higher pulmonary artery systolic blood pressure (96,5 ± 22,4 versus 77,9 ± 19,4 mmHg; p < 0,05), and reduced cardiac output which were determined by RHC (3,98 ± 1,1 versus 4,95 ± 1,21 l/min; p < 0,05). Decreased VO2peak was found in patients with PAD index < 20 % (14,8 versus 18,8 ml/min/kg; p = 0,05).Conclusions.PA distensibility index may be used for noninvasive assessment of PAH severity and progression.

Increased vasoreactivity and chronic pulmonary hypertension following thoracic irradiation in sheep

1986 ◽  
Vol 61 (5) ◽  
pp. 1875-1881 ◽  
Author(s):  
E. A. Perkett ◽  
K. L. Brigham ◽  
B. Meyrick
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Reactivity ◽  
Structural Changes ◽  
Blood Gases ◽  
Base Line ◽  
External Diameter ◽  
Thoracic Irradiation ◽  
Arterial Blood ◽  
Chronic Pulmonary Hypertension ◽  
Pulmonary Arterial

Six chronically catheterized sheep were exposed to 1,500-rad whole-lung irradiation and followed for a four-week period. Pulmonary arterial, left atrial and systemic arterial pressures, cardiac output, arterial blood gases, and pH were measured at base line and biweekly following radiation. Pulmonary vasoreactivity to 12% O2, 100% O2, and an analogue of prostaglandin H2 (PGH2-A) was also assessed. Five nonirradiated sheep served as controls. By the 2nd wk following irradiation, pulmonary vascular resistance had doubled. Final pulmonary arterial pressure was increased 50% over the base-line value (base line = 14 +/- 1 cm H2O; final 22 +/- 2; mean +/- SE; P less than 0.05). Arterial PO2 was decreased to approximately 70 Torr throughout the study. In addition, pulmonary vasoreactivity to PGH2-A, but not to breathing 12 or 100% O2, was significantly increased above base line in the irradiated animals (P less than 0.05). Morphometric techniques applied to the lungs in which the pulmonary arterial circulation was distended with barium gelatin mixture, showed extension of muscle into the distal intra-acinar arteries, and a reduction in both the external diameter and the number of barium-filled peripheral arteries in the irradiated animals. Thus thoracic irradiation results in functional and structural changes of chronic pulmonary hypertension and increased pulmonary vasoreactivity to PGH2-A. The structural changes in the peripheral pulmonary arterial bed may contribute to the increased pulmonary vascular reactivity following thoracic irradiation.

Supplemental oxygen reduces right ventricular hypertrophy in monocrotaline-injected rats

1989 ◽  
Vol 66 (4) ◽  
pp. 1642-1648 ◽  
Author(s):  
N. S. Hill ◽  
P. Jederlinic ◽  
J. Gagnon
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Pulmonary Arteries ◽  
Blood Gases ◽  
Dry Weight ◽  
Supplemental Oxygen ◽  
Left Ventricular ◽  
Sprague Dawley ◽  
Arterial Blood ◽  
Early Injury

We evaluated the possible contributory role of hypoxia in the development of monocrotaline-induced pulmonary hypertension. Male Sprague-Dawley rats were injected subcutaneously with monocrotaline (60 mg/kg) or saline in controls and were kept in oxygen-enriched (inspired O2 fraction of 0.35) or compressed air chambers. After 21 days, rats were anesthetized while spontaneously breathing room air, hemodynamic parameters and arterial blood gases were measured, and animals were killed. Right ventricular peak systolic pressures (RVPP), right ventricular-to-left ventricular plus septal weight ratios (RV/LV + S), hematocrits, lung dry weight-to-body weight ratios, and medial thickness of pulmonary arteries were significantly reduced in monocrotaline-injected rats exposed to mild hyperoxia compared with air. The air-exposed monocrotaline-injected rats had significantly more arterial hypoxemia than the other groups, and mild hyperoxia had no effect on any of the measured variables in saline-injected rats. To determine whether the effects of mild hyperoxia occurred early or late after monocrotaline injection, we moved separate groups of rats from air to mild hyperoxia and vice versa 10 days after monocrotaline injection. After 21 days, significant reductions in RVPP and RV/LV + S occurred only in rats exposed to mild hyperoxia during the latter 11 days after injection. Our findings suggest that hypoxia contributes to the development of pulmonary hypertension relatively late after monocrotaline injection in rats but that it does not influence the early injury.

scholarly journals Elimination of nasal obstruction improves pulmonary functions and oxygenation

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eman Sobh ◽  
Fatma Elhussieny ◽  
Taghreed Ismail
Keyword(s):  
Nasal Obstruction ◽  
Blood Gases ◽  
Medical Problem ◽  
Forced Expiratory Volume ◽  
Nasal Packing ◽  
Nasal Pack ◽  
Arterial Blood ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

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