scholarly journals COVID-19 as a cause of chronic pulmonary hypertension: pathophysiological rationale and potential of instrumental investigations

2021 ◽  
Vol 20 (5) ◽  
pp. 2844
Author(s):  
E. Kobelev ◽  
T. A. Bergen ◽  
A. R. Tarkova ◽  
O. Ya. Vasiltseva ◽  
O. V. Kamenskaya ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Failure ◽  
Pulmonary Function Tests ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Clinical Situation ◽  
Medical Problem ◽  
Pulmonary Angiography ◽  
Computed Tomographic ◽  
Leading Role ◽  
Chronic Pulmonary Hypertension

Coronavirus disease 2019 (COVID-19) is a poorly understood and dangerous medical problem. COVID-19-related pulmonary vessels involvement is a complex set of interrelated pathophysiological processes associated with vascular endothelial dysfunction and accompanied by thrombosis of various localization, vasomotor disorders, severe respiratory failure, as well as pulmonary embolism (PE) resulting in chronic thromboembolic pulmonary hypertension (CTEPH). According to computed tomographic pulmonary angiography, the incidence of PE in patients with COVID-19 ranges from 23 to 30%. The aim of this work was to focus the doctors' attention on the risk of pulmonary hypertension in patients after COVID-19.Despite the ability of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) to infect various organs and systems, the main and most serious complications are pulmonary infiltration, acute respiratory distress syndrome, acute respiratory failure and PE, which in some cases becomes the triggering mechanism for CTEPH development. The literature review presents data on main pathological abnormalities developing in target organs during COVID-19 and playing an important role in increasing the CTEPH risk. The paper describes the main methods of instrumental investigations of CTEPH and an algorithm for its use in COVID-19 survivors.The revealed data demonstrated that the absence of obvious signs of pulmonary hypertension/CTEPH, the cardiopulmonary system abnormalities cannot be ruled out. Therefore, it seems appropriate to actively follow up COVID-19 survivors. A thoroughly, purposefully collected anamnesis, pulmonary function tests and stress echocardiography in an ambiguous clinical situation will play a leading role as they identify cardiopulmonary disorders and provide the doctor with basic information for further planning of patient management.

scholarly journals Diagnostic advances and opportunities in chronic thromboembolic pulmonary hypertension

2015 ◽  
Vol 24 (136) ◽  
pp. 253-262 ◽  
Author(s):  
Andrea M. D'Armini
Keyword(s):  
Pulmonary Hypertension ◽  
Delayed Diagnosis ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Standard Technique ◽  
Pulmonary Angiography ◽  
Computed Tomographic ◽  
Right Heart Catheterisation ◽  
Thromboembolic Pulmonary Hypertension ◽  
Computed Tomographic Pulmonary Angiography ◽  
Operability Assessment

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by the presence of thromboembolic material in the pulmonary circulation, and patients have a poor prognosis without treatment. Patients present with nonspecific symptoms, such as breathlessness and syncope, which means that other more common conditions are sometimes suspected before CTEPH, leading to delayed diagnosis and treatment. This is problematic because CTEPH is potentially curable with surgical pulmonary endarterectomy (PEA); indeed, CTEPH should always be considered in any patient with unexplained pulmonary hypertension (PH).Several key evaluations are necessary and complementary to confirm a diagnosis of CTEPH and assess operability. Echocardiography is initially used to confirm a general diagnosis of PH. Ventilation/perfusion scanning is then essential in the first stage of CTEPH diagnosis, with a wedge-shaped perfusion deficit indicative of CTEPH. This should be followed by right heart catheterisation (RHC) which is mandatory in confirming the diagnosis and providing haemodynamic parameters that are key predictors of the risk associated with PEA and subsequent prognosis. RHC is ideally coupled with conventional pulmonary angiography, the gold-standard technique for confirming the location and extent of disease, and thus whether the obstruction is surgically accessible. Computed tomographic pulmonary angiography is also now routinely used as a complementary technique to aid diagnosis and operability assessment.Recent improvements in the resolution of other noninvasive techniques, such as cardiac magnetic resonance imaging, allow for detailed reconstructions of the vascular tree and imaging of vessel defects, and interest in their use is increasing.

Pulmonary hypertension after ventriculoatrial shunt implantation

2010 ◽  
Vol 113 (6) ◽  
pp. 1279-1283 ◽  
Author(s):  
Stefan Kluge ◽  
Hans Jörg Baumann ◽  
Jan Regelsberger ◽  
Uwe Kehler ◽  
Jan Gliemroth ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Significant Proportion ◽  
Systolic Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Doppler Velocity ◽  
Systolic Pulmonary Artery Pressure ◽  
Function Tests

Object Ventriculoatrial (VA) shunts inserted for the treatment of hydrocephalus are known to be a risk factor for pulmonary hypertension. The aim of this study was to evaluate the incidence of pulmonary hypertension among adult patients with VA shunts. Methods All patients who had received a VA shunt at one of two institutions between 1985 and 2000 were invited for a cardiopulmonary evaluation. The investigation included a thorough history taking, clinical examination, echocardiography, and pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO). Pulmonary hypertension was defined as systolic pulmonary artery pressure > 35 mm Hg at rest. Results The study group consisted of 86 patients, of whom 38 (44%) could be examined. The patients' mean age was 47.1 ± 18.4 years; the median interval between shunt insertion and cardiopulmonary evaluation was 15 years (range 5–20 years). Of the 38 patients, 20 (53%) had Doppler velocity profiles of tricuspid regurgitation that were adequate for the estimation of pulmonary artery systolic pressure. Doppler-defined pulmonary hypertension was observed in 3 patients (8%), 2 of whom underwent right heart catheterization. Chronic thromboembolic pulmonary hypertension was confirmed in both patients, and medical therapy, including anticoagulation, was started. The VA shunt was removed in both cases and replaced with a different type of device. Pulmonary function tests revealed a restrictive pattern in 15% and typical obstructive findings in 9% of patients. In 30% of patients the DLCO was less than 80% of predicted, and blood gas analysis showed hypoxemia in 6% of patients. No significant differences in pulmonary function tests were noted between the patients with and without echocardiographic evidence of pulmonary hypertension. However, patients with pulmonary hypertension had significantly lower DLCO values. Conclusions The authors detected pulmonary hypertension by using Doppler echocardiography in a significant proportion of patients with VA shunts. It is therefore recommended that practitioners perform regular echocardiography and pulmonary function tests, including single-breath DLCO in these patients to screen for pulmonary hypertension to prevent hazardous late cardiopulmonary complications.

Sign in / Sign up

Export Citation Format

Share Document