Pulmonary artery ganglionic plexi radiofrequency ablation using non-fluoroscopic navigation for the treatment of pulmonary hypertension: a pilot study

Aim. To evaluate the safety of the pulmonary artery radiofrequency catheter denervation in different pulmonary hypertension (PH) clinical forms.Methods. 6 patients with different clinical forms of PH were included in the study with the further randomization into two groups. Group I patient (n = 3) underwent pulmonary denervation and group II patients (n = 3) underwent a placebo procedure. The examination of patients included routine clinical tests, the measurements of N-terminal precursor of the brain natriuretic peptide (NT-proBNP) levels, coagulation blood tests, ECG recordings, echocardiography (with the estimation of mean pulmonary artery pressure), chest X-ray, the assessment of the respiratory function, right heart catheterization (RHC), six-minute walk test (6MWT), the assessment of the quality of life according to the SF-36 questionnaire. Intraoperative measures indicating the safety of the procedure were also studied.Results. There were no statistically significant differences found in the intraoperative data between the groups. None intraoperative and postoperative complications during in the in-hospital period found. Mean pulmonary artery pressure reduced in two patients without any elevations 24 hours following the intervention. A decrease in mean pulmonary arterial pressure from 48 to 41 mm Hg was observed in a patient with primary PH. The second patient with post-embolic pulmonary hypertension demonstrated a reduction in mean pulmonary artery pressure from 43 to 32 mm Hg. The third patient had no changes according to the RHC. All three patients showed a positive tendency according to the 6MWT and echocardiography, while none of these changes were recorded in Group II. The mean NT-pro-BNP level in Group I decreased from 1767±291 to 488±129 vs. 1519±305 and 1594±337 in Group II, respectively (P = 0.013). Conclusion Pulmonary artery denervation is a safe and promising treatment method, but further studies are required to prove its effectiveness.

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Measures of Right Ventricular Afterload Predict Exercise Pulmonary Hypertension beyond Mean Pulmonary Artery Pressure

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.550 ◽

2021 ◽

Vol 40 (4) ◽

pp. S189

Author(s):

S. Osman ◽

R.F. Bentley ◽

S. Mak

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Right Ventricular ◽

Pulmonary Artery Pressure ◽

Artery Pressure ◽

Right Ventricular Afterload ◽

Mean Pulmonary Artery Pressure ◽

Ventricular Afterload

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P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.951 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Fauvel ◽

O Raitiere ◽

J Burdeau ◽

N Si Belkacem ◽

F Bauer

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Tricuspid Regurgitation ◽

Peak Velocity ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure ◽

Definition Of

Abstract Background Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure >25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure > 20 mm Hg. Purpose The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab. Methods We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter. Results Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p < 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p < 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff > 3m/s used as surrogate for mean pulmonary artery pressure > 20 mm Hg may produce a 111% increase of right heart catheterization demand. Conclusions The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure > 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity > 3 m/s as a screening test leading to more than twice RHC demand.

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Echocardiographic Estimation of Mean Pulmonary Artery Pressure: A Comparison of Different Approaches to Assign the Likelihood of Pulmonary Hypertension

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2017.09.009 ◽

2018 ◽

Vol 31 (1) ◽

pp. 89-98 ◽

Cited By ~ 11

Author(s):

Kristian Hellenkamp ◽

Bernhard Unsöld ◽

Sitali Mushemi-Blake ◽

Ajay M. Shah ◽

Tim Friede ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure

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Serum soluble suppression of tumorigenicity-2 level associates with severity of pulmonary hypertension associated with uncorrected atrial septal defect

Pulmonary Circulation ◽

10.1177/2045894020915832 ◽

2020 ◽

Vol 10 (2) ◽

pp. 204589402091583 ◽

Cited By ~ 1

Author(s):

Reza S. Pratama ◽

Anggoro B. Hartopo ◽

Dyah W. Anggrahini ◽

Vera C. Dewanto ◽

Lucia K. Dinarti

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Right Ventricle ◽

Atrial Septal Defect ◽

Pulmonary Artery Pressure ◽

Septal Defect ◽

Eisenmenger Syndrome ◽

Secundum Atrial Septal Defect ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure

Uncorrected atrial septal defect undergoes right ventricle chronic volume overload which may lead to pulmonary hypertension and Eisenmenger Syndrome. The soluble suppression of tumorigenicity-2 is a left ventricle strain biomarker; however, its role in right ventricle strain is unclear. This study aimed to investigate the implication of serum soluble suppression of tumorigenicity-2 in adult uncorrected atrial septal defect. This was a cross-sectional study. We enrolled 81 adult uncorrected secundum atrial septal defect patients. Clinical and hemodynamic data were collected. Serum samples were withdrawn from the pulmonary artery during right heart catheterization. Serum soluble suppression of tumorigenicity-2 and NT-proBNP levels were measured. Subjects were divided into three groups based on clinical and hemodynamic severity. The correlation of soluble suppression of tumorigenicity-2 with patients' data and comparison among groups were analyzed. A p value <0.05 was considered statistically significant. Results showed that, there were significant correlations between serum soluble suppression of tumorigenicity-2 and mean pulmonary artery pressure ( r = 0.203, p = 0.035) and right ventricle end-diastolic diameter ( r = 0.203, p <0.05). Median serum soluble suppression of tumorigenicity-2 level was incrementally increased from group I (atrial septal defect and no-pulmonary hypertension), group II (left-to-right atrial septal defect and pulmonary hypertension), to group III (Eisenmenger Syndrome): (17.4 ng/mL, 21.8 ng/mL, and 29.4 ng/mL, respectively). A post-hoc analysis showed that serum soluble suppression of tumorigenicity-2 level was significantly different between groups I and III ( p = 0.01). Serum N terminal pro brain natriuretic peptide (NT-proBNP) level was consistently associated with worse clinical and hemodynamic parameters. No correlation was found between serum soluble suppression of tumorigenicity-2 and NT-proBNP level. In conclusion, serum soluble suppression of tumorigenicity-2 level had significant positive correlation with mean pulmonary artery pressure and right ventricle end-diastolic diameter in uncorrected secundum atrial septal defect patients. Higher serum soluble suppression of tumorigenicity-2 level was associated with the presence of pulmonary hypertension and Eisenmenger Syndrome in uncorrected secundum atrial septal defect patients.

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