scholarly journals Parameters of acute vasoreactivity testing after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 17 (3) ◽  
pp. 53-58
Author(s):  
Sergey Y. Yarovoy ◽  
Irina E. Chazova ◽  
Yuri G. Matchin ◽  
Nikolay M. Danilov
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Structural Parameters ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Hemodynamic Parameters ◽  
Artery Pressure ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension

Aim.To study the effect of balloon pulmonary angioplasty (BPA) on the changes of pulmonary artery pressure, cardiac output and structural parameters of pulmonary arteries after acute vasoreactivity testing (AVT) in inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods.The prospective study included 22 patients with inoperable CTEPH. 11 patients underwent intravascular ultrasound (IVUS) of the pulmonary arteries. The assessment of clinical and hemodynamic parameters, vasoreactivity, structural parameters of the pulmonary arteries according to IVUS data was performed at 2 visits before the first BPA and after a series of BPA. Results.The patients underwent 2.31.4 stages of BPA. The follow up was 160 (85; 248) days. Positive changes after a series of BPA were revealed in clinical (functional class, distance in the 6-minute walk test, level of brain natriuretic peptide) and hemodynamic (systolic and mean pulmonary artery pressure, right atrium pressure, etc.) parameters. The results of the AVT after BPA demonstrated a decrease in the portion of non-responders from 63.6 to 55.5%, and a group of responders (16.7%) has appeared. According to IVUS before and after AVT, the response to iloprost administration was observed basically in branches of subsegmental pulmonary arteries and initially corresponded to the process of vasodilation. However, after a series of BPA there was noted a paradoxical reaction in the middle section after the AVT a decrease in the vessel lumen and an increase in the thickness and area of the vessel wall. This effect is probably associated with the response to the test at the level of the microvasculature, as in pulmonary arterial hypertension before the onset of its pronounced structural changes. The data obtained confirm the reverse remodeling of the pulmonary vessels and the restoration of vasoreactivity after a series of BPA. Conclusion.BPA improves clinical and hemodynamic parameters, as well as pulmonary vasoreactivity, in inoperable patients with CTEPH. AVT may be included in the recommendations for the examination of patients with CTEPH to assess the effectiveness of BPA and determine the disease prognosis.

Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

2014 ◽  
Vol 12 (4) ◽  
pp. 186-192 ◽  
Author(s):  
David Poch ◽  
Victor Pretorius
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Artery Wedge Pressure ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

Long Term Results of Pulmonary Endarterectomy (PEA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). The Pavia Endarterectomy Program.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4006-4006
Author(s):  
Franco Piovella ◽  
Andrea M. D’Armini ◽  
Marisa Barone ◽  
Vincenzo Emmi ◽  
Chiara Beltrametti ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Nyha Class ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Class I ◽  
Pulmonary Endarterectomy ◽  
Artery Pressure ◽  
Thromboembolic Pulmonary Hypertension

Abstract Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease which results from obstruction of the major pulmonary arteries by incompletely resolved or organized pulmonary emboli which have become incorporated into the pulmonary artery wall, eventually causing an increase in pulmonary vascular resistances. Pulmonary endarterectomy (PEA) is the treatment of choice. Careful pre- and post-operative management is essential for a successful outcome following PEA. In 1994, we started in Pavia a program in which members of a multidisciplinary team work in close interaction with the aim of increase experience in the challenging problems these patients present in the evaluative, surgical, and post-operative phases of their care. So far, 134 PEAs have been performed. Preoperatively, New York Heart Association (NYHA) class distribution was respectively 3-II, 56-III, and 75-IV; mean pulmonary artery pressure and pulmonary vascular resistances were 47 ± 13 mmHg and 1149 ± 535 dynes/sec/cm−5 respectively. The overall operative mortality has been 9.7% (in 2005 mortality rate was 4.5%). At present, 92% of the PEA patients are actively participating in the follow-up study. Follow-up visits are at 3 months after PEA, yearly for the following 5 years, and then at 7, 10, and 15 years postoperatively. Both early and late survivals were excellent. Survival rate at 3 months, 1 year, and 3 years were respectively of 89.5±2.7%, 87.3±3.0%, and 82.7±3.6%. Survival rates had not changed at 5, 7, and 10 years postoperative. Three months after PEA, 29 (58%) subjects were within NYHA class I, 18 (36%) in class II, and 3 (6%) in class III. At 1-year follow-up, 40 (80%) patients were within NYHA class I, 10 (20%) in class II. A statistically significant difference exists not only between the preoperative and the postoperative data (p <0.0001), but also between the functional status at 3 months and the other two postoperative controls (p <0.001). Table summarizes the results of hemodynamic tests collected at three months, one year and three years on the first 35 patients who completed the follow-up program. Hemodynamic data from 35 patients participating to the Pavia Pulmonary Endarterectomy Program with complete 3-year follow-up. CVP mPAP CO CI PVR PVRI CVP (mmHg) central venous pressure; mPAP (mmHg) mean pulmonary artery pressure; CO (L/min) cardiac output; CI (L/min/m2) cardiac index; PVR (dynes/sec/cm-5) pulmonary vascular resistances; PVRI (dynes/sec/cm-5/m2) pulmonary vascular resistances index; RV-EF (%) right ventricle ejection fraction. RV-EF A: Before-PEA 7±6 48±12 3.3±0.9 1.8±0.5 1125±412 2027±731 15±8 B:Before discharge 5±4 25±10 5.2±1.1 2.9±0.5 289±142 505±234 32±8 C: 3 months 2±2 24±11 5.1±1.4 2.8±0.6 231±198 542±271 32±7 D: 1 year 1±2 23±12 5.0±1.1 2.7±0.6 290±191 531±343 35±8 E: 3 years 2±2 24±12 4.9±1.1 2.6±0.5 317±226 579±393 34±8 p value A vs. B: nsA vs. C, D, and E: <0.0001B vs. C, D and E: <0.05 A vs. B, C, D and E: <0.0001 A vs. B, C, D and E: <0.0001 A vs. B, C, D and E: <0.0001 A vs. B, C, D and E: <0.0001 A vs. B, C, D and E: <0.0001 A vs. B, C, D and E:

scholarly journals SUBTRACTION PULMONARY ANGIOGRAPHY IN DIAGNOSIS OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

2018 ◽  
pp. 40-49
Author(s):  
T. N. Veselova ◽  
A. Yu. Demchenkova ◽  
T. V. Martynyuk ◽  
N. M. Danilov ◽  
S. K. Ternovoy ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Angiography ◽  
Walk Test ◽  
Artery Pressure ◽  
Thromboembolic Pulmonary Hypertension ◽  
6 Minute Walk Test ◽  
Minute Walk

Purpose. To assess the state of the vascular bed and perfusion of the lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by the method of subtraction computed tomography (CT).Materials and methods. Between November 2015 and May 2018, 65 patients with diagnosis of CTEPH were examined. All patients were examined on a computer tomograph Aquilion ONE 640 VISION Edition (Toshiba Medical Systems) with 320 rows of detectors, slice thickness – 0,5 mm. Assessment of perfusion disorders was carried out using new software, which allows combining contrast and noncontrast images by subtraction. Were analyzed parameters of the parenchyma, blood supply and perfusion status with the calculation of indices of obstruction and perfusion disorders. The obstruction index was compared with the index of perfusion abnormalities, a 6-minute walk test, and mean pulmonary artery pressure according to the right heart catheterization data. Results. The significant correlation was found between the obstruction index and the index of perfusion disorders in patients with CTEPH (r = 0.605; p = 0.000001). Interrelations between vascular-perfusion indices (an obstruction index and an index of perfusion disorders), mean pulmonary artery pressure and distance in a 6-minute walk test were not revealed.Conclusion. Subtraction CT pulmonary angiography allows to assess the severity of vascular lesion and perfusion disorders within a single study, also determine the effectiveness of treatment in patients with CTEPH.

The protective effects of radiofrequency pulmonary artery denervation on the progression of chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Rudenko ◽  
D Feshchenko
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Control Group ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Mean

Abstract   This study aimed to assess the safety and efficacy of radiofrequency pulmonary artery denervation with the Simplicity system in patients with distal chronic thromboembolic pulmonary hypertension. Methods and results 60 chronic thromboembolic pulmonary hypertension patients with mean pulmonary artery pressure &gt;25 mm Hg and absence of proximal artery lesion defined by pulmonary angiography were randomized into 2 groups. Group 1 included 30 patients who underwent pulmonary artery denervation procedure. The other 30 patients were assigned to the control group (only angio plus right heart catheterization). The procedure of pulmonary artery denervation was performed at the lateral wall of main pulmonary artery and ostium of the left and right pulmonary arteries using the electrode from Simplicity denervation system. The programmed ablation parameters were temperature &gt;50°C and time = 120 s. Using the coronary guiding technique, the tip of electrode was applied at each spot rotating the tip with pace of 2 mm. The success was defined by decrease of mean pulmonary artery pressure &gt;10%, absence of complications. The primary end point was comparison of mean pulmonary artery pressure change from baseline to 12 months in pulmonary artery denervation group compared with change from baseline to 12 months in control group. The secondary point was change in 6-min walk distance and pulmonary vascular resistance at the 12-month follow-up. There were no complications after pulmonary artery denervation. The hemodynamic success was achieved in 93% of all cases. The mean number of radiofrequency applications to achieve success was 10.3 per patient. During follow-up period 3 patients died in pulmonary artery denervation group: (1 died of gastro-intestinal bleeding, 2 – of right ventricular failure) and 3 patients in control group. The mean decreases in the mean pulmonary artery pressure were 8.7 mm Hg in the pulmonary artery denervation group and 3.1 mm Hg in control group (p&lt;0.05). After pulmonary artery denervation in comparison with the control group was observed significant decrease in pulmonary vascular resistance (8.3±2.8 WU vs. 11.2±3.7). 6-min walk distance significantly increased by 81 m after pulmonary artery denervation and 29 m in control group (p&lt;0.05). This improvement was associated with significant improvements in the WHO functional class. Conclusions The usage of the Simplicity denervation system in pulmonary artery denervation procedure is safe and effective. Further studies are required to determine the role of pulmonary artery denervation in the treatment of chronic thromboembolic pulmonary hypertension. The next step of pulmonary artery denervation development will be the use of this method combined with recommended treatment (medical therapy, pulmonary endarterectomy and balloon pulmonary angioplasty) as additional option, that may sufficiently improve outcomes in some patients Funding Acknowledgement Type of funding source: None

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