Role of Endothelin-1 Receptor Antagonist in Reducing Perioperative Pulmonary Arterial Hypertension after Surgical Correction of Ventricular Septal Defect

Background: This study was designed to determine the role of oral ambrisentan, an endothelin-1 receptor, in reducing perioperative pulmonary arterial hypertension during surgical correction of ventricular septal defect.Methods: This study was carried out among 54 patients of ventricular septal defect with pulmonary arterial hypertension undergoing surgical correction. The patients were divided into two groups; study group received oral ambrisentan, an endothelin-1 receptor antagonist peri-operatively, starting one week before surgery. Pulmonary arterial pressure was measured by echocardiography, cardiac catheterization and directly from pulmonary artery during surgical procedure.Results: Pulmonary arterial pressure was reduced significantly in the group in which oral amrisentan was given perioperatively. There was further reduction of pulmonary arterial pressure at discharge from hospital and at one month follow-up.Conclusion: Oral ambrisentan can reduce pulmonary arterial pressure perioperatively in patients underwent surgical correction of ventricular septal defect.Cardiovasc. j. 2016; 9(1): 55-59

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Atrial septal defect closure with an Amplatzer septal occluder fenestrated with a coronary stent in a child with pulmonary arterial hypertension

Cardiology in the Young ◽

10.1017/s1047951112001771 ◽

2012 ◽

Vol 23 (5) ◽

pp. 692-696 ◽

Cited By ~ 5

Author(s):

Gregory J. Skinner ◽

Robert M. Tulloh ◽

Andrew J. Tometzki ◽

Ingram Schulze-Neick ◽

Gareth J. Morgan

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Pressure ◽

Arterial Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Arterial Pressure ◽

Severe Disease ◽

Idiopathic Pulmonary Arterial Hypertension ◽

Stent Insertion ◽

Pulmonary Arterial

AbstractThe presence of an atrial septal defect in pulmonary hypertension has benefits and detractions. Even in idiopathic pulmonary arterial hypertension, a significant left-to-right shunt at atrial level may increase the pulmonary arterial pressure and exacerbate the disease. However, it is well recognised that the presence of an atrial communication may be protective in subgroups with severe disease, allowing maintenance of cardiac output during times of increased pulmonary resistance. In the present paper, we present the case of a young boy with significant idiopathic pulmonary arterial hypertension and an atrial septal defect. We report our technique of septal occlusion using a device to decrease left-to-right shunting with concomitant stent insertion in that device to maintain the potential for right-to-left shunting during times of high pulmonary arterial pressure.

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Diastolic Pulmonary Arterial Pressure as a Prognostic Indicator for Closure of Atrial Septal Defect with Severe Pulmonary Arterial Hypertension

Journal of Hypertension Open Access ◽

10.4172/2167-1095.1000231 ◽

2016 ◽

Vol 5 (3) ◽

Author(s):

Yan Chaowu ◽

Pan Xiangbin

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Pressure ◽

Arterial Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Arterial Pressure ◽

Prognostic Indicator ◽

Pulmonary Arterial ◽

Severe Pulmonary Arterial Hypertension

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Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients

Experimental Biology and Medicine ◽

10.1177/1535370218775321 ◽

2018 ◽

Vol 243 (9) ◽

pp. 754-761

Author(s):

Jie Liu ◽

Lei Fei ◽

Guang-Qing Huang ◽

Xiao-Ke Shang ◽

Mei Liu ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Myocardial Perfusion ◽

Arterial Pressure ◽

Right Ventricle ◽

Arterial Hypertension ◽

Pulmonary Arterial Pressure ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Mean Pulmonary Arterial Pressure ◽

Pulmonary Arterial

Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients’ long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients. Furthermore, myocardial perfusion imaging was not observed in the normal subjects but in pulmonary arterial hypertension patients, especially severe pulmonary arterial hypertension subgroup, and showed potential diagnostic properties for pulmonary arterial hypertension. In conclusion, mean pulmonary arterial pressure levels are correlated with several right heart catheterization and echocardiography markers in pulmonary arterial hypertension patients; echocardiography and 99mTc myocardial perfusion can be used to evaluate right ventricle performance in pulmonary arterial hypertension patients. Impact statement In this study, we analyzed the clinical parameters for evaluating RV function, including right ventricle catheterization (RHC), echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging (MPI) in normal Asian subjects and PAH patients ( n = 23 for each group). Our results demonstrated that six RHC indexes, four echocardiography indexes and MPI index were significantly altered in PAH patients and correlated with the levels of mean pulmonary arterial pressure. Importantly, we evaluated the diagnostic performance of MPI and found that MPI has a strong diagnostic accuracy in PAH patients. The findings from this study will be of interest to clinical investigators who make diagnosis and therapeutic strategies for PAH patients.

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Profile of Endothelin-1, Nitric Oxide, and Prostacyclin Levels in Pulmonary Arterial Hypertension Related to Uncorrected Atrial Septal Defect: Results from a Single Center Study in Indonesia

Cardiology Research and Practice ◽

10.1155/2020/7526508 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Lucia Kris Dinarti ◽

Anggoro Budi Hartopo ◽

Dyah Wulan Anggrahini ◽

Ahmad Hamim Sadewa ◽

Budi Yuli Setianto ◽

...

Keyword(s):

Nitric Oxide ◽

Pulmonary Arterial Hypertension ◽

Plasma Level ◽

Pulmonary Artery ◽

Arterial Hypertension ◽

Atrial Septal Defect ◽

Pulmonary Artery Pressure ◽

Septal Defect ◽

Endothelin 1 ◽

Pulmonary Arterial

Background and Objectives. Pulmonary arterial hypertension (PAH) pathomechanism involves an increased plasma level of endothelin-1 and a reduced plasma level of prostacyclin and nitric oxide. Whether similar mechanisms prevail in PAH associated with atrial septal defect (ASD) is unclear. This study aimed to investigate the relationship of endothelin-1, prostacyclin, and nitric oxide with PAH in uncorrected ASD in Indonesian population. Methods. The study design was cross-sectional. The subjects were adult uncorrected secundum ASD with PAH. Pulmonary artery pressure was measured with right heart catheterization. Pulmonary venous blood was obtained during catheterization for measuring endothelin-1, prostacyclin, and nitric oxide. Correlation tests were performed to determine any association between biomarkers and mean pulmonary artery pressure (mPAP). The levels of biomarkers were compared based on the severity of PAH. Statistical significance was determined at p<0.05. Results. Forty-four subjects were enrolled in this study. Endothelin-1 level and mPAP had significant moderate positive correlation (r = 0.423 and p value = 0.004). However, no significant correlation was observed between prostacyclin, nitric oxide levels, and mPAP. The pattern of endothelin-1, prostacyclin, and nitric oxide was distinctive. Levels of endothelin-1 were incrementally increased from mild, moderate, to severe PAH. The levels of prostacyclin and nitric oxide had similar pattern in association with the severity of PAH, which was increased in mild-to-moderate PAH but decreased in severe PAH. Conclusions. There was a distinctive pattern of endothelin-1, prostacyclin, and nitric oxide based on severity of PAH in adult uncorrected ASD. Significant correlations existed between endothelin-1 and the severity of PAH and mPAP.

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