scholarly journals Results of aortopulmonary collateral arteries coil embolization in pre-fontan patients

2021 ◽  
Vol 35 ◽  
pp. 93-99
Author(s):  
Tran Dac Long ◽  
Nguyen Cong Ha ◽  
Nguyen Trung Kien ◽  
Dao Thi Thu Ha
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Coil Embolization ◽  
Single Ventricle ◽  
Artery Pressure ◽  
Collateral Arteries ◽  
Mean Pulmonary Artery Pressure ◽  
Aortopulmonary Collateral ◽  
Fontan Surgery ◽  
Fontan Patients

Background: Aortopulmonary collateral arteries (APCAs) are common pulmonary blood supply in the group of congenital heart disease with functionally single ventricle. APCAs causes loss of aortic outflow, increase in pulmonary arterial hydrostatic pressure, reducing blood flow from the SVC and IVC to the pulmonary artery (in patients after Glenn and Fontan operations). Therefore, the closure of APCAs is vital in the management of single ventricle patients before and during Fontan operation. The technique of percutaneous APCAs occlusion with coils is a new, effective and better method of control of APCAs, excluding the need for surgical ligation of the APCAs.. Objectives: To evaluate results of aortopulmonary collateral arteries coil embolization  in pre-fontan patients Methods: This is the descriptive clinical and retrospective study Result: 29 patients with average age of 7.9 underwent cardiac catheterization with APCAs coil embolization successfully before the Fontan  surgery. Complication rate was very low. This method effectively reduced mean pulmonary artery pressure with statistical significance. The results of Fontan surgery of this group were better than that in other studies in the rate of diaphragmatic paralysis and chylous effusion Conclusions: The technique of percutaneous APCAs occlusion with coils before Fontan surgery is safe, effective in reducing mean pulmonary artery pressure and improving results of Fontan surgery.

Inflammation and Congenital Heart Disease Associated Pulmonary Hypertension

2015 ◽  
Vol 18 (1) ◽  
pp. 038 ◽  
Author(s):  
Mete Gursoy ◽  
Ece Salihoglu ◽  
Ali Can Hatemi ◽  
A. Faruk Hokenek ◽  
Suleyman Ozkan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cell Distribution ◽  
Inflammation Markers ◽  
Distribution Width ◽  
Artery Pressure ◽  
Lymphocyte Ratio ◽  
Mean Pulmonary Artery Pressure ◽  
Pulmonary Arterial

<strong>Background:</strong> Increased blood flow may trigger pulmonary arterial wall inflammation, which may influence progression of pulmonary artery hypertension in patients with congenital heart disease. In this study, we aimed to investigate the correlation between preoperative inflammation markers and pulmonary arterial hypertension. <br /><strong>Methods:</strong> A total of 201 patients with pulmonary hypertension were enrolled in this study retrospectively; they had undergone open heart surgery between January 2012 and December 2013. Patients’ preoperative C-reactive protein (CRP), neutrophil to lymphocyte ratio, red blood cell distribution width, pulmonary pressures, and postoperative outcomes were evaluated.<br /><strong>Results:</strong> Patient age, neutrophil to lymphocyte ratio, red blood cell distribution width, and CRP were found to be significantly correlated with both preoperative peak and mean pulmonary artery pressures. These data were entered into a linear logistic regression analysis. Patient age, neutrophil to lymphocyte ratio, and CRP were found to be independently correlated with peak pulmonary pressure (P &lt; .001, P &lt; .001, and P = .004) and mean pulmonary artery pressure (P &lt; .001, P &lt; .001, and P = .001), whereas preoperative mean pulmonary artery pressure was found to be independently correlated with intensive care unit stay (P &lt; .001). No parameter was found to be significantly correlated with extubation time and mortality. Eighteen patients had experienced pulmonary hypertensive crisis; in this subgroup, patients’ mean pulmonary artery pressure and neutrophil to lymphocyte ratio were found to be significant (P = .047, P = .003). <br /><strong>Conclusion:</strong> Preoperative inflammation markers may be correlated with the progression of pulmonary hypertensive disease, but further studies with larger sample size are needed to determine the predictive role of these markers for postoperative outcomes.<br /><br />

Prognostic importance of mitral e′ velocity in constrictive pericarditis

2020 ◽  
Author(s):  
Jeong Hoon Yang ◽  
William R Miranda ◽  
Rick A Nishimura ◽  
Kevin L Greason ◽  
Hartzell V Schaff ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Constrictive Pericarditis ◽  
Multivariable Analysis ◽  
Artery Pressure ◽  
Myocardial Disease ◽  
Mean Pulmonary Artery Pressure ◽  
Diastolic Velocity ◽  
Long Term Mortality

Abstract Aims  Increased medial mitral annulus early diastolic velocity (e′) plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e′ velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e′ for long-term mortality after pericardiectomy in patients with CP. Methods and results  We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e′ velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e′ and mean pulmonary artery pressure, respectively (both P &lt; 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e′ and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e′ &lt;15 as opposed to 34 patients (57.6%) in the mixed CP group (P &lt; 0.001). Conclusion  Increased mitral e′ velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e′ and PAWP is present in these patients but there is no direct inverse correlation between them.

Survival and predictors of mortality in patients after the Fontan operation

2020 ◽  
Vol 28 (9) ◽  
pp. 572-576
Author(s):  
Saviga Sethasathien ◽  
Suchaya Silvilairat ◽  
Hathaiporn Kraikruan ◽  
Rekwan Sittiwangkul ◽  
Krit Makonkawkeyoon ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Fontan Operation ◽  
Hazard Ratio ◽  
Early Mortality ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure ◽  
Atrioventricular Valve Regurgitation

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

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

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 &gt;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 &gt; 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 &lt; 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 &lt; 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 &gt; 3m/s used as surrogate for mean pulmonary artery pressure &gt; 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 &gt; 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity &gt; 3 m/s as a screening test leading to more than twice RHC demand.

Evaluation of Mean Pulmonary Artery Pressure Following Experimental Pulmonary Embolism in Dogs

1991 ◽  
Vol 21 (2) ◽  
pp. 248
Author(s):  
Kwang Kon Koh ◽  
Myung A Kim ◽  
Joo Hee Cho ◽  
Myoung Mook Lee ◽  
Young Bae Park ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure

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

2020 ◽  
Vol 10 (2) ◽  
pp. 204589402091583 ◽  
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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