Results of aortopulmonary collateral arteries coil embolization in pre-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.

Exercise-Induced Pulmonary Hypertension: How to Define, Diagnose, and Treat At-Risk Patients

Introduction Pulmonary hypertension is a devastating disease with a rapid progression of symptoms leading to high patient mortality. It is characterized by high blood pressure in the pulmonary vasculature and poor pulmonary perfusion, resulting in patient fatigue, dyspnea, and syncope, especially upon physical exertion. A sub-clinical form of pulmonary hypertension also exists which is referred to as exercise induced pulmonary hypertension, where patients display normal resting hemodynamic properties but abnormal pulmonary responses to exercise. Discussion Recent evidence suggests early intervention and treatment of pulmonary hypertension can improve patient outcomes. However, there is a lack of clinical evidence supporting effective treatments for exercise induced pulmonary hypertension (EIPH), arguably the earliest stage of pulmonary hypertension. This is due in part to the removal of EIPH from official guidelines such as the European Respiratory Society in 2008. EIPH was removed from clinical guidelines due to a lack of consensus on the definition and standardized testing procedures for diagnosing EIPH. Emerging evidence suggests that exercise testing following a standardized protocol of stress echocardiography or right heart catheterization of patients may allow for the classification of EIPH as a mean pulmonary artery pressure/cardiac output slope > 3 mmHg/L/min, and/or mean pulmonary artery pressure > 30 mmHg with a pulmonary vascular resistance > 3 Wood Units. Conclusion Providing evidence for a consensus definition of EIPH, along with a validated, standardized testing procedure, will hopefully foster the progression of research on EIPH and further the development of treatments and improve patient outcomes for people with pulmonary hypertension.

Efficacy and Safety of Percutaneous Pulmonary Artery Subtotal Occlusion and Chronic Total Occlusion Intervention in Chronic Thromboembolic Pulmonary Hypertension

Background: Balloon pulmonary angioplasty (BPA) is an emerging percutaneous therapy for patients with inoperable chronic thromboembolic pulmonary hypertension, and patients with mean pulmonary artery pressure ≤30 mm Hg have an excellent survival. Common vascular lesion types are ring-like stenoses (type A), web lesions (type B), subtotal occlusions (type C), chronic total occlusions (CTOs; type D), and tortuous lesions (type E). Occlusive lesions (ie, subtotal occlusions and CTOs) are the most challenging. Risk and benefit of pulmonary occlusive lesion intervention in chronic thromboembolic pulmonary hypertension has not been studied. We evaluated the impact of percutaneous pulmonary artery subtotal occlusion and CTO intervention on BPA treatment response. Methods: One hundred twenty patients underwent 712 BPA procedures between April 2014 and October 2019 at the Medical University of Vienna. Clinical features and hemodynamics were assessed at baseline and 6 to 12 months after the last BPA session. Results: A total of 2542 lesions were targeted: 720 occlusions (28.3%; 352 CTOs and 368 subtotal occlusions) and 1822 nonocclusion lesions (71.7%). Complications occurred in 6.0% of all procedures (severe complications in 0.4% of all procedures). The overall success rate for recanalization of occlusions was 81% (subtotal occlusions [type C lesions], 98%; CTOs [type D lesions], 50%). Number of successfully treated lesions of any type (β, −0.86 [−1.19 to −0.53]; P <0.001), number of successfully treated occlusions (β, −2.17 [−3.38 to −0.97]; P =0.001), and number of successfully treated nonocclusion lesions (β, −0.81 [−1.25 to −0.37]; P <0.001) emerged as predictors of relative change in the mean pulmonary artery pressure. The impact on relative change in the mean pulmonary artery pressure was higher for CTOs (β, −5.88 [−10.49 to −1.26]; P =0.014) than for subtotal occlusions (β, −2.51 [−4.18 to −0.83]; P =0.004). Conclusions: The number of successfully treated vascular lesions predicts treatment response to BPA. The number of successfully recanalized occlusions (particularly CTOs) appears to have the strongest impact on change in mean pulmonary artery pressure, highlighting the importance of advanced BPA technique.

Comparison of cardiovascular and psychological profile of young military men after COVID-19 with and without pneumonia

Aim. To compare the cardiovascular and psychological profile of young military population after coronavirus disease 2019 (COVID-19) with/without pneumonia.Material and methods. We examined 26 military men under 30 years of age (22,3±3,7 years/21,0 [19,8; 24,3] years) with documented COVID 19 (3 months±2 weeks after two virus-negative polymerase chain reaction tests). The participants were divided into 2 groups: experimental group (n=16) — those with COVID-19 pneumonia; comparison group (n=10) — those without pneumonia. All subjects underwent a complex of clinical and diagnostic tests.Results. Military men with COVID-19 pneumonia were significantly older (23,0 [20,5; 28,5] years vs 19,5 [19,0; 20,0] years, p=0,001). They had a prolonged PQ interval (154,5 [140,0; 163,5] ms vs 137,0 [134,0; 144,0] ms; p=0,014). According to echocardiography, the following parameters were significantly larger in experimental group: anteroposterior right ventricular dimension (26,0 [24,5; 27,5] mm vs 23,5 [22,0; 25,0] mm, p=0,012), right atrium length (48,0 [46,0; 51,5] mm and 45,5 [44,0; 47,0] mm, p=0,047), tricuspid regurgitation peak gradient (18,0 [15,5; 22,0] mm vs 14,0 [12,0; 20,0] mm, p=0,047), pulmonary artery systolic pressure (PASP) (30,3 [27,6; 34,0] mm Hg vs 23,0 [20,5; 30,5] mm Hg, p=0,038), mean pulmonary artery pressure (20,3 [18,9; 22,7] mm Hg vs 16,8 [14,5; 20,6] mm Hg, p=0,038). The estimated pulmonary vascular resistance was significantly higher in the study group (1,50 [1,2; 1,8] Wood units vs 1,17 [1,1; 1,2] Wood units, p<0,001). The groups did not differ significantly in terms of symptoms of stress (perceived stress scale score of 10) and anxiety and depression disorders (GAD7 and PHQ9 questionnaires), quality of life (SF-36 survey).Conclusion. In young military personnel, COVID-19 pneumonia in the long term after the disease is associated with longer PQ interval, older age and larger right heart sizes on echocardiography, as well as with a higher tricuspid regurgitation peak gradient, PASP, mean pulmonary artery pressure, and pulmonary vascular resistance. In this category of population, no association was found between the severity of COVID-19 and psychological status parameters.

Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model

Background Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs. Methods Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pulse pressure, pulse pressure variation) and centrally obtained hemodynamic parameters (mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output) were obtained. Blood volume was restored, and the pigs were over-resuscitated with 2,500 ml of crystalloid, collecting parameters after each 500-ml bolus. Hemorrhage and resuscitation phases were analyzed separately to determine differences among parameters over the range of volume. Conformity of parameters during hemorrhage or over-resuscitation was assessed. Results During the course of hemorrhage, changes from baseline euvolemia were observed in vital signs (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) after 100 ml of blood loss. Central hemodynamic parameters (mean pulmonary artery pressure and pulmonary capillary wedge pressure) were changed after 200 ml of blood loss, and central venous pressure after 300 ml of blood loss. During the course of resuscitative volume overload, changes were observed from baseline euvolemia in mean pulmonary artery pressure and central venous pressure after 500-ml resuscitation, in pulmonary capillary wedge pressure after 1,000-ml resuscitation, and cardiac output after 2,500-ml resuscitation. In contrast to hemorrhage, vital sign parameters did not change during over-resuscitation. The strongest linear correlation was observed with pulmonary capillary wedge pressure in both hemorrhage (r2 = 0.99) and volume overload (r2 = 0.98). Conclusions Pulmonary capillary wedge pressure is the most accurate parameter to track both hemorrhage and over-resuscitation, demonstrating the unmet clinical need for a less invasive pulmonary capillary wedge pressure equivalent. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New