Assessment of Right Atrial Pressure With 2-Dimensional and Doppler Echocardiography: A Simultaneous Catheterization and Echocardiographic Study

Ommen, Steve R.; Nishimura, Rick A.; Hurrell, David G.; Klarich, Kyle W.

doi:10.4065/75.1.24

Cited by 191 publications

(109 citation statements)

References 14 publications

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“…Such variation in right atrial pressure estimates can significantly affect reported RVSP values, as well as the threshold of RVSP used to determine the need for right heart catheterization. 16,17 The screening RVSP cutoff (Ͼ50 mm Hg) algorithm described herein did offer a practical approach in deciding which transplantation candidates should proceed to invasive hemodynamic measurements. In our experience, using an RVSP cutoff of Ͼ30 mm Hg or Ͼ40 mm Hg would have resulted in catheterization being conducted in 50% and 20% of screened patients, respectively (unpublished Mayo Clinic data).…”

Section: Discussionmentioning

confidence: 99%

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Portopulmonary hypertension: Results from a 10-year screening algorithm

et al. 2006

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Portopulmonary hypertension (POPH) is the elevation of pulmonary artery pressure due to increased resistance to pulmonary blood flow in the setting of portal hypertension. Increased mortality has occurred with attempted liver transplantation in such patients and thus, screening for POPH is advised. We examined the relationship between screening echocardiography and right heart catheterization determinations of pressure, flow, volume, and resistance. A prospective, echocardiography-catheterization algorithm was followed from P ulmonary hypertension associated with advanced liver disease has variable etiologies and prognostic implication. [1][2][3][4] First, the hyperdynamic, high-flow circulatory state (as a consequence of splanchnic vasodilatation caused by portal hypertension) results in high cardiac output (CO) and an increase in mean pulmonary artery pressure (MPAP), but the pulmonary vascular resistance (PVR) remains normal. Second, elevated MPAP with increased central blood volume estimate as measured by the pulmonary arterial occlusion pressure (PAOP) results in variable effect on PVR. Third, for reasons yet to be characterized, and regardless of liver disease severity, additional hemodynamic change can occur due to development of pulmonary artery endothelial/smooth muscle proliferation, vasoconstriction, in situ thrombosis, and plexogenic arteriopathy. Such pathology results in progressive obstruction to pulmonary arterial flow from the right ventricle to the lungs, very high pulmonary artery

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Section: Discussionmentioning

confidence: 99%

“…Right atrial pressure estimate was determined via echocardiographic assessment of the inferior vena cava size and degree of collapse with respiration 15,16 (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Portopulmonary hypertension: Results from a 10-year screening algorithm

et al. 2006

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“…The patient was diagnosed with PAH four years ago and has been receiving medical treatments including calcium channel blocker, β-blocker, antiplatelet drug, oral hypoglycemic agent and insulin therapy. Her present illness showed no asso- [6]. It also showed dilated pulmonary artery and enlarged right ventricular cavity size.…”

Section: Case Reportmentioning

confidence: 99%

Combined Sciatic, Femoral, and Obturator Nerve Blocks for Ankle Surgery in a Patient with Severe Pulmonary Hypertension—A Case Report

Lee¹,

Shin²,

Kim³

et al. 2017

OJAnes

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We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.

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“…6,7 RAP is estimated value from characteristics of the inferior vena cava with respiratory variation. 8 Twelve patients were diagnosed as isolated severe TR. We also selected the age-and gender-matched patients with secondary TR associated with pulmonary hypertension and control participants for comparison of echocardiographic parameters with isolated TR patients.…”

Section: Methodsmentioning

confidence: 99%

Right Ventricular Remodeling and Dysfunction With Subsequent Annular Dilatation and Tethering as a Mechanism of Isolated Tricuspid Regurgitation

Seo

Moon

et al. 2008

Circ J

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n adults, tricuspid regurgitation (TR) usually occurs secondary to left-sided valvular lesions or chronic pulmonary disease. Secondary TR, in conjunction with left-sided valve disease and left ventricular (LV) dysfunction, even with a structurally normal tricuspid valve (TV), is thought to be caused by tricuspid annular dilatation 1 and tethering of the TV leaflet after right ventricular (RV) dilatation. In contrast to secondary TR, acquired isolated TR can be defined when TR is present without other valvular lesions, pulmonary disease or pulmonary hypertension. 2,3 Because of the paucity of data, management and clinical decision-making regarding patients with isolated TR is difficult. Furthermore, the mechanism of isolated TR remains unknown. We hypothesize that RV remodeling and dysfunction would be the most important mechanism for isolated TR. Therefore, we evaluated RV function and TV deformities (TV annular dilatation and tethering) in patients with isolated TR and compared these parameters with ageand gender-matched patients with secondary TR, as well as MethodsWe reviewed approximately 20,000 patients who had echocardiograms in our laboratory over a 5-year period retrospectively. Patients with secondary TR associated with significant other valvular disease, LV systolic dysfunction, coronary artery disease and a RV systolic pressure greater than 50 mmHg were excluded. We also excluded the patients with Ebstein's anomaly and thyroid dysfunction.TR was graded qualitatively by Framingham Heart Study criteria: 4 mild if the regurgitant jet area/right atrial area was 19% or less; moderate if 20% to 40%; or severe if ≥41%. Enlargement of the RV was considered mild if the RV was greater than two-thirds of the LV but less than the LV size; moderate if the RV equaled the LV; and severe if the RV was greater than the LV at apical 4-chamber view. 5 The peak TR velocity was measured by continuous-wave Doppler, and pulmonary arterial systolic pressure was estimated by measurement of the systolic regurgitant tricuspid flow velocity and an estimate of right atrial pressure (RAP) applied in the modified Bernoulli method: RVSP = 4V 2 + RAP. 6,7 RAP is estimated value from characteristics of the inferior vena cava with respiratory variation. 8 Twelve patients were diagnosed as isolated severe TR. We also selected the age-and gender-matched patients with secondary TR associated with pulmonary hypertension and control participants for comparison of echocardiographic parameters with isolated TR patients. Among patients with Right Ventricular Remodeling and Dysfunction With Subsequent Annular Dilatation and Tethering as a Mechanism of Isolated Tricuspid RegurgitationHye-Sun Seo, MD, PhD; Jong-Won Ha, MD, PhD; Jae Youn Moon, MD; Eui-Young Choi, MD, PhD; Se-Joong Rim, MD, PhD; Yangsoo Jang, MD, PhD; Namsik Chung, MD, PhD; Won-Heum Shim, MD, PhD; Seung-Yun Cho, MD, PhD; Sung Soon Kim, MD, PhDBackground Secondary tricuspid regurgitation (TR) as a result of pulmonary hypertension and/or left-sided heart disease is caused by tricus...

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Assessment of Right Atrial Pressure With 2-Dimensional and Doppler Echocardiography: A Simultaneous Catheterization and Echocardiographic Study

Cited by 191 publications

References 14 publications

Portopulmonary hypertension: Results from a 10-year screening algorithm

Portopulmonary hypertension: Results from a 10-year screening algorithm

Combined Sciatic, Femoral, and Obturator Nerve Blocks for Ankle Surgery in a Patient with Severe Pulmonary Hypertension—A Case Report

Right Ventricular Remodeling and Dysfunction With Subsequent Annular Dilatation and Tethering as a Mechanism of Isolated Tricuspid Regurgitation

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