Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow Acceleration After Pulmonary Thromboendarterectomy Implications for Discordant Recovery of Pulmonary Artery Pressure and Compliance

Abstract

hronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life-threatening disease that eventually progresses to right heart failure. In addition, CTEPH is associated with abnormal left ventricular (LV) systolic and diastolic functions caused by ventricular interaction under right ventricular (RV) pressure overload. [1][2][3][4] It has been reported that pulmonary thromboendarterectomy is useful for dramatically reducing pulmonary artery pressure (PAP), 5-7 to improve LV systolic and diastolic functions, 3,4 and to obtain long-term survival. 8,9 On the other hand, few data exist regarding the change in pulmonary Circulation Journal Vol.71, November 2007 artery compliance after pulmonary thromboendarterectomy. Moreover, factors affecting changes in PAP and compliance after thromboendarterectomy are unclear. Because PAP and compliance may affect RV afterload and prognosis, it is of clinical value to define their changes after thromboendarterectomy.Doppler echocardiography is a useful method for estimating PAP and compliance non-invasively, using the tricuspid regurgitant peak pressure gradient (TRPG) calculated by the simplified Bernoulli equation 10 and the acceleration time (ACT) of pulmonary artery flow, respectively. 11 The aims of the present study were to examine the changes in PAP and ACT of pulmonary artery flow before and after pulmonary thromboendarterectomy using echocardiography, and to clarify the factors affecting these changes in patients with CTEPH. Methods SubjectsWe retrospectively analyzed 51 consecutive patients with CTEPH who underwent pulmonary thromboendarterectomy. The exclusion criteria were: (1) moderate or severe Circ J 2007; 71: 1771 -1775 (Received October 23, 2006 revised manuscript received July 20, 2007; accepted July 24, 2007 Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow AccelerationAfter Pulmonary Thromboendarterectomy Implications for Discordant Recovery of Pulmonary Artery Pressure and ComplianceHirofumi Maeba**; Satoshi Nakatani; Motoaki Sugawara † ; Jun Mimura**; Norifumi Nakanishi; Hitoshi Ogino*; Masafumi Kitakaze; Toshiji Iwasaka**; Kunio MiyatakeBackground Pulmonary artery pressure (PAP) is reduced dramatically after pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, it is unclear whether pulmonary artery compliance increases in conjunction with the reduction in PAP. Pulmonary artery compliance may affect right ventricular afterload and prognosis. Methods and ResultsIn 33 patients with CTEPH (9 men, 22-76 years), changes in the tricuspid regurgitation pressure gradient (TRPG) and the acceleration time (ACT) of pulmonary artery flow (a surrogate parameter of pulmonary artery compliance) were examined before and after pulmonary thromboendarterectomy using echocardiography to clarify factors affecting the changes. At 6 months, both TRPG and ACT normalized (≤30 mmHg, ≥100 ms, respectively) in 25 patients (group A) but not in 8 (group B). In grou...

Right ventricular reverse remodelling after balloon pulmonary angioplasty

“…Patients who could not remain in a supine position for .20 min because of dyspnoea were excluded in the present study as they could not undergo CMR. Patients were diagnosed with CTEPH using the standard criteria as previously described [17,18]. They were considered to have inoperable disease if they had distal, surgically inaccessible thrombi or severe concomitant medical comorbidity based on a detailed medical history, physical examination, ECG, chest radiograph, echocardiograph, lung ventilation/perfusion scintigraphy, CT scan, CMR imaging, right heart catheterisation (RHC), and pulmonary digital subtraction angiography.…”

“…We routinely used nonivasive continuous positive airway pressure ventilation after BPA overnight. Additional BPA sessions were recommended for each patient until a mPAP of ,30 mmHg was achieved and each BPA session was repeated at a mean (range) interval of 5.2¡6.7 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) weeks.…”

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

“…Valvular heart disease (in particular, mitral valve) LV systolic/diastolic dysfunction Pulmonary vascular resistance [46,47] Consider right heart assessment protocol Assess associated causes RV ≥1/2 LV from PLAX [11] RVOT AT <105 ms [8,15,16] RV IVRT >75 ms [8,31,32] IVC >20 mm and <50% inspiratory collapse [8] TAPSE <20 mm [8, 28-30, 33, 53, 54] End-diastolic PRV >1.0 m . s -1 [14,17] TRV ≥2.6 m .…”

Sodium Valproate, a Histone Deacetylase Inhibitor, but Not Captopril, Prevents Right Ventricular Hypertrophy in Rats

“…20 Pulsed-wave Doppler echocardiography was recorded in the main pulmonary artery and acceleration time was measured from the onset of flow to the time of peak velocity. 21 The 6-limb lead ECG and 2-chest lead ECG, similar to leads V1 and V6 in humans, were recorded while the animals were anesthetized. Each rat was fixed in position on its back on a pad, and the ECG was recorded by the ECG module (PageWriter 200i, Hewlett Packard, USA) every week.…”