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Introducción: La tromboembolia pulmonar aguda (TEP) es un padecimiento grave. La ecocardiografía tridimensional (ECO-3D) es un método accesible, novedoso y preciso para cuantificar la función ventricular y auricular derechas. A la fecha, no existen suficientes estudios que evalúen su papel en esta entidad. Objetivo: Determinar la utilidad del ECO-3D en la evaluación de la función ventricular y auricular derecha, y el riesgo de complicaciones cardiovasculares en pacientes con TEP aguda. Material y métodos: Se analizaron 35 pacientes, admitidos al HC CMN SXXI con TEP por angioTAC, mediante equipo Phillips IE 33, se midieron parámetros bidimensionales (2D) y 3D relacionados con función ventricular y auricular derecha (TomTec y qlab 10). Se evaluaron complicaciones cardiovasculares intrahospitalarias. Resultados: El riesgo relativo de eventos cardiovasculares mayores combinados (ECMC) intrahospitalarios por ECO-3D fue: índice de esfericidad de la aurícula derecha > 1.32; RR 20.3 IC 95% 2.9-13.8; p = 0.0001, FEVD RR 7.3 IC 95% 2.5-20.9; p = 0.0001, VDFVD > 77 mL RR de 7.3 IC 95% 2.56-20.9; p = 0.0001, VSFVD RR 5.5 IC 95% 2.26-13.3; p = 0.0001. El análisis multivariado mostró tres predictores de riesgo independiente: índice de esfericidad de la aurícula derecha > 1.32, TEP masiva y presión arterial media. Conclusiones: La evaluación combinada mediante ecocardiografía 3D de función ventricular y auricular derechas permiten una evaluación cuantitativa, predicción del riesgo para la presentación de complicaciones cardiovasculares y tiempo de estancia intrahospitalarios en pacientes con TEP aguda.
Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, novel and accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in this entity. Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complications in patients with acute PE. Material and methods: 35 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters by Philips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated. Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index > 1.32; RR 20.3 95% CI 2.9-13.8; p = 0.0001, RVEF RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV> 77 mL RR 2.56 95% CI 7.3-20.9, p = 0.0001, RR 5.5 RVESV 95% CI 2.26-13.3; p = 0.0001. Multivariate analysis showed three independent risk predictors: right atrial sphericity index > 1.32, massive PE and mean arterial pressure. Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, risk prediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.
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Objective To observe the influence and safety of rosuvastatin on high sensitive C-reactive protein (hs-CRP),Endothelin-1 (ET-1),N-terminal pro-brain natriuretic peptide (NT-proBNP),pulmonary artery systolic pressure(PASP) and cardiac function in patients with chronic pulmonary heart disease.Methods Eighty patients with chronic pulmonary heart disease were enrolled and divided into the statin group(n =40) and the control group (n =40).All patients were given conventional therapy,while the statin group received additionally rosuvastatin 10 mg/d for 6 months.The control group did not receive any lipid-lowering drugs.The plasma levels of hs-CRP,ET-1,NT-proBNP,liver and kidney functions and creatine kinase (CK),echocardiographic indicators of PASP and right ventricular ejection fraction (RVEF) were measured and compared before and after 6-month treatment.Results The levels of hs-CRP,ET-1,NT-proBNP and PASP were significantly lower after 6-month treatment than before treatment in the two groups (Statin group:hs-CRP:(7.45 ± 1.96) mg/L vs.(20.67 ± 5.12) mg/L,t =9.57,P ＜ 0.01 ; ET-1:(45.72 ± 6.85) ng/L vs.(56.39 ±7.34) ng/L,t =3.78,P ＜ 0.01 ; NT-proBNP:(136.54 ± 20.67) ng/L vs.(182.83 ± 23.27) ng/L,t =4.15,P ＜0.01 ;PASP:(42.6 ± 6.3)mm Hg vs.(52.3 ± 8.4) mm Hg,t =3.54,P ＜ 0.01 ; Control group:hs-CRP:(12.73 ±3.14) mg/L vs.(20.58 ±4.98)mg/L;t =4.96,P ＜0.01 ;ET-1:(51.66 ± 6.42)ng/L vs.(56.43 ±7.81) ng/L,t =3.43,P ＜ 0.01 ; NT-proBNP:(162.74 ± 21.59) ng/L vs.(181.56 ± 22.78) ng/L; t =3.60,P ＜0.01 ;PASP:(45.7 ±6.5) mm Hg vs.(51.8 ± 8.2) mm Hg,t =3.62,P ＜ 0.01),but the statin group reduced even more significantly (t =2.36,2.21,2.25 and 2.09 respectively,P ＜ 0.05).The level of RVEF was significantly higher after 6-month treatment than before treatment in the two groups (Statin group:(50.8 ±7.9) ％ vs.(41.5 ±6.7)％,t =3.69,P ＜0.01 ;Control group:(46.6 ±7.8)％ vs.(42.0 ±6.2)％,t =3.58,P ＜ 0.01),but the statin group increased even more significantly(t =2.18,P ＜ 0.05).Statistical differences of liver and kidney function and serum CK were not found in the two groups before and after treatment(P ＞ 0.05).The adverse reaction in the statin group was few.Conclusion Rosuvastatin can reduce the levels of hs-CRP,ET-1,NT-proBNP and PASP,improve RVEF and cardiac function in patients with chronic pulmonary heart disease,and its security is fine.
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BACKGROUND: Most surgeons prefer delivering cardioplegia alternatively via the aortic root and coronary sinus in patients undergoing coronary artery bypass graft surgery (CABG). Recently, some surgeons have delivered cardioplegia via the grafted vessel to the obstructed right coronary artery in order to preserve right ventricular function whenever retrograde cardioplegia is delivered. Thus, we have compared the effect on right ventricular preservation between the aforementioned two methods after cardiopulmonary bypass in patients undergoing a right CABG. METHODS: Twenty-eight patients undergoing an elective CABG with significant right coronary artery obstructive disease were allocated into 2 groups. In the alternative cardioplegia delivery group (A-group), cold blood cardioplegia was delivered via the aortic root and coronary sinus alternatively. In the simultaneous cardioplegia delivery group (S-group), cold blood cardioplegia was delivered via the coronary sinus and grafted vessel to the obstructed right coronary artery simultaneously. Hemodynamic measurements were obtained pre-bypass, at pericardial closure and at sternal closure. Data recorded included right ventricular ejection fraction, right ventricular volume index and right and left ventricular hemodynamics. RESULTS: There was no significant difference in the right ventricular ejection fraction between the two groups at pre-bypass, pericardial closure and sternal closure. In both groups, the right ventricular ejection fraction and cardiac index were not decreased, and the left ventricular ejection fraction was higher at pericardial closure than pre-bypass. However, in both groups, there was a decrease in the right andleft ventricular stroke work index and right ventricular stroke volume index at sternal closure. CONCLUSIONS: We have concluded that simultaneous cardioplegia delivery via the coronary sinus and grafted vessel to the obstructed right coronary artery was not superior to the alternative cardioplegia delivery via the aortic root and coronary sinus for preservation of right ventricular function in patients undergoing a right CABG.
Subject(s)
Humans , Cardiopulmonary Bypass , Coronary Artery Bypass , Coronary Sinus , Coronary Vessels , Heart Arrest, Induced , Hemodynamics , Stroke , Stroke Volume , Transplants , Ventricular Function, RightABSTRACT
BACKGROUND: In patients with mitral valvular disease with pulmonary hypertension (PHT) accompanying right ventricular (RV) dysfunction, mitral valve replacement (MVR) improves RV function and other hemodynamic variables in long term follow-up. However, there are controversies in improvement of RV function in the immediate postoperative period. We compared the RV function immediately after a MVR with a pulmonary artery catheter (PAC) between patients with normal and decreased RV function with PHT preoperatively. METHODS: Twenty nine patients undergoing a MVR were included in the study. The patients (n = 14) with mean pulmonary arterial pressure (PAP) < or = 25 mmHg were assigned to group I and the patients (n = 15) with mean PAP 25 mmHg were assigned to group II. A PAC with rapid response-thermistors which enables us to determine right ventricular ejection fraction (RVEF) was inserted in all patients and hemodynamic variables were measured before and after cardiopulmonary bypass (CPB). RESULTS: After CPB, PAP, pulmonary vascular resistance index (PVRI), and RV end-diastolc volume (RVEDV) were significantly decreased and RVEF was significantly increased in group II compared with group I in which no hemodynamic variables were changed. CONCLUSIONS: A MVR decreased RV afterload and increased RV function more significantly in patients with preoperative PHT accompanying RV dysfunction than in patients with normal PAP preoperatively.
Subject(s)
Humans , Arterial Pressure , Cardiopulmonary Bypass , Catheters , Hemodynamics , Hypertension, Pulmonary , Mitral Valve , Postoperative Period , Pulmonary Artery , Stroke Volume , Vascular Resistance , Ventricular Function, RightABSTRACT
Objective To explore the relationship between preoperative right ventricular ejection fraction(RVEF) and postoperative complications in the elderly patients with lung resection. Methods RVEF was assessed in 118 consecutive aged patients before pulmomary resection by echocardiography, 64 of whom received RVEF measurement again 3 weeks after operation. Results Preoperative RVEF in patients with postoperative complications was obviously lower than that in patients without ones. The frequency of postoperative complications in patients with different preoperative RVEF(
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The left ventricle is realized as the cardiac structure of greatest importance for cardiac pump function, and the role of the right ventricle has been overlooked. However, the right ventricle and the left ventricle are in series and physiologically coupled so that a disturbance in the one ventricular function will influence the behavior of the other. Thus, there ia growing interest in the importance of the right side of the heart, particularly in patients undergoing cardiac surgery. Moreover recently, right ventricular failure has been identified as a cause of progressive deterioration in patients undergoing cardiac operations, and it may limit the overall success of the procedure. This study was performed to investigate right ventricular ejection fraction of the cardiac patients at pre and post-perfusion period. 10 cases were measured and analyzed. The results were as follows: I) There were no singificant differences statistically in demographic data of the patients. 2) Pulmonary capillary wedge pressure(PCWP) of postperfusion 10 min. was significantly increased compared to preperfusion period(p<0.01). 3) Systemic vascular resistance(SVR) of immediate postperfusion period was significantly decreased compared to preperfusion period. 4) Heart rate and central venous pressure(CVP) of postperfusion period were statistically significantly increased, but clinically no significant change compared to preperfusion period. 5) Cardiac output(CO) and right ventricular ejection fraction(RVEF) of postperfusion period were no significant change compared to preperfusion period.