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Objective To evaluate the effect of preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P < 0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P > 0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P > 0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.
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Heart transplantation can save the life and improve the quality of life of patients with end-stage heart failure. Nevertheless, it is not suitable for all patients with end-stage heart failure. As a common complication of end-stage heart failure, pulmonary artery hypertension may increase the incidence of right heart failure after heart transplantation, which is associated with the short- and long-term fatality risk in the recipients after heart transplantation. In clinical practice, different transplant centers have different criteria for heart transplantation indications in patients with end-stage heart failure complicated with pulmonary artery hypertension. Accurate preoperative evaluation of surgical indications plays a critical role in determining the success of heart transplantation. In this article, the definition, pathogenesis and effects on heart transplantation, diagnostic methods and reversibility judgment of pulmonary artery hypertension, diagnostic treatment of reversible pulmonary artery hypertension and indications of heart transplantation in patients with end-stage heart failure complicated with reversible pulmonary hypertension were reviewed.
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Background: The development of pulmonary hypertension i.e.mean pulmonary artery pressure (mPAP) above 25 mmHg withnormal capillary wedge pressure and pulmonary vascularresistance(PVR) above 240 dyn/s/cm−5 in association withelevated pressure in portal circulation is known asportopulmonary hypertension (POPH). Comparing withidiopathic PAH, patients with POPH have a worst survivalprofile, with a 3-year survival of only 38% versus78% foridiopathic PAH. Recent evidence from France shows thatPOPH is the fourth most common form of PAH reported overallin the population-based French National Registry, afteridiopathic PAH and PAH associated with connective tissuediseases and con- genital heart disease. The aim of this studyis to evaluate frequency of POPH in portal hypertensivepatient.Materials and Methods: A cross sectional study of patientadmitted in RIMS, medicine department was performedfulfilling features of portal hypertension with ultrasoundshowing splenomegaly, ascites, portal vein diameter more than13 mm, portal vein velocity less than 15 cm/s and uppergastrointestinal endoscopy showing esophageal varices andpatient with connective tissue disease, congenital heartdisease, left ventricular systolic or diastolic dysfunction,valvular heart disease, lungs disease, sleep related breathingdisorder, chronic hemolytic and myeloproliferative disorderwere excluded. All patient underwent screening withechocardiography for measuring pulmonary artery systolicpressure (PASP) and PASP more than 35 mmHg wereconsidered for POPH which was confirmed with right heartcatheterisation by measuring mean pulmonary artery pressure(mPAP) of more than 25 mmHg.Observation: Among forty-two patient in this study, there werethirty-three male patients and nine female patients. POPH wasseen three female and two male patients with total of five out offorty- two with prevalence of 11.9% out of which 7.1% werefemale and 4.8% were male.Conclusion: Portopulmonary hypertension prevalence is 2–6%. In this study pulmonary hypertension is significantly high inportal hypertensive patient with percentage of 11.9% and moreprevalent in female.
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Objective@#To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension.@*Methods@#Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed. According to the estimated mean pulmonary artery pressure (mPAP), the patients were divided into normal group (mPAP<19 mmHg), borderline group (19 mmHg≤mPAP<25 mmHg) and elevated group (mPAP≥25 mmHg).@*Results@#①Compared with normal group，the patients were older in borderline group and elevated group[(39.2±10.1)years old vs (46.5±13.5)years old vs (51.8±14.2)years old，all P<0.001] and the proportions of male were relatively lower (69.9% vs 58.9% vs 54.4%，all P<0.01). The incidences of smoking，drinking and cardiovascular complications increased significantly. ②Compared with normal group，the left atrium[(30.2±8.2)ml/m2 vs (34.5±9.7)ml/m2，P<0.001]，left ventricle[(57.4±11.6)ml/m2 vs (60.6±12.5)ml/m2，P<0.01]and right atrium[(19.5±5.9)ml/m2 vs (22.6±7.0)ml/m2，P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLSLV) increased[(-20.1±2.5)% vs (-21.1±3.1)%，P<0.001]，but the long-axis strain in the middle segment of right ventricular free wall (GLSRVFWmid) decreased[(-31.4±6.6)%对(-27.2±8.8)%，P<0.001] in borderline group.Meanwhile，left ventricular diastolic function was impaired. ③Age，sex，right atrial volume，right ventricular area，RV-S′，GLSLV，GLSRVFWmid and mitral valve E/e′ were independent risk factors for mPAP elevation.@*Conclusions@#Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension. Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension.
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Objective To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension.Methods Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People's Hospital were retrospectively analyzed.According to the estimated mean pulmonary artery pressure (mPAP),the patients were divided into normal group (mPAP<19 mmHg),borderline group(19 mmHg≤mPAP<25 mmHg)and elevated group(mPAP≥25 mmHg).Results ①Compared with normal group,the patients were older in borderline group and elevated group[(39.2±10.1)years old vs(46.5±13.5)years old vs(51.8±14.2)years old,all P <0.001]and the proportions of male were relatively lower(69.9％ vs 58.9％ vs 54.4％,all P <0.01).The incidences of smoking,drinking and cardiovascular complications increased significantly.②Compared with normal group, the left atrium[(30.2±8.2)ml/m2 vs(34.5±9.7)ml/m2,P <0.001],left ventricle[(57.4±11.6)ml/m2 vs(60.6±12.5)ml/m2,P <0.01]and right atrium[(19.5±5.9)ml/m2 vs(22.6±7.0)ml/m2,P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLSLV) increased [(-20.1±2.5)％ vs (-21.1 ±3.1)％,P <0.001],but the long-axis strain in the middle segment of right ventricular free wall(GLSRVFWmid)decreased[(-31.4±6.6)％ 对(-27.2±8.8)％,P <0.001]in borderline group.Meanwhile,left ventricular diastolic function was impaired.③Age,sex,right atrial volume,right ventricular area,RV-S',GLSLV ,GLSRVFW mid and mitral valve E/e' were independent risk factors for mPAP elevation.Conclusions Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension.Echocardiography is critical for the early diagnosis andfollow-up monitoring of pulmonary hypertension.
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Pulmonary artery thromboendarterectomy (PTE) has been regarded as a promising, potentially curative surgical procedure. However, PTE is associated with specific postoperative complications, such as reperfusion pulmonary edema and right heart failure leading to a considerable mortality of 7-24%. Despite its limitations PTE is a better surgical alternative to lung transplantation which carries high morbidity and mortality. The aim of the study is to analyze the efficacy, safety, morbidity and survival associated in the postoperative period and quality of life after six months of PTE in Indian patients. Forty-one patients with surgically correctable chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy. All patients were in New York Heart Association (NYHA) Class II, III or IV. Preoperative mean pulmonary artery pressure was 40.98 ± 9.29 mmHg and mean pulmonary vascular resistance was 418.39 ± 95.88 dynes/sec/cm -5 . All patients were followed up to six months and a telephonic survey was conducted using a standard questionnaire. They were assessed and classified as per NYHA grading. There was a significant reduction in the mean pulmonary artery pressure (from 40.98 ± 9.29 mmHg to 24.13 ± 7.36 mmHg, P < 0.001) and pulmonary vascular resistance (from 418.39 ± 95.88 dynes/sec/cm -5 to 142.45 ± 36.27 dynes/sec/cm -5 , P < 0.001) with a concomitant increase in the cardiac index (from 1.99 ± 0.20 L/min/m 2 to 3.28 ± 0.56 L/min/m 2 , P < 0.001) during the postoperative period. The mortality rate in our study was 12.19% (five patients). Ninety per cent of the patients reported a significant improvement in the quality of life and exercise tolerance after surgery compared to the preoperative state. Pulmonary endarterectomy is an effective and potentially curative surgical treatment for patients with severe chronic thromboembolic pulmonary hypertension. The current techniques of operation make the procedure relatively safe and long-term survival, NYHA functional status and exercise capacity improve significantly.
Subject(s)
Adult , Endarterectomy/adverse effects , Endarterectomy/mortality , Female , Humans , Hypertension, Pulmonary/psychology , Hypertension, Pulmonary/surgery , Male , Postoperative Complications/therapy , Pulmonary Artery/surgery , Quality of Life , Treatment OutcomeABSTRACT
Objective To monitor right heart hemodynamic changes of patients with lung cancer during and after the procedures of pneumonectomy and discuss the effect of pneumonectomy on right heart function and risk of postoperation morbidities. Method 16 patients with lung cancer were randomly selected and the clinical database was queried and Swan-Ganz catheter was applied awake from jugular vein to pulmonary artery ,measuring mean arterial pressure(MAP) ,heart rate(HR) ,central venous pressure(CVP) ,mean pulmonary artery pressure (MPAP),mean pulmonary capllary wedge pressure(MPCWP) ,and eardiaoc output(CO) and calculating cardiac index (CI),left ventricular-stroke work index (LVSWI), right ventricular stroke work index (RVSWI) , and stroke volume index(SVI) instantaneously before anaesthesia, after anaesthesia with single lung ventilation, after pulmonary artery and pulmonary vein occlusion and supine chest dosed during the procedure of pneumonectomy. Pre-and post-operative complications were recored. Results Cardiovascular complications occurred in 6 patients(37.5%) postoperatively. There were no operative or perioperative deaths. MPAP increased significantly after the procedure of pneumonectomy compared with that of preoperation, and MPAP > 26 mm Hg was in 4 patients who got cardiovascular complications postoperatively with morbidity of 100% ,which was "significantly higher than the morbidity of 16.7% (2/12) when MPAP < 25 mm Hg. Conclusion Pneumonectomy has significant effects on right heart hemodynemic changes and as MPAP increases postoperatively, the risk of cardiovascular complications becomes higher.
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The effect of elevated mixed venous oxygen tension(PvO2) on the diffuse alveolar hypoxia was studied in dogs using venovenous(VV) extracorporeal lung assist(ECLA). Six mongrel dogs were mechanically ventilated with the continous infusion of pentobarbital. A double lumen tube was inserted via the right external jugular vein and was eonnected with the ECLA cireuit to establish a VV bypass. A Kurare oxygenator 0.3m2 was chosen to obviate the use of homologous blood for priming. The total volume of the ECLA circuit was 150mL Without ventilating the oxygenator during VV ECLA, we decreased F1O2 from 0.21 to 0.1 via 0.15 to evaluate the hypoxic repsonse of lung. Stepwise reductions in F1O2 0.21 to 0.l caused the arterial oxygen tension(PvO2) and (PvO2 to decrease while the mean pulmonary arterial pressure(MPAP) and pulmonary vascular resistance(PVR) progressively increased. We hypothesized that the reduction of F1O2 without aceompanying decrease of PvOmight not induce hypoxic pulmonary vasoconstriciton(HPV) which was proved at low F1O2 with low PvO VV ECLA was tried on another 7 dogs while monitoring arterial oxygen saturation(SaO2) and mixed venous oxygen saturation(SvO2) by two oximetrix catheters. The elevation of SvO2 during VV ECLA was followed by the elevation of SaO2 We compared MPAP and PVR at high F1O2 with those at low F1O2with VV ECLA while making SaO2 equal. PvO2 were 39+/-11mmHg at F1O2 0.21 and 62+/-11mmHg at F1O2 0.15 with VV ECLA. PvO2 were 30+/-8mmHg at F1O2 0.15 and 53+/-10mmHg at F1O2 0.1 with VV ECLA. MPAP and PVR were 18+/-5mmHg and 176+/-56 dyne sec/cm5 at F1O2 0.21 and 19+/-4mmHg and 198+/-94 dyne sec/cm5 at F1O2 0.15 with VV ECLA . MPAP and PVR were 25 5 mmHg and 430+/-250 dyne. sec/ cm5 at F1O2 0.15 and 25+/-5mmHg and 400+/-197 dyne sec/cm5 at F1O2 0.1 with VV ECLA. Decrease of F1O2 from 0.21 to 0.15 and from 0.15 to 0.1 did not cause significant ehanges in MPAP and PVR during VV ECLA. Our findings indicate that small increase of PvO2 by VV ECLA may prevent or diminish hypoxic resyonse of the whole lung.
Subject(s)
Animals , Dogs , Hypoxia , Catheters , Jugular Veins , Lung , Oxygen , Oxygenators , Pentobarbital , Pulmonary CirculationABSTRACT
In this paper, we non-invasively measured PCWP and PAP using the parameters of echocardiography and routine heart film in 21 patients with dilated cardiomyopathy and compared the results with those of Swan-Ganz taken at the near time. The regression formula of PCWP and PAP obtained respeatively from the dimension of left atrium and index of cardiac area for PCWP and the dimension of left atrium, index of cardiac area and width of right inferior pulmonary artery for PAP can correctly reflect the pressures.