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OBJECTIVE:To investigate the effects of urapidil on the hemodynamics of the right heart in patients with rheumatic heart disease and secondary pulmonary hypertension METHODS:34 patients with rheumatic heart disease and varying degrees of secondary pulmonary hypertension were included in the study In all patients,the hemodynamic parameters and pressure of systemic circulation were determined before and 20,40,60 min after urapidil intraverous injection in a dose of 0 4mg/kg RESULTS:Pulmonary artery pressure,pulmonary vascular resistance,pulmonary capillary wedge pressure and systemic artery pressure were decreased after urapidil injection The reduction of resistance in the pulmonary vascular bed was greater than that in the systemic circulation There were no significant alterations in heart rate and cardic output No serious side-effects were observed in the study CONCLUSION:Urapidil may be a promising drug in the treatment of patients with pulmonary hypertension due to rheumatic heart disease
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Objective:To investigate the collagen changes of pulmonary arteriole and its significance in patients with rheumatic heart disease.Methods:The preoperative hemodynamic parameters were obtained by catheterization?The 79 cases of lung specimen for study group were taken from the right lower lobe after cardio-pulmonary bypass,and 10 cases for control group were from autopsy or biopsy.Immunohistochemical staining with antibodies against collagen type Ⅰ,type Ⅲ was performed by S-ABC method.The levels of collagen type Ⅰ and type Ⅲ were examined quantitatively under computerized image analysis system.The correlations were analyzed between the clinical data and collagen in pulmonary arteriole.Results:There were significantly higher levels of collagen type Ⅰ and type Ⅲ in pulmonary vessels of the study group than that of the control group.The worse the lesion was, the higher the levels of collagen type Ⅰ and type Ⅲ were for pulmonary vacular lesions of pathological grade 1 to 3, but for grade 4, the levels of collagen type I and type III were not higher than that of grade 3. The concentration of collagen type Ⅰ in arteriole wall was correlated with the factors such as the severity of pulmonary vascular lesions,mean pulmonary artery pressure, cardiac function and age. Conclusions:Proliferation of the collagen contributed to the formation and the maintenance of pulmonary hypertension and vascular lesions resulted from rheumatic heart disease. The content of collagen type Ⅰ and type Ⅲ in pulmonary vascular lesions of grade 4 resulted from rheumatic heart disease was not so much as that of grade 3.This was perhaps one of the reasons that why extreme pulmonary hypertension and severe pulmonary vascular disease were not contraindications for operation. If an operation is necessary, 4 factors including pulmonary vascular lesion, pulmonary hypertension , age and heart function should be taken into consideration, because they had correlation with the content of collagen type I which was dominant in reversion of pulmonary vascular disease.