Pulmonary valve echogram and portal pressure after as compared to before captopril therapeutic use in patients with both portal and pulmonary hypertension of bilharzial origin

ABSTRACT

The effect of captopril, a converting enzyme inhibitor, was investigated in 20 patients with schistosomal pulmonary hypertension [pH], 16 males and 4 females with age ranging from 16 to 42 years [mean 35-years]. Pulmonary valve and tricuspid valve echograms, were performed in all patients. According to the severity of pH, cases were divided into three subgroups utilizing the RVPEP/RVET ratio [mild subgroup], with a ratio of 0.26 to 0.35. It comprised 10 patients, 7 males and 3 females, [moderate subgroup], with a ratio of 0.35 to 0.40. It comprised 5 patients, all were males. [severe subgroup], with a ratio more than 0.40. It comprised 5 patients, one male and 4 females. Again the 20 cases were classified radiologically according to the diameter of the main pulmonary artery [MPAD] into two subgroups [the non-aneurysmal subgroup], with the MPAD from 4 - 6 cm. It comprised 12 patients, [the aneurysmal subgroup], with the MPAD more than 6 cm. It comprised 8 patients. One week following captopril therapy [75 mg/day] significant changes of RVEP/RVET were observed in the whole test group and its different-subgroups [P<0.001], which are indicative of a reduction in the pulmonary artery pressure. The pulmonary hypotensive action of captopril was marked in mild and moderate subgroups, while its effect was minimal in severe form of bilharzial pulmonary hypertension. This reduction was associated with definite, subjective symptomatic improvement. Significant reduction in right atrial diameter was also observed following captopril therapy [P<0.01], while mitral valve aortic valve and left ventricular functions did not change significantly [P>0.05] while under therapy. These results suggest that captopril may be of help in patients with schistosomal pulmonary hypertension