[Radiographic assessment of pulmonary hypertension: Methodical aspects].

Pulmonary hypertension is a menacing complication of a number of diseases, which is responsible for high mortality rates and considerably poorer quality of life in a patient. The timely detection for pulmonary hypertension allows timely initiation of treatment, thus improvement in prognosis in the patient. Chest X-ray is the most commonly used radiographic technique for various causes. Physicians' awareness about the radiographic manifestations of pulmonary hypertension may contribute to the earlier detection of this severe disease. Owing to the natural contrast of reflected structures, a chest X-ray film gives a unique opportunity to assess pulmonary circulation vessels, to reveal the signs of pulmonary hypertension, and to estimate trends in the course of the disease. The paper details a procedure for analysis and the normal radiographic anatomy of pulmonary circulation vessels, gives the present classification of pulmonary hypertension, and sets forth its X-ray semiotics.

[Age-related diagnostic features of congenital atrial septal defect in adults according to the data of radiodiagnostic studies].

OBJECTIVE: To reveal diagnostic features in atrial septal defect (ASD) in different age groups; to define a role of X-ray study in the diagnosis of ASD. MATERIAL AND METHODS: Forty-eight patients (16 men and 32 women) aged 15 to 71 years with ASD at different sites were examined. All the patients underwent chest X-ray, echocardiography, and cardiac phase-contrast magnetic resonance imaging (MRI). The examinees were divided into 2 age groups: 1) less than 40 years (n = 18) and 2) more than 40 years (n = 30). The groups were compared using quantitative and alternative signs and they did not significantly differ in the volume of intracardiac shunt and in the size of the defect. The X-ray and MRI indicators reflecting the calibers of pulmonary arteries were also compared in patient groups with different pulmonary artery systolic pressures (PASP) (< 35, 36-60, and > 60 mm Hg). RESULTS: The older age group more frequently showed signs of heart failure, valvular regurgitation, and an atypical X-ray pattern. The sizes of atria, pulmonary artery and its branches, and PASP were also increased in the older age group. The patient group with high PASP (> 60 mm Hg) significantly differed from the others in all the indicators analyzed. Normal PASP and moderate pulmonary hypertension groups greatly differed only in the Moore index. CONCLUSION: Chest X-ray reflects rather precisely the hemodynamic type of the defect. High pulmonary hypertension has clear X-ray and MRI manifestations. The specificity of X-ray in the diagnosis of PASP is lower in the older age group due to the higher rate of an atypical X-ray pattern. Radiology is important in detecting pulmonary venous hypertension in patients with PASP. Pulmonary venous hypertension is indicative of elevated pressure in the left atrium and pulmonary veins and arises from different causes: shunt inversion, restrictive defect, mitral valve comorbidity, and left ventricular systolic and diastolic dysfunction.

[Using nonselective endothelin receptor antagonist in idiopathic pulmonary hypertension].

Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.

[Primary pulmonary hypertension: activation of sympathico-adrenal system and free radical oxidation. Positive effects of carvedilol therapy].

AIM: To study the condition of the sympathico-adrenal system (SAS), synthesis of cAMP dependent on beta2-adrenoreceptors and parameters of free radical oxidation in patients with primary pulmonary hypertension (PPH); to examine efficacy of non-selective beta- and alpha1-adrenoblocker carvedilol in PPH patients. MATERIAL AND METHODS: Twenty patients with PPH had 6-minute walk test, ECG monitoring with assessment of heart rhythm variability (HRV). Tests for noradrenalin and adrenalin concentration in blood plasma, cAMP synthesis by blood lymphocytes in basal conditions and under stimulation with isoproterenol and forskolin, free radical oxidation were made initially, 1 and 6 months later. Ten patients received carvedilol in addition to standard therapy, 10 patients served control. RESULTS: PPH patients had higher NA in the blood, low cAMP synthesis, high malonic aldehyde, low activity of glutathionperoxidase, increased activity of superoxidedismutase and catalase of erythrocytes. The most pronounced changes in the above parameters were observed in patients with PPH FC III-IV. HRV declined in progression of cardiac failure. 6-months of combined treatment with carvedilol increased the distance of 6-min walk. Carvedilol had no effect on HRV, it reduced NA, stimulated cAMP synthesis, demonstrated no antioxidant activity. CONCLUSION: In PPH there is activation of SAS and desensitization of beta2-AR cells, oxidative stress develops. Addition of carvedilol to standard therapy with PPH improves clinical condition due to adrenoblocking properties of the drug.

[Pulmonary venous occlusive disease].

The present study deals with the radiation diagnosis of the rare disease--pulmonary venous occlusive disease. The follow-up covered three cases that ended with death. The clinical picture of the disease did not differ from the manifestations of primary pulmonary hypertension. All the patients underwent chest X-ray study in four standard projections. The morphological verification of its diagnosis was made on the basis of autopsy data. X-rat study promoted identification of such signs as peculiar changes in the lung pattern in form of its looping, reticulation, fine-focality along with reticular changes, the presence of Kerley lines, the diameter of root branches, enlargements of the pulmonary trunk without any symptoms of the enlarged left atrium.

[Catecholamine levels in plasma and beta2-adrenoreceptor-dependent synthesis of cAMP in lymphocytes of patients with primary pulmonary hypertension]. / Kontsentratsiia katekholaminov v plazme krovi i zavisimyi ot beta2-adrenoretseptorov sintez tsAMF v limfotsitakh bol'nykh pervichnoi legochnoi gipertoniei.

AIM: To evaluate norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta-2-adrenoceptor dependent cAMP synthesis in primary pulmonary hypertension (PPH) patients in comparison with healthy controls. MATERIAL AND METHODS: Seven volunteers and fifteen patients with PPH were included in the study. NE and E plasma levels were measured by high performance liquid chromatography. Basal and stimulated (isoproterenol and forskolin) adenylyl cyclase activity in lymphocytes was measured by cAMP production using an enzyme immunoassay (Biotrak, Amersham UK). RESULTS: There was a 110% (p = 0.001) NE level increase in PPH patients. In systolic pulmonary artery pressure (SPAP) > 95 mm Hg lymphocyte cAMP production associated with adenylyl cyclase catalytic subunit was decreased by 170% and 70% vs PPH patients with SPAP < 95 mm Hg and healthy controls, respectively (p < 0.05). A significant negative correlation between forskolin cAMP production by lymphocytes and SPAP level was observed in PPH patients (k = -0.810, p = 0.011 by Kendell; k = -0.893, p = 0.007 by Spirman). Heart failure progressing from I-II to III NYHA functional classes was accompanied by plasma NE enhance and lymphocyte beta-2-adrenoreceptor-activated cAMP production decrease. CONCLUSION: The data demonstrate sympathoadrenal system activation and lymphocyte beta-2-adrenoceptor desensitization in PPH patients.

[The use of aspirin in patients with primary pulmonary hypertension]. / Primenenie aspirina u bol'nykh s pervichnoi legochnoi gipertoniei.

AIM: To investigate aspirin efficacy in patients with primary pulmonary hypertension (PPH) after a course of prostaglandin E-1 (PE) treatment. MATERIALS AND METHODS: 12 PPH patients (mean age 35.7 +/- 2.5 years) having the disease for 6.7 +/- 1.1 years were assigned to a 6-month course of aspirin treatment in a dose 100 mg/day in combination with calcium antagonist isradipin. All the patients have previously undergone 21-day PE treatment (vasaprostan). Before and after the treatment, the patients were examined clinically and biochemically. RESULTS: As shown by ECG, chest x-ray, bicycle exercise, aspirin used in combination with isradipin led to stabilization of the disease. Platelet aggregation also remained stable, thromboxan B2 and endothelin-1 levels went down. Low doses of aspirin allowed to avoid side effects typical for this drug. CONCLUSION: Use of aspirin in a dose 100 mg/day in combination with calcium antagonists to treat primary pulmonary hypertension is justified.

[The results of catheterization and the x-ray angiographic assessment of cardiac contractility and volume in primary pulmonary hypertension]. / Rezul'taty kateterizatsii i rentgenoangiograficheskaia otsenka sokratimosti i ob''emov serdtsa pri pervichnoi legochnoi gipertonii.

To ascertain the role of invasive investigations in the diagnosis of primary pulmonary hypertension (PPH), 12 PPH patients underwent catheterization of the left and right heart compartments, contrast right and left ventriculography and oximetry. Compared to control values, the patients had high pressure in the pulmonary artery and right ventricle. Some of them exhibited elevated pressure in the right atrium. Pulmonary artery wedge pressure, left ventricular end-diastolic and systolic, diastolic pressure in the aorta did not differ significantly from those in the controls. Right and left ventriculography revealed an increase in the end-systolic and end-diastolic volumes of the right ventricle which diminished its stroke index and ejection fraction. The latter two were reduced in the left ventricle also. Because the procedure was well tolerated by the patients, it is recommended for PPH diagnosis and follow-up.