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Selective Segmental Pulmonary Angiography: Anatomical, Technical and Safety Aspects of a Must-Learn Technique in Times of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2021; 10:jcm10153358. [PMID: 34362139 PMCID: PMC8347158 DOI: 10.3390/jcm10153358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
With the advent of balloon pulmonary angioplasty (BPA) for non-surgical chronic thromboembolic pulmonary hypertension (CTEPH) patients, there is renewed interest in the pulmonary angiography technique. This technique is still the standard imaging modality to confirm CTEPH, which, in addition, helps to determine the most appropriate treatment. Furthermore, learning this technique fulfills two main purposes: to identify BPA candidates and to provide the operator with the catheter handling needed to perform BPA. Operators interested in performing BPA must learn not only the pulmonary arteries’ anatomy, but also which are the best angiographic projections and the most suitable catheters to canalize and display each segmental branch. Unfortunately, this information is scarce in the literature. With this goal, learning the diagnostic pulmonary angiography technique can be a first step on the way to perform BPA. Although there are descriptions on how to perform a pulmonary angiography with balloon-tipped catheters and the digital subtraction technique, this technique does not provide operators with the catheter knowledge and manual skill needed to cannulate each segmental branch. In contrast, learning the conventional selective segmental pulmonary angiography (SSPA) technique provides the operator with this knowledge and skills. In this review, based on the experience of the authors, we describe the pulmonary arteries’ anatomy and detail the practical aspects of the SSPA procedure, with the aim of providing operators with the anatomical and technical knowledge needed to perform BPA. We also summarize the contemporary complications of SSPA in CTEPH patients at a reference center.
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Bacon JL, Madden BP, Gissane C, Sayer C, Sheard S, Vlahos I. Vascular and Parenchymal Enhancement Assessment by Dual-Phase Dual-Energy CT in the Diagnostic Investigation of Pulmonary Hypertension. Radiol Cardiothorac Imaging 2020; 2:e200009. [PMID: 33778636 DOI: 10.1148/ryct.2020200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/30/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate pulmonary hypertension (PH) determination by dual-phase dual-energy CT pulmonary angiography vascular enhancement and perfused blood volume (PBV) quantification. Materials and Methods In this prospective study, consecutive participants who underwent both right heart catheterization and dual-phase dual-energy CT pulmonary angiography were included between 2012 and 2014. CT evaluation comprised a standard pulmonary arterial phase dual-energy CT pulmonary angiography acquisition (termed series 1) followed 7 seconds after series 1 completion by a second dual-energy CT pulmonary angiography acquisition limited to the central 10 cm of the pulmonary vasculature (termed series 2). In both series, enhancement in the main pulmonary artery (PAenh), the descending aorta (DAenh), and whole-lung PBV (WLenh) was calculated from dual-energy CT pulmonary angiography iodine images. Dual-energy CT pulmonary angiography and standard cardiovascular metrics were correlated to mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) with additional receiver operating characteristic curve analysis. Results A total of 102 participants (median age, 70; range, 58-78 years; 60 women) were included. Sixty-five participants had PH defined by mPAP of greater than or equal to 25 mm Hg, and 51 participants had PH defined by PVR of greater than 3 Wood units. By either definition, participants with PH had higher PAenh/WLenh ratio and lower WLenh and DAenh in series 1 (P < .05) and higher PAenh and WLenh in series 2 (P < .05). Change in WLenh determined highest diagnostic accuracy to define disease by mPAP (area under the receiver operating characteristic curve [AUC], 0.78) and PVR (AUC, 0.79) and the best mPAP correlation (r = 0.62). PAenh series 2 correlated best with PVR (r = 0.49). Multiple linear regression analysis incorporating WLenh and series 1 DAenh improved PVR correlation (r = 0.56). Combining these dual-energy CT pulmonary angiography metrics with main pulmonary artery size and right-to-left ventricular ratio achieved the highest correlations (mPAP, r = 0.71; PVR, r = 0.64). Conclusion Dual-phase dual-energy CT pulmonary angiography enhancement quantification appears to improve mPAP and PVR prediction in noninvasive PH evaluation.Supplemental material is available for this article.See also the commentary by Kay in this issue.© RSNA, 2020.
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Affiliation(s)
- Jenny Louise Bacon
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Brendan Patrick Madden
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Conor Gissane
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Charles Sayer
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Sarah Sheard
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Ioannis Vlahos
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
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Saydain G, Awan A, Manickam P, Kleinow P, Badr S. Pulmonary Hypertension an Independent Risk Factor for Death in Intensive Care Unit: Correlation of Hemodynamic Factors with Mortality. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:27-33. [PMID: 26124692 PMCID: PMC4479167 DOI: 10.4137/ccrpm.s22199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/02/2015] [Accepted: 02/18/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Critically ill patients with pulmonary hypertension (PH) pose additional challenges due to the existence of right ventricular (RV) dysfunction. The purpose of this study was to assess the impact of hemodynamic factors on the outcome. METHODS We reviewed the records of patients with a diagnosis of PH admitted to the intensive care unit. In addition to evaluating traditional hemodynamic parameters, we defined severe PH as right atrial pressure >20 mmHg, mean pulmonary artery pressure >55 mmHg, or cardiac index (CI) <2 L/min/m2. We also defined the RV functional index (RFI) as pulmonary artery systolic pressure (PASP) adjusted for CI as PASP/CI; increasing values reflect RV dysfunction. RESULTS Fifty-three patients (mean age 60 years, 72% women, 79% Blacks), were included in the study. Severe PH was present in 68% of patients who had higher Sequential Organ Failure Assessment (SOFA) score (6.8 ± 3.3 vs 3.8 ± 1.6; P = 0.001) and overall in-hospital mortality (36% vs 6%; P = 0.02) compared to nonsevere patients, although Acute Physiology and Chronic Health Evaluation (APACHE) II scores (19.9 ± 7.5 vs 18.5 ± 6.04; P = 0.52) were similar and sepsis was more frequent among nonsevere PH patients (31 vs 64%; P = 0.02). Severe PH (P = 0.04), lower mean arterial pressure (P = 0.04), and CI (P = 0.01); need for invasive ventilation (P = 0.02) and vasopressors (P = 0.03); and higher SOFA (P = 0.001), APACHE II (P = 0.03), pulmonary vascular resistance index (PVRI) (P = 0.01), and RFI (P = 0.004) were associated with increased mortality. In a multivariate model, SOFA [OR = 1.45, 95% confidence interval (C.I.) = 1.09–1.93; P = 0.01], PVRI (OR = 1.12, 95% C.I. = 1.02–1.24; P = 0.02), and increasing RFI (OR = 1.06, 95% C.I. = 1.01–1.11; P = 0.01) were independently associated with mortality. CONCLUSION PH is an independent risk factor for mortality in critically ill patients. Composite factors rather than individual hemodynamic parameters are better predictors of outcome. Monitoring of RV function using composite hemodynamic factors resulting in specific interventions is likely to improve survival and needs to be studied further.
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Affiliation(s)
- Ghulam Saydain
- Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Aamir Awan
- Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Palaniappan Manickam
- Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Paul Kleinow
- Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Safwan Badr
- Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Tang Q, Liu M, Ma Z, Guo X, Kuang T, Yang Y. Non-invasive evaluation of hemodynamics in pulmonary hypertension by a Septal angle measured by computed tomography pulmonary angiography: Comparison with right-heart catheterization and association with N-terminal pro-B-type natriuretic peptide. Exp Ther Med 2013; 6:1350-1358. [PMID: 24255661 PMCID: PMC3829756 DOI: 10.3892/etm.2013.1324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/12/2013] [Indexed: 12/25/2022] Open
Abstract
The septal angle, an angle between the interventricular septum and the line connecting the sternum midpoint and thoracic vertebral spinous process, as measured by computed tomographic pulmonary angiography (CTPA), has been observed to be increased in patients with pulmonary hypertension (PH), but its meaning remains unclear. The aim of this study was to investigate the potential role of the septal angle in evaluating hemodynamics and its association with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with PH. Patients with PH (n=106), including 76 with chronic thromboembolic pulmonary hypertension (CTEPH) and 30 with pulmonary artery hypertension (PAH), were retrospectively reviewed. The patients underwent CTPA prior to right-heart catheterization. The septal angle was measured on transversal CTPA images. Hemodynamic parameters were evaluated by right-heart catheterization. The level of plasma NT-proBNP was measured by enzyme-linked sandwich immunoassay. The septal angle had a moderate correlation with cardiac output (CO; r=−0.535, P=0.000) and a high correlation with pulmonary vascular resistance (PVR; r=0.642, P=0.000). The mean level of NT-proBNP in PH was 1,716.09±1,498.30 pg/ml, which correlated with the septal angle (r=0.693, P=0.000). In a stepwise forward regression analysis, the Septal angle was entered into the final equation for predicting PVR, leading to the following equation: PVR = 28.256 × Septal angle - 728.72. In CTEPH, the Septal angle strongly correlated with NT-proBNP (r=0.668, P=0.000) and PVR (r=0.676, P=0.000). In PAH, the Septal angle strongly correlated with NT-proBNP (r=0.616, P=0.003) and PVR (r=0.623, P=0.000). The CTPA-derived Septal angle is a superior predictor for evaluating and monitoring the level of NT-proBNP and PVR in patients with PH.
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Affiliation(s)
- Qiang Tang
- Department of Cardiology, Shougang Hospital, Peking University, Beijing 100144, P.R. China
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Kyle WB. Pulmonary Hypertension Associated with Congenital Heart Disease: A Practical Review for the Pediatric Cardiologist. CONGENIT HEART DIS 2012; 7:575-83. [DOI: 10.1111/chd.12012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2012] [Indexed: 12/11/2022]
Affiliation(s)
- W. Buck Kyle
- Pediatrics; Texas Children's Hospital/Baylor College of Medicine; Houston; Tex; USA
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Pulmonary endarterectomy: recent changes in a single institution's experience of more than 2,700 patients. Ann Thorac Surg 2012; 94:97-103; discussion 103. [PMID: 22626752 DOI: 10.1016/j.athoracsur.2012.04.004] [Citation(s) in RCA: 379] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/29/2012] [Accepted: 04/02/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is a known sequela of acute pulmonary embolic disease and yet remains underdiagnosed. Although nonsurgical options for patients with CTEPH have become increasingly available, including pulmonary artery hypertensive medical therapy, surgical endarterectomy provides the most appropriate intervention as a potential cure for this debilitating disorder. This article summarizes the most recent outcomes of pulmonary endarterectomy at a single institution over the past 12 years, with emphasis on the surgical approach to segmental-level chronic thromboembolic disease. METHODS More than 2,700 pulmonary endarterectomy operations have been performed at the University of California, San Diego Medical Center. Because of recent changes in the patient population and in surgical results, 1,500 patients with symptomatic chronic thromboembolic disease who underwent pulmonary endarterectomy between March 1999 and December 2010 were analyzed. The outcomes for the more recent 500 patients, compared with the previous 1,000 were studied. RESULTS In-hospital mortality for the cohort of 1,000 patients (group 1) was 5.2% compared with 2.2% for the last 500 operations (group 2) (p < 0.01). There was no mortality in the last 260 consecutive patients undergoing isolated pulmonary endarterectomy. More patients presented with segmental type III disease in the more recent 500 patients (21.4% versus 13.1%; p < 0.001). Between the 2 patient groups, there was a comparable decline in pulmonary vascular resistance (PVR) (group 1: 861.2 ± 446.2 to 94.8 ± 204.2 dynes/sec/cm(-5); group 2: 719.0 ± 383.2 to 253.4 ± 148.6 dynes/sec/cm(-5)) and mean pulmonary artery (PA) pressures (group 1: 46.1 ± 11.4 to 28.7 ± 10.1 mm Hg; group 2: 45.5 ± 11.6 to 26.0 ± 8.4 mm Hg) after endarterectomy. CONCLUSIONS Despite a patient population with more distal disease, results continue to improve. Pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement, with favorable outcomes achievable even in patients with distal segmental-level chronic thromboembolic disease.
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Sánchez Nistal M. Hipertensión pulmonar: aportación de la TCMD al diagnóstico de sus distintos tipos. RADIOLOGIA 2010; 52:500-12. [DOI: 10.1016/j.rx.2010.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/25/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022]
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Liu M, Ma Z, Guo X, Zhang H, Yang Y, Wang C. Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction. Eur J Radiol 2010; 80:e462-9. [PMID: 20889276 DOI: 10.1016/j.ejrad.2010.08.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 08/23/2010] [Accepted: 08/26/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to investigate the role of computed tomographic pulmonary angiography (CTPA) in the assessment of severity and right ventricular function in chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS AND METHODS Clinical and radiological data of 56 patients with CTEPH January 2006-October 2009 were retrospectively reviewed in the present study. All patients received CTPA with a 64-row CT using the retrospective ECG-Gated mode before digital subtraction pulmonary angiography and right-heart catheterization. CTPA findings including Right Ventricular diameter (RVd) and left ventricular diameter (LVd) were measured at the end diastole. CT Pulmonary Artery Obstruction Indexes including Qanadli Index and Mastora Index were used in the assessment of severity of pulmonary arterial obstruction. Hemodynamic parameters and pulmonary hypertension classification were evaluated by right-heart catheterization in all patients. Right ventricular function was measured with echocardiography in 49 patients. RESULTS Qanadli Index and Mastora Index respectively were (37.93±14.74)% and (30.92±16.91)%, which showed a significant difference (Z=-5.983, P=0.000) and a good correlation (r=0.881, P=0.000). Neither Qanadli nor Mastora Index correlated with pulmonary hypertension classification (r=-0.009, P=0.920) or New York Heart Association heart function classification (r=-0.031, P=0.756). Neither Qanadli nor Mastora Index correlated with any echocardiographic right ventricular parameters (P>0.05), while RVd/LVd by CTPA correlated with echocardiographic right ventricular functional parameters (P<0.05). Both Qanadli (r=-0.288, P=0.006) and Mastora Index (r=-0.203, P=0.032) demonstrated a weakly negative correlation with SPO2. CTPA findings correlated with hemodynamic variables. Backward linear regression analysis revealed that the RVd/LVd, Right Ventricular Anterior Wall Thickness (RVAWT), Main Pulmonary Artery trunk diameter (MPAd) were shown to be independently associated with mean Pulmonary Artery Pressure (mPAP) levels (model: r2=0.351, P=0.025; RVd/LVd: beta=11.812, P=0.000; RVAWT: beta=2.426, P=0.000; MPAd: beta=0.677, P=0.003). CONCLUSION Computed tomographic pulmonary angiography is a valuable tool to evaluate hemodynamics, right ventricular function of CTEPH, but neither Qanadli Index nor Mastora Index can reflect pulmonary arterial obstruction in CTEPH accurately.
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Affiliation(s)
- Min Liu
- Department of Radiology, Chao Yang Hospital, Capital Medical University, No. 8, Gong Ti Nan Road, Beijing 100020, China.
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Sánchez Nistal M. Pulmonary hypertension: The contribution of MDCT to the diagnosis of its different types. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Elan Hekier
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA.
| | - Jess Mandel
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA
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Nistal MAS, Martín MTV. Métodos de imagen en la hipertensión pulmonar tromboembólica crónica. Arch Bronconeumol 2009; 45 Suppl 6:21-9. [DOI: 10.1016/s0300-2896(09)73499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Celermajer DS, Marwick T. Echocardiographic and right heart catheterization techniques in patients with pulmonary arterial hypertension. Int J Cardiol 2008; 125:294-303. [PMID: 17689753 DOI: 10.1016/j.ijcard.2007.04.184] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The cardiovascular assessment of patients with suspected pulmonary arterial hypertension (PAH) involves Doppler echocardiography and often subsequent confirmation by right heart catheterization (RHC). However, there appears to be limited consensus on the appropriate technique(s) for assessing PAH, and thus no clear, comprehensive guidelines exist for assessment of PAH. The aim of this paper is to review the Doppler echocardiographic and RHC techniques for the diagnosis and/or assessment of PAH. METHOD We searched Medline (1966 to August 2006) and EMBASE (1980 to August 2006) bibliographic databases to allow identification of all potentially relevant studies and review articles. In addition, the reference lists of included articles were scanned to identify relevant references and unpublished reports missed by the search strategy. RESULTS Our findings show that recommendations for the echocardiographic assessment of PAH at rest or with exercise are heterogeneous. Clinical practice guidelines provide limited details. Although more specific information regarding echocardiographic techniques can be obtained from individual research articles, the techniques employed and the methods used to calculate specific hemodynamic variables do not appear to be consistent throughout the literature. RHC techniques for the confirmation of PAH are more consistent, albeit less frequently reported. The literature search identified several articles where indications and considerations for the catheterization of patients with PAH are discussed, together with safety considerations and principles for the accurate assessment of hemodynamic variables. CONCLUSION Although clinical practice guidelines and numerous research studies provide details of echocardiographic measures in patients with PAH, greater consensus and standardisation of measurement techniques is required. A minimum dataset for the evaluation of PAH by these techniques is suggested.
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Affiliation(s)
- David S Celermajer
- Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
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Neish SR, Towbin JA. Pathophysiology, Clinical Recognition, and Treatment of Congenital Heart Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Centres de référence et partenariat privé/public: l’expérience de l’hypertension artérielle pulmonaire et de la sclérodermie systémique. Presse Med 2006. [DOI: 10.1016/s0755-4982(06)74944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Thistlethwaite PA, Madani M, Jamieson SW. Outcomes of Pulmonary Endarterectomy Surgery. Semin Thorac Cardiovasc Surg 2006; 18:257-64. [PMID: 17185189 DOI: 10.1053/j.semtcvs.2006.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2006] [Indexed: 11/11/2022]
Abstract
Chronic thromboembolic pulmonary hypertension has emerged as one of the leading causes of severe pulmonary hypertension. This disease is estimated to occur in approximately 1 to 5% of all patients who have previously developed an acute pulmonary embolism, although the true prevalence is suspected to be much higher. Chronic thromboembolic pulmonary hypertension is characterized by intraluminal thrombus organization, fibrous stenosis, and vascular remodeling of pulmonary vessels. Pulmonary endarterectomy is an operation that is considered curative for thromboembolic pulmonary hypertension and is therefore superior to transplantation for this condition. This article focuses on the surgical outcomes of patients undergoing pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension and discusses the currently known factors that affect survival after this operation.
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Hachulla E, Gressin V, Guillevin L, Carpentier P, Diot E, Sibilia J, Kahan A, Cabane J, Francès C, Launay D, Mouthon L, Allanore Y, Tiev KP, Clerson P, de Groote P, Humbert M. Early detection of pulmonary arterial hypertension in systemic sclerosis: a French nationwide prospective multicenter study. ACTA ACUST UNITED AC 2006; 52:3792-800. [PMID: 16320330 DOI: 10.1002/art.21433] [Citation(s) in RCA: 450] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Screening allows for early management of pulmonary arterial hypertension (PAH), a severe complication of systemic sclerosis (SSc). Since no consensus has been reached on the method and criteria for optimal screening, we sought to develop an algorithm based on symptoms, Doppler echocardiography, and right heart catheterization (RHC) for application to a nationwide multicenter SSc population in France. METHODS This prospective study was conducted from September 2002 to July 2003 by experts at 21 SSc centers. At each center, SSc patients without severe pulmonary function abnormalities underwent Doppler echocardiography by an experienced cardiologist. Patients with a peak velocity of tricuspid regurgitation (VTR) of >3 meters/second or 2.5-3 meters/second with unexplained dyspnea were asked to undergo RHC to confirm PAH according to international guidelines. RESULTS Of the 599 patients analyzed, 29 had known PAH and 33 had suspected PAH, based on Doppler echocardiography, and underwent RHC. Of these 33, 18 were found to have PAH, 3 had left ventricular dysfunction, and 12 had no PAH. Newly diagnosed cases of PAH were of mild severity (mean +/- SD pulmonary artery pressure [mPAP] 30 +/- 9 mm Hg, mean +/- SD total pulmonary resistance [TPR] 524 +/- 382 dynes x second/cm(5)). Hemodynamic findings in patients with known PAH were mPAP 49 +/- 17 mm Hg and TPR 1,007 +/- 615 dynes x second/cm(5). The estimate of PAH prevalence was 7.85% (95% confidence interval 5.70-10.00). CONCLUSION This screening algorithm, based on dyspnea, Doppler echocardiographic evaluation of VTR, and RHC, enabled early detection of PAH at a mild stage. Whether mild PAH will evolve to severe PAH in reported cases and whether this early diagnosis translates into improved prognosis for patients with mild PAH will be evaluated in the ongoing 3-year followup of this cohort.
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Kluger N, Gati S, Molinari E, Francès C. Manifestations pulmonaires dans la sclérodermie systémique. Ann Dermatol Venereol 2005; 132:905-14. [PMID: 16327725 DOI: 10.1016/s0151-9638(05)79514-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- N Kluger
- Dermatologie, Hôpital Tenon, Paris
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