Objective To analyze the relation between preoperative pulmonary artery pressure(PAP) and postoperative complications in heart transplant patients, and summarize the experience of perioperative management of pulmonary hypertension (PH), to facilitate the early period heart function recovery of postoperative heart transplant patients. Methods A total of 125 orthotopic heart transplant patients were divided into two groups according to preoperative pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR), pulmonary [CM(1583mm]hypertension group (n=56): preoperativePASPgt;50 mm Hg or PVRgt;5 Wood·U; control group (n=69): preoperative PASP≤50 mmHg and PVR≤5 Wood·U. Hemodynamics index including preoperative cardiac index (CI)，preoperative and postoperative PVR and PAP were collected by SwanGanz catheter and compared. The extent of postoperative tricuspid regurgitation was evaluated by echocardiography. Postoperative pulmonary hypertension was treated by diuresis，nitrogen oxide inhaling，nitroglycerin and prostacyclin infusion, continuous renal replacement therapy(CRRT)and extracorporeal membrane oxygenation(ECMO). Results All patients survived except one patient in pulmonary hypertension group died of multiorgan failure and severe infection postoperatively in hospital. Acute right ventricular failure occurred postoperatively in 23 patients, 10 patients used ECMO support, 10 patients with acute renal insufficiency were treated with CRRT. 124 patients were followed up for 2.59 months，7 patients died of multiple organ failure, infection and acute rejection in follow-up period, the survivals in both groups have normal PAP, no significant tricuspid regurgitation. No significant difference in cold ischemia time of donor heart, cardiopulmonary bypass(CPB) and circulation support time between both groups; but the patients of pulmonary hypertension group had longer tracheal intubation time in comparison with the patients of control group (65±119 h vs. 32±38 h, t=2.17，P=0.028). Preoperative PASP，mean pulmonary artery pressure(MPAP) and PVR in pulmonary hypertension group were significantly higher than those in control group, CI was lower in pulmonary hypertension group ［PASP 64.30±11.50 mm Hg vs. 35.60±10.20 mm Hg; MPAP 43.20±8.50 mm Hg vs. 24.20±7.20 mm Hg; PVR 4.72±2.26 Wood·U vs. 2.27±1.24 Wood·U; CI 1.93±0.62 L/（min·m2） vs. 2.33±0.56 L/（min·m2）; Plt;0.05］. Postoperative early PASP, MPAP and PVR in pulmonary hypertension group were significantly higher than those in control group (PASP 35.40±5.60 mm Hg vs. 31.10±5.70 mm Hg, MPAP 23.10±3.60 mm Hg vs. 21.00±4.00 mm Hg, PVR 2.46±0.78 Wood·U vs. 1.79±0.62 Wood·U; Plt;0.05). Conclusion Postoperative right heart insuficiency is related to preoperative pulmonary hypertension in heart transplant patients. Donor heart can quickly rehabilitate postoperatively by effectively controlling perioperative pulmonary hypertension with good follow-up results.
Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.
Abstract： Right ventricular dysfunction or right heart failure is a complex clinical syndrome and often leads to a poor prognosis and high mortality. In order to detect right ventricular dysfunction at an early stage, provide a therapy guidance and evaluate treatment outcomes， right ventricular function evaluation has aroused more and more concern in clinical physicians. With the advantages of being non-invasive， accuracy and repetitiveness， echocardiography is used extensively in the assessment of heart function. In this review， we focus on how to use echocardiography to evaluate right ventricular function easily, efficiently， accurately and sensitively， and provide a good foundation for its further clinical application.
Objective To investigate clinical outcomes of one and a half ventricle repair for acute right ventricular dysfunction after biventricular repair. Methods Clinical data of 5 pediatric patients with congenital heart diseases who underwent emergency bidirectional Glenn shunt without cardiopulmonary bypass for acute right ventricular dysfunction after biventricular repair，converting the operation into one and a half ventricle repair，from February 2007 to June 2012 in Qingdao Women and Children Hospital were retrospectively analyzed. There were 4 male patients and 1 female patient with their age of 7-18 months and body weight of 6-13 kg. Preoperative diagnosis included pulmonary atresia with intact ventricular septum （PA/IVS） in 1 patient，tricuspid stenosis （TS） with ventricular septal defect （VSD） and atrial septal defect （ASD） in 2 patients，and tricuspid stenosis with tetralogy of Fallot （TOF） in 2 patients. Postoperative care focused on cardiopulmonary support and control of pulmonary artery pressure. Results Mean pulmonary artery pressure （mPAP） was 12-18 mm Hg at 72 hours after emergency bidirectional Glenn shunt. Mechanical ventilation time was 3-182 hours and ICU stay was 2-13 days. Postoperatively 1 patient died of pulmonary hypertension crisis. The other 4 patients were discharged with their transcutaneous oxygen saturation in the resting state of 93%-99%，which was improved in different degrees compared with preoperative value. These 4 patients were followed up from 6 months to 4 years. Three patients were in NYHA classⅠand 1 patient was in NYHA class Ⅱ during follow-up. Echocardiography showed smooth vena cava to pulmonary artery anastomosis without thrombosis formation. Conclusion One and a half ventricle repair can be used as an adjunct surgical strategy for acute right ventricular dysfunction after biventricular repair.
Objective To investigate the changes of pulmonary circulation and right ventricular function after lung volume reduction surgery. Methods We retrospectively analyzed the clinical data of 34 patients of severe chronic obstructive pulmonary disease with single or double lung volume reduction surgery through thoracoscope in our hospital from 2013 through 2014. Ultrasonic testing was conducted peroperatively, on postoperative day 3–5, at 1 month and 3 months after surgery. Results Right ventricular stroke volume (61.00±10.54 ml vs. 38.34±10.04 ml) and right ventricular ejection fraction decreased (58.00%±9.00% vs. 49.00%±10.00%), mean pulmonary arterial pressure (23.35±5.07 mm Hg vs. 29.57±6.32 mm Hg) and total pulmonary vascular resistance (9.28±2.14 mm Hg vs. 12.05±4.36 mm Hg) increased with statistical differences (P＜0.05) on postoperative day 3–5. Right heart ejection fraction was 51%±11% with a statistical increase (P＜0.05) at 1 month after surgery. There was no statistical difference in indicators above between 3 months after surgery and before surgery. Conclusion Changes of pulmonary circulation and right ventricular function may be temporary. Right ventricular dysfunction decreases, pulmonary arterial pressure, and total pulmonary vascular resistance increases on postoperative day 3–5 d. But the changes gradually recover in 1–3 months after surgery, and could be gradually restored to preoperative level.
Evaluationthe right heart function has vital clinical value, especially in patients after surgical repair of tetralogy of Fallot(TOF).As an important tool used to assess the structure and function of heart, echocardiography has been used to evaluatethe right heart function of TOF after the surgery. This article reviews the current research on echocardiography techniques and right heart function in patients after surgical repair of Tetralogy of Fallot．
Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.
Objective To discuss the safety and validity of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) patients with severe right heart failure (RHF). Methods PEA procedures were performed on 36 patients in Fu Wai Hospital from January 2015 to April 2016. There were 28 males and 8 females, with a mean age of 46.56±11.85 years. According to the New York Heart Association (NYHA) cardiac function classification, 36 patients were divided into preoperative severe RHF group (grade Ⅲ-Ⅳ,n=28) and preoperative without severe RHF group (grade Ⅱ,n=8). Hemodynamic parameters before and after PEA were recorded and 3-18 months' follow-up was done. Results All the patients having PEA surgeries had an obvious decrease of mean pulmonary arterial pressure (from 49.53±13.14 mm Hg to 23.58±10.79 mm Hg) and pulmonary vascular resistance (from 788.46±354.60 dyn·s/cm5 to 352.89±363.49 dyn·s/cm5, bothP<0.001). There was no in-hospital mortality among all the patients. Persistent pulmonary hypertension occurred in 2 patients, perfused lung in 2 patients, pericardial effusion in 2 patients. No mortality was found during the follow-up period. All patients improved to NYHA grade Ⅰ-Ⅱ (WHO grade Ⅰ-Ⅱ), and only 2 patients remained in the NYHA grade Ⅲ (P<0.01). Conclusion The CTEPH patients having PEA surgeries had an obvious improvement in both their hemodynamics results and postoperative heart function, which in return could improve their quality of life.