Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy

For patients with chronic thromboembolic pulmonary hypertension who undergo pulmonary thromboendarterectomy (PTE) it has not yet been systematically investigated how operation affects the severity of tricuspid regurgitation (TR). This study sought (1) to evaluate the extent of TR reversibility after operation, (2) to identify potential predictors of the reversibility of TR, and (3) to investigate the influence of geometric and hemodynamic alterations on the extent of TR severity.Thirty-nine patients (55+/-12 years) undergoing PTE without tricuspid valve repair were investigated before and 13+/-8 days after operation by Doppler color flow mapping. Geometry of the tricuspid valve as well as r…

Reversibilität von Veränderungen der links- und rechtsventrikulären Geometrie und Hämodynamik bei pulmonaler Hypertonie. Echokardiographische Charakterisierung bei Patienten vor und nach pulmonaler Thrombendarteriektomie (Reversibility of changes in left- and right ventricular geometry and hemodynamics in patients with pulmonary hypertension. Echocardiographic characteristics before and after pulmonary thrombendarterectomy)

Durch pulmonale Thrombendarteriektomie kann bei Patienten mit chronischer embolisch bedingter pulmonaler Hypertonie eine akute rechtsventrikulare Nachlastsenkung erzielt werden. Der Einflus auf die rechts- und linksventrikulare Geometrie und Hamodynamik wurde prospektiv mit Hilfe der transthorakalen Echokardiographie an einem Kollektiv von 14 Patienten (8 Frauen, 6 Manner; Alter 55 ± 20 Jahre) vor und nach 18 ± 12 Tagen postoperativ untersucht. Nach operativer Desobliteration der Pulmonalarterien fand sich eine Abnahme des invasiv bestimmten totalen pulmonalen Gefaswiderstands von 986 ± 318 auf 323 ± 280 dyn x s/cm5; p < 0,05. Der echokardiographisch erfaste systolische pulmonalarterielle D…

Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension

Study objectives: This study sought to evaluatethe pathophysiology of left and right heart failure in patients withchronic thromboembolic pulmonary hypertension (CTEPH) who werehospitalized to undergo pulmonary thromboendarterectomy (PTE). Design: Thirty-nine patients (16 women and 23 men;mean ± SD age, 55 ± 12 years) with severe CTEPH were examinedbefore and 13 ± 8 days after PTE by way of transthoracicechocardiography and right heart catheterization. Measurements and results: Examination resultsconfirmed in all cases that before surgery the right ventricles wereenlarged and systolic function was impaired. Moderate to severetricuspid valve regurgitation was observed. Left ventriculareccent…

Inflammation in right ventricular dysfunction due to thromboembolic pulmonary hypertension

Activation of the immune system is well established in patients with chronic heart failure (CHF) and impaired left ventricular function. High levels of pro-inflammatory cytokines are associated with a poor prognosis. Chronic thromboembolic pulmonary hypertension (CTEPH) frequently leads to impaired right ventricular function. It is not known whether such patients display chronic immune activation as well.We studied 49 patients with CTEPH (50±2 years, right ventricular ejection fraction [RVEF] 29±2%, left ventricular ejection fraction [LVEF] 51±3%, mean±SEM) and compared their results with 17 patients with CHF (71±2 years, LVEF 23±1%) and 34 age-matched control subjects (age 57±2 years). We …

Value of contrast-enhanced MR angiography and helical CT angiography in chronic thromboembolic pulmonary hypertension.

The aim of this study was to evaluate the diagnostic value of contrast-enhanced MR angiography (ce MRA) and helical CT angiography (CTA) of the pulmonary arteries in the preoperative workup of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The ce MRA and CTA studies of 32 patients were included in this retrospective evaluation. Image quality was scored by two independent blinded observers. Data sets were assessed for number of patent segmental, subsegmental arteries, and number of vascular segments with thrombotic wall thickening, intraluminal webs, and abnormal proximal to distal tapering. Image quality for MRA/CTA was scored excellent in 16 of 16, good in 11 of 14, m…

Assessment of the Tricuspid Valve Morphology by Transthoracic Real-Time-3D-Echocardiography

Aim: To demonstrate the feasibility of transthoracic three-dimensional real-time echocardiography (3D-TTE) supplemental to routine assessments of the tricuspid valve and to analyze interrater agreement. Methods: Twenty healthy subjects and 74 patients with right ventricular failure were examined with conventional 2D and additionally 3D-TTE (SONOS 7500, Philips, Netherlands). The 3D exams were performed and recorded by one of two raters. The recordings were evaluated offline and independently by both raters for visualization of morphological and functional features of the tricuspid valve according to a subjective 3-point scale. Statistical analyses were performed for interrater agreement and…

Aktuelle Frühergebnisse nach pulmonaler Thrombendarteriektomie bei chronischer thromboembolischer pulmonaler Hypertonie (Early results of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension)

Die pulmonale Thrombendarteriektomie ist ein potentiell kuratives Operationsverfahren bei Patienten mit chronischer thromboembolischer pulmonaler Hypertonie. Von Juni 1989 bis Dezember 1994 wurden in unserer Klinik 109 Patienten einer pulmonalen Thrombendarteriektomie unterzogen. Seit Januar 1995 wurden vielfaltige Veranderungen des operativen und postoperativen Therapiekonzepts vorgenommen. Wir berichten uber die Fruhergebnisse von 32 Thrombendarteriektomien, die von Januar 1995 bis Januar 1997 durchgefuhrt worden sind.

Assessment of cardiac performance using Tei indices in patients undergoing pulmonary thromboendarterectomy.

This study was designed to evaluate left and right ventricular performance using Tei indices in patients with severe chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy (PTE). The Doppler-derived indices are easily measurable indicators of ventricular function based on nongeometric assessment, which helps overcome some of the difficulties entailed in the geometric assessment of left ventricular (LV) and right ventricular (RV) function in pulmonary hypertension.The indices were derived for 24 patients (aged 54+/-14 years) before and after PTE. Calculation of these indices was based on the duration of two time intervals using the formula (A - B)/B, where A…

Chronisch thromboembolische pulmonale Hypertonie: Empfehlungen der Kölner Konsensus Konferenz 2016

The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In ev…

Solitäre fibröse Pleuratumoren - Seltene Tumoren mit unvorhersehbarem klinischen Verhalten

Solitary fibrous tumors of the pleura are rare tumors with unpredictable clinical behaviour. We report about two patients with an incidental finding of an intrathoracic tumor. Preoperative diagnosis was uncertain. In both patients, a solid tumor of the pleura was resected en bloc in combination with a wedge resection of the lung following anterolateral thoracotomy. The postoperative course was eventful. Six months after primary complete resection there were no signs of tumor recurrence.

258 Right heart wall motion and volume analysis in severe chronic pulmonary hypertension using realtime three dimensional echocardiography compared to MR imaging

Long-term results after thromboendarterectomy for chronic pulmonary embolism1

Objective: In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. Methods: Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n = 1/12/9) were re-evaluated 48‐72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed. Results: All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NY…

Surgical treatment of chronic thromboembolic pulmonary hypertension

Background: Chronic thromboembolic pulmonary artery obstruction from unresolved pulmonary emboli is characterized by persistent elevation of pulmonary vascular resistance and progressive right heart dysfunction and failure. The diagnosis of chronic thromboembolic pulmonary hypertension is difficult and often missed. Medical therapy is ineffective in these patients. The prognosis is poor and depends on the degree of pulmonary hypertension. Pulmonary thromboendarterectomy has proven to be an effective and potentially curative surgical therapy for this clinical entity although less than 1000 cases have been reported in the surgical literature. Methods: The current principles of diagnosis, pati…

Quantitative Assessment of Right Ventricular Volumes in Severe Chronic Thromboembolic Pulmonary Hypertension using Transthoracic Three-dimensional Echocardiography: Changes due to Pulmonary Thromboendarterectomy

Evaluation of a three-dimensional reconstruction method to show the changes of right ventricular volume and systolic function when patients undergo pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.In the examination of 11 patients (four female, seven male; age 56+/-10 years) before and after pulmonary thromboendarterectomy, end-diastolic and end-systolic right ventricular volumes were determined as a sum total of the calculated volumes of derived parallel slices of the right ventricle. Using a Tomtec workstation and a Vingmed CFM 800 echocardiography device, the acquired data were ECG-and respiration-triggered in the course of transthoracic examination, usin…

Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy.

Abstract Background In primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE). Methods Ten patients (mean age 49 years old [32 to 70 years old], New York Heart Association functional class III and IV) received a dose of 33 μg aerosolized iloprost immediately before surgery (T1), after intensive care unit admission (T2), and 12-hours postoperatively (T3). Effects on pulmona…

Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy.

Objective: Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of a double-blinded randomized trial with the aerosolized prostacyclin analogue iloprost in patients with residual pulmonary hypertension after PEA. Methods: Twenty-two patients (age, 55 � 13 years; 8 females; propofol- and sufen…

Chronic Thromboembolic Pulmonary Hypertension: Pre- and Postoperative Assessment with Breath-hold MR Imaging Techniques

To evaluate the potential of breath-hold magnetic resonance (MR) imaging techniques in morphologic and functional assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after surgery.Thirty-four patients with CTEPH were examined before and after pulmonary thromboendarterectomy (PTE). For morphologic assessment, contrast material-enhanced MR angiography was used; for assessment of hemodynamics, velocity-encoded gradient-echo sequences and cine gradient-echo sequences along the short axis of the heart were performed. Contrast-enhanced MR angiography was compared with selective digital subtraction angiography (DSA) for depiction of central thromboembolic m…

Chirurgische Therapie des Pulmonalarteriensarkoms

BACKGROUND AND OBJECTIVES Pulmonary artery sarcoma is a rare neoplasm and possibly unnoticed cause of pulmonary hypertension. The presentation is one of central pulmonary artery obstruction and progressive right-heart failure. In most cases, the diagnosis of malignancy is confirmed post mortem. We report the outcome of eight patients with primary pulmonary artery sarcomas. METHODS Eight patients (four female, four male, mean age 48,2 years, preop. NYHA functional class III/IV: n = 5/3) were referred for further evaluation of pulmonary hypertension. Malignancy was suspected in six of these patients by means of computed tomography (CT) and magnetic resonance tomography (MRT). In two patients …