6533b7d8fe1ef96bd126b5be

RESEARCH PRODUCT

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

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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 ventriculareccentricity indexes reflected a leftward displacement of theinterventricular septum. End-diastolic left ventricular size andsystolic function had decreased, and the left ventricular fillingpattern showed impaired diastolic function. After surgery, meanpulmonary artery pressure was significantly lower (48 ± 10 mm Hg vs25 ± 7 mm Hg; p 2 vs 21 ± 5 cm 2 (p 2 vs 14 ± 4 cm 2 (p 2 vs 3.7 ± 0.8 L/min/m 2 ). Conclusions: In CTEPH, functions are impaired in theright as well as the left ventricles of the heart. Improved lungperfusion and the reduction of right ventricular pressure overload aredirect results of PTE, which in turn bring a profound reduction of right ventricular size and a recovery of systolic function. Normalization of interventricular septal motion as well as improvedvenous return to the left atrium lead to a normalization of leftventricular diastolic and systolic function, and the cardiac indeximproves.