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Heart Catheterization (heart + catheterization)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Cardiovascular Disease	70%
Transplantation	8%
4 Other Subdomains	22%

Kinds of Heart Catheterization

right heart catheterization

Selected Abstracts

The Surface Electrocardiogram Predicts Risk of Heart Block During Right Heart Catheterization in Patients With Preexisting Left Bundle Branch Block: Implications for the Definition of Complete Left Bundle Branch Block

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2010
BENZY J. PADANILAM M.D.
LBBB and Heart Block.,Background: Patients with left bundle branch block (LBBB) undergoing right heart catheterization can develop complete heart block (CHB) or right bundle branch block (RBBB) in response to right bundle branch (RBB) trauma. We hypothesized that LBBB patients with an initial r wave (,1 mm) in lead V1 have intact left to right ventricular septal (VS) activation suggesting persistent conduction over the left bundle branch. Trauma to the RBB should result in RBBB pattern rather than CHB in such patients. Methods: Between January 2002 and February 2007, we prospectively evaluated 27 consecutive patients with LBBB developing either CHB or RBBB during right heart catheterization. The prevalence of an r wave ,1 mm in lead V1 was determined using 118 serial LBBB electrocardiographs (ECGs) from our hospital database. Results: Catheter trauma to the RBB resulted in CHB in 18 patients and RBBB in 9 patients. All 6 patients with ,1 mm r wave in V1 developed RBBB. Among these 6 patients q wave in lead I, V5, or V6 were present in 3. Four patients (3 in CHB group and 1 in RBBB group) developed spontaneous CHB during a median follow-up of 61 months. V1 q wave ,1 mm was present in 28% of hospitalized complete LBBB patients. Conclusions: An initial r wave of ,1 mm in lead V1 suggests intact left to right VS activation and identifies LBBB patients at low risk of CHB during right heart catheterization. These preliminary findings indicate that an initial r wave of ,1 mm in lead V1, present in approximately 28% of ECGs with classically defined LBBB, may constitute a new exclusion criterion when defining complete LBBB. (J Cardiovasc Electrophysiol, Vol. pp. 781-785, July 2010) [source]

Percutaneous Left and Right Heart Catheterization in Fully Anticoagulated Patients Utilizing the Radial Artery and Forearm Vein: A Two-Center Experience

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006
TED S. N. LO M.R.C.P.
Background: Stopping oral anticoagulants prior to cardiac catheterization is associated with an increased risk of thromboembolism. Performing the procedures via the femoral artery and vein without interruption of anticoagulation is associated with a high rate of major access site complications. The transradial technique for left heart catheterization is safe in fully anticoagulated patients but few data are available on the percutaneous right and left heart catheterization utilizing a combination of the radial artery and antecubital vein in this group of patients. Methods: We report our experience in 28 consecutive patients that underwent left and right heart catheterizations via this percutaneous arm approach without interruption of anticoagulation. These were compared to 31 consecutive non-anticoagulated patients that underwent the procedure via a conventional femoral artery and vein approach. Results: Arterial and venous accesses were achieved and complete angiographic and hemodynamic data obtained in all patients. There were no access site complications in the anticoagulated patients despite an International normalized ratio (INR) of 2.5 ± 0.5. Procedural duration was longer in the anticoagulated group of patients, but fluoroscopy time and patient radiation dose were similar in both groups. Conclusion: Our experience suggests that left and right heart catheterization can be safely performed in most fully anticoagulated patients using this technique with a low bleeding and thromboembolic risk and no increase in radiation exposure. [source]

Identifying Left Ventricular Dysfunction in Pulmonary Hypertension

CONGESTIVE HEART FAILURE, Issue 5 2009
Navin Rajagopalan MD
The significance of left ventricular (LV) dysfunction in patients with pulmonary hypertension (PH) is unknown. Our purpose was to quantify LV function in PH patients by measuring LV myocardial performance index (MPI) and correlating it with invasively determined hemodynamic variables. The authors prospectively measured LV MPI via transthoracic echocardiography in 50 patients with PH (53±11 years; 35 women) who also underwent right heart catheterization within 1 day of echocardiography. For comparative purposes, LV MPI was also measured in 15 healthy volunteers who served as controls. LV MPI was significantly increased in the PH group compared with controls (0.62±0.27 vs 0.36±0.08; P<.001), indicating worse LV dysfunction despite that LV ejection fraction was not significantly different between the groups (58%±4% vs 60%±3%). LV MPI demonstrated significant correlations with invasively determined mean pulmonary artery pressure (r=.50; P<.001), pulmonary vascular resistance (r=.57; P<.001), and cardiac index (r=,.64; P<.001). By receiver operating characteristic analysis, LV MPI >0.75 predicted cardiac index <2 L/min/m2 with 89% sensitivity and 78% specificity (area under the curve, 0.89). In a multivariate model, LV MPI was independently associated with cardiac index (P<.01). Patients with PH demonstrate abnormal LV function as quantified by elevated LV MPI, which correlates significantly with pulmonary vascular resistance and cardiac index. [source]

Invasive and Noninvasive Correlations of B-Type Natriuretic Peptide in Patients With Heart Failure Due to Chagas Cardiomyopathy

CONGESTIVE HEART FAILURE, Issue 3 2008
Fábio Vilas-Boas MD
Heart failure due to Chagas cardiomyopathy (HFCC) differs from failure with other etiologies because of the occurrence of intense inflammatory infiltrate and right ventricle compromise. This article investigates correlations of B-type natriuretic peptide (BNP) levels with parameters of severity in HFCC. Twenty-eight patients and 8 normal controls underwent heart catheterization and clinical and laboratory analyses. BNP levels were higher in patients with HFCC (P<.0001) and correlated with New York Heart Association (NYHA) class; right atrial pressure; wedge pressure; cardiac output; levels of serum sodium, hemoglobin, urea, and tumor necrosis factor-,; and ejection fraction. Interferon-, and transforming growth factor-, did not correlate with BNP level. The authors conclude that BNP levels are elevated in patients experiencing HFCC, irrespective of NYHA class, and that the occurrence of HFCC correlates with severity of disease. [source]

Correlation of Tricuspid Annular Velocities With Invasive Hemodynamics in Pulmonary Hypertension

CONGESTIVE HEART FAILURE, Issue 4 2007
Navin Rajagopalan
The authors performed tissue Doppler imaging of the tricuspid annulus in patients with pulmonary hypertension to assess its correlation with invasive indices of right ventricular function. The study population consisted of 32 patients with suspected pulmonary hypertension who underwent pulsed tissue Doppler imaging of the tricuspid annulus and right heart catheterization. Peak systolic (Sa), early diastolic (Ea), and late diastolic (Aa) velocities of the lateral tricuspid annulus were measured and correlated with hemodynamic variables. Peak Sa demonstrated excellent correlation with hemodynamic variables, including cardiac index (r=0.78; P<.001), pulmonary vascular resistance (r=,0.79; P<.001), and transpulmonary gradient (r=,0.72; P<.001). Peak Sa <10 cm/s predicted cardiac index <2.0 L/min/m2 with 89% sensitivity and 87% specificity. In conclusion, tissue Doppler imaging of the tricuspid annulus is a complementary method to assess right ventricular function in pulmonary hypertensive patients. [source]

Comparison of Impedance Cardiography to Direct Fick and Thermodilution Cardiac Output Determination in Pulmonary Arterial Hypertension

CONGESTIVE HEART FAILURE, Issue 2004
Gordon L. Yung MD
Cardiac output (CO) is an important diagnostic and prognostic tool for patients with ventricular dysfunction. Pulmonary hypertension patients undergo invasive right heart catheterization to determine pulmonary vascular and cardiac hemodynamics. Thermodilution (TD) and direct Fick method are the most common methods of CO determination but are costly and may be associated with complications. The latest generation of impedance cardiography (ICG) provides noninvasive estimation of CO and is now validated. The purpose of this study was to compare ICG measurement of CO to TD and direct Fick in pulmonary hypertension patients. Thirty-nine enrolled patients were analyzed: 44% were male and average age was 50.8±17.4 years. Results for bias and precision of cardiac index were as follows: ICG vs. Fick (,0.13 L/min/m2 and 0.46 L/min/m2), TD vs. Fick (0.10 L/min/m2 and 0.41 L/min/m2), ICG vs. TD (respectively, with a 95% level of agreement between ,0.72 and 0.92 L/min/m2; CO correlation of ICG vs. Fick, TD vs. Fick, and ICG vs. TD was 0.84, 0.89, and 0.80, respectively). ICG provides an accurate, useful, and cost-effective method for determining CO in pulmonary hypertension patients, and is a potential tool for following responses to therapeutic interventions. [source]

Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension

ECHOCARDIOGRAPHY, Issue 5 2009
Navin Rajagopalan M.D.
Background: Determination of pulmonary vascular resistance (PVR) in patients with suspected or known pulmonary hypertension (PH) requires right heart catheterization. Our purpose was to use Doppler echocardiography to estimate PVR in patients with PH. Methods: Patient population consisted of 52 patients (53 ± 12 years; 35 females) who underwent Doppler echocardiography and right heart catheterization within 24 hours of each other. The ratio of peak tricuspid regurgitation velocity (TRV) and right ventricular outflow time-velocity integral (VTIRVOT) was measured via transthoracic echocardiography and correlated to invasively determined PVR. A linear regression equation was generated to determine PVR by echocardiography based upon the TRV/VTIRVOT ratio. PVR by echocardiography was compared to invasive PVR using Bland-Altman analysis. Results: Significant correlation was demonstrated between TRV/VTIRVOT and PVR by catheterization (r = 0.73; P < 0.001). However, Bland-Altman analysis showed that agreement between PVR determined by echocardiography and invasive PVR was poor (bias = 0; standard deviation = 4.3 Wood units). In a subset of patients with invasive PVR < 8 Wood units (26 patients), correlation between TRV/VTIRVOT and invasive PVR was strong (r = 0.94; P < 0.001). In these patients, agreement between PVR by echocardiography and invasive PVR was satisfactory (bias = 0; standard deviation = 0.5 Wood units). There was no correlation between TRV/VTIRVOT and invasive PVR in patients with PVR > 8 Wood units (n = 26; r = 0.17). Conclusion: While TRV/VTIRVOT correlates significantly with PVR, using it to estimate PVR in a PH patient population cannot be recommended. [source]

The Surface Electrocardiogram Predicts Risk of Heart Block During Right Heart Catheterization in Patients With Preexisting Left Bundle Branch Block: Implications for the Definition of Complete Left Bundle Branch Block

Ablation of Posteroseptal and Left Posterior Accessory Pathways Guided by Left Atrium,Coronary Sinus Musculature Activation Sequence

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2008
RÓBERT PAP M.D.
Introduction: While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. Methods and Results: Forty patients with posteroseptal or left posterior AP were included. The LA,CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. Conclusion: During retrograde AP conduction, the sequence of LA,CS musculature activation,as deduced from analysis of electrograms recorded at the earliest site inside the CS,can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach. [source]

Percutaneous Left and Right Heart Catheterization in Fully Anticoagulated Patients Utilizing the Radial Artery and Forearm Vein: A Two-Center Experience

Percutaneous Retrieval of a Broken Catheter from the Left Atrium in an Adult

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002
ANGELO BRUNO RAMONDO M.D.
We performed a percutaneous retrieval of a broken catheter from the left atrium in an adult patient using transseptal left heart catheterization and a helical basket guidewire. To our knowledge, this is the first description of such a therapeutical option for a foreign body lodged in the left atrium of an adult patient. [source]

Cardiac Output Technologies with Special Reference to the Horse

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2003
Kevin T.T. Corley
Critical illness, anesthesia, primary cardiovascular disease, and exercise may result in marked hemodynamic alterations. Measuring cardiac output (CO) is central to defining these alterations for both clinician and researcher. In the past 10 years, several new methods of measuring CO have been developed for the human medical market. Some of these methods are now validated in the horse and are in clinical use. The Fick method has been used in equine research for more than a century. It depends on simultaneous measurement of mixed venous (pulmonary arterial) and peripheral arterial oxygen content and oxygen uptake by the lungs. The technique is technically demanding, which restricts its clinical use. Indicator dilution techniques, with indocyanine green, cold (thermodilution), or lithium as the marker, have also been widely used in the horse. The indocyanine technique is cumbersome, and thermodilution requires right heart catheterization, which is not a benign procedure, making both of these methods less than ideal for clinical use. Lithium dilution requires catheterization of a peripheral artery and a jugular vein. It has recently been validated in anesthetized adult horses and neonatal foals. Doppler echocardiography is a noninvasive ultrasound-based technique. More accurate measurements are obtained with transesophageal than with transthoracic measurements; however, both methods require considerable technical expertise. Bioimpedance and pulse contour analysis are 2 new methods that have yet to be validated in the horse. With the currently available technology, lithium dilution appears to be the method of measuring CO best suited to the equine clinic. [source]

Development of pulmonary hypertension in 5 patients after pediatric living-donor liver transplantation: De novo or secondary?

LIVER TRANSPLANTATION, Issue 5 2006
Yasumasa Shirouzu
The development of portopulmonary hypertension (PH) in a patient with end-stage liver disease is related to high cardiac output and hyperdynamic circulation. However, PH following liver transplantation is not fully understood. Of 617 pediatric patients receiving transplants between June 1990 and March 2004, 5 (median age 12 yr, median weight 24.5 kg) were revealed to have portopulmonary hypertension (PH) after living-donor liver transplantation (LDLT), as confirmed by echocardiography and/or right heart catheterization. All children underwent LDLT for post-Kasai biliary atresia. In 2 patients with refractory biliary complications, PH developed following portal thrombosis; 2 with stable graft function, who had had intrapulmonary shunting (IPS) before LDLT, were found to have PH in spite of overcoming liver dysfunction due to hepatitis. PH developed shortly after distal splenorenal shunting in 1 patient, who suffered liver cirrhosis due to an intractable outflow blockage. The onset of PH ranged from 2.8 to 11 yr after LDLT, and mean pulmonary artery pressure (mPAP) estimated by echocardiography at the time of presentation ranged from 43 to 120 mmHg. Three of the 5 patients are alive under prostaglandin I2 (PGI2) treatment. Of these, 1 is prepared for retransplantation for an intractable complications of liver allograft, while the other 2 with satisfactory grafts are being considered for lung transplantation. Even after LDLT, PH can develop with portal hypertension. Periodic echocardiography is essential for early detection and treatment of PH especially in the recipients with portal hypertension not only preoperatively but also postoperatively. Liver Transpl 12:870,875, 2006. © 2006 AASLD. [source]

Performance of Phonoelectrocardiographic Left Ventricular Systolic Time Intervals and B-Type Natriuretic Peptide Levels in the Diagnosis of Left Ventricular Dysfunction

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2007
Brian Moyers M.D.
Background: Systolic time intervals measured by echocardiography and carotid artery tracings are validated methods of assessing left ventricular function. However, the clinical utility of phonoelectrocardiographic systolic time intervals for predicting heart failure using newer technology has not been evaluated. Methods: We enrolled 100 adult patients undergoing left heart catheterization. Participants underwent computerized phonoelectrocardiographic analysis, left ventricular end-diastolic pressure (LVEDP) measurement, transthoracic echocardiographic measurement of left ventricular ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. The heart rate-adjusted systolic time intervals included the time from the Q wave onset to peak S1 (electromechanical activation time, EMAT), Q wave onset to peak S2 (electromechanical systole, Q-S2), and peak S1 to peak S2 (left ventricular systolic time, LVST). Left ventricular dysfunction was defined as the presence of both LVEDP >15 mmHg and LVEF <50%. Results: EMAT (r =,0.51; P < 0.0001), EMAT/LVST (r =,0.41; P = 0.0001), and Q-S2 (r =,0.39; P = 0.0003) correlated with LVEF, but not with LVEDP. An abnormal EMAT ,15 (odds ratio 1.38, P < 0.0001) and EMAT/LVST ,0.40 (OR 1.13, P = 0.002) were associated with left ventricular dysfunction. EMAT ,15 had 44% sensitivity, 94% specificity, and a 7.0 likelihood ratio for left ventricular dysfunction, while EMAT/LVST ,0.40 had 55% sensitivity, 95% specificity, and a 11.7 likelihood ratio. In patients with an intermediate BNP (100,500 pg/mL), the likelihood ratio increased from 1.1 using the BNP result alone to 11.0 when adding a positive EMAT test for predicting left ventricular dysfunction. Conclusions: Phonoelectrocardiographic measures of systolic time intervals are insensitive but highly specific tests for detecting abnormalities in objective markers of left ventricular function. EMAT and EMAT/LVST provide diagnostic information independent of BNP for detecting patients with left ventricular dysfunction. [source]

The three-year incidence of pulmonary arterial hypertension associated with systemic sclerosis in a multicenter nationwide longitudinal study in France

ARTHRITIS & RHEUMATISM, Issue 6 2009
Eric Hachulla
Objective An algorithm for the detection of pulmonary arterial hypertension (PAH), based on the presence of dyspnea and the findings of Doppler echocardiographic evaluation of the velocity of tricuspid regurgitation (VTR) and right-sided heart catheterization (RHC), which was applied in a large multicenter systemic sclerosis (SSc) population, estimated the prevalence of PAH to be 7.85%. The aim of this observational study was to investigate the incidence of PAH and pulmonary hypertension (PH) during a 3-year followup of patients from the same cohort (the ItinérAIR-Sclérodermie Study). Methods Patients with SSc and without evidence of PAH underwent evaluation for dyspnea and VTR at study entry and during subsequent visits. Patients in whom PAH was suspected because of a VTR of 2.8,3.0 meters/second and unexplained dyspnea or a VTR of >3.0 meters/second underwent RHC to confirm the diagnosis. Results A total of 384 patients were followed up for a mean ± SD of 41.03 ± 5.66 months (median 40.92 months). At baseline, 86.7% of the patients were women, and the mean ± SD age of the patients was 53.1 ± 12.0 years. The mean ± SD duration of SSc at study entry was 8.7 ± 7.6 years. After RHC, PAH was diagnosed in 8 patients, postcapillary PH in 8 patients, and PH associated with severe pulmonary fibrosis in 2 patients. The incidence of PAH was estimated to be 0.61 cases per 100 patient-years. Two patients who exhibited a mean pulmonary artery pressure of 20,25 mm Hg at baseline subsequently developed PAH. Conclusion The estimated incidence of PAH among patients with SSc was 0.61 cases per 100 patient-years. The high incidence of postcapillary PH highlights the value of RHC in investigating suspected PAH. [source]

Survival in pulmonary hypertension associated with the scleroderma spectrum of diseases: Impact of interstitial lung disease

ARTHRITIS & RHEUMATISM, Issue 2 2009
Stephen C. Mathai
Objective Pulmonary hypertension (PH) is an important cause of mortality in systemic sclerosis (SSc), where it can be isolated (pulmonary arterial hypertension [PAH]) or associated with interstitial lung disease (ILD). This study was undertaken to characterize determinants of survival among SSc patients with either type of PH who received PAH-specific therapy. Methods Consecutive SSc patients with PAH or ILD-associated PH confirmed by right heart catheterization were included in the study. Kaplan-Meier and Cox proportional hazards models were used to compare survival between SSc patients with PAH and those with ILD-associated PH and to identify predictors of survival. Results Fifty-nine patients (39 with PAH and 20 with ILD-associated PH) were identified. The majority (15 of 20 with ILD-associated PH and 27 of 39 with PAH) received an endothelin receptor antagonist as initial therapy. Median followup time was 4.4 years (range 2.7,7.4 years). Survival was significantly worse in SSc patients with ILD-associated PH than in those with PAH (1-, 2-, and 3-year survival rates 82%, 46%, and 39% versus 87%, 79%, and 64%, respectively; P < 0.01 by log rank test). In a multivariable analysis, ILD-associated PH was associated with a 5-fold increase in risk of death compared with PAH. Pulmonary vascular resistance index was also an independent predictor of mortality in the overall cohort (hazard ratio 1.05, P < 0.01) and was a significant univariable risk factor in each group separately. Type of initial PAH therapy and the use of warfarin were not related to survival. Conclusion Survival in SSc complicated by PH remains poor despite currently available treatment options. While therapy may be associated with improved survival in PAH compared with historical controls, the prognosis for patients with ILD-associated PH is particularly grim. Early diagnosis and treatment may improve outcomes since worsening hemodynamic factors were associated with reduced survival. [source]

It was a nice sunny day: It was just a right heart catheterization,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2010
FSCAI, Samuel M. Butman MD
No abstract is available for this article. [source]

Transfemoral percutaneous removal of a knotted Swan-Ganz catheter,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2009
Athanasios Katsikis MD
Abstract Intracardiac knotting of balloon-tipped flow-directed catheters during a heart catheterization procedure represents a rare but serious complication. In case that such an event occurs, leading to inability to remove the catheter, various different methods have been described to solve the problem, varying from the least invasive to open heart surgery. The formation of large knots requires surgical removal in the vast majority of cases. We describe the successful nonsurgical removal of a Swan-Ganz catheter, after the formation of a large double knot, during a right heart catheterization performed without fluoroscopic guidance in the intensive care unit. This technique could serve as a last resort in cases that surgical removal seems inevitable due to size-related inapplicability of other nonsurgical methods. © 2009 Wiley-Liss, Inc. [source]

Right coronary fistula and aneurysm draining to the right atrium

ACTA PAEDIATRICA, Issue 9 2009
Erkki Pesonen
Abstract In a 3-year-old boy, a continuous heart murmur was heard. The echocardiogram showed a dilated right coronary artery suggesting the existence of a coronary fistula. A more detailed echocardiogram when the patient was sedated revealed a fistula leading to a large aneurysm and further to the right atrium. The accidental dissection and thrombosis during the interventional heart catheterization resulted in a closure of the fistula. A continuous heart murmur and a dilated coronary artery are the hallmarks of coronary fistula. Conclusion:, Anatomic details of coronary fistula might be possible to see in an echocardiogram. Interventional heart catheterization is usually an adequate treatment option. [source]

Phenotyping the Right Ventricle in Patients with Pulmonary Hypertension

CLINICAL AND TRANSLATIONAL SCIENCE, Issue 4 2009
M.S., Marc A. Simon M.D.
Abstract Right ventricular (RV) failure is associated with poor outcomes in pulmonary hypertension (PH). We sought to phenotype the RV in PH patients with compensated and decompensated RV function by quantifying regional and global RV structural and functional changes. Twenty-two patients (age 51 ± 11, 14 females, mean pulmonary artery (PA) pressure range 13,79 mmHg) underwent right heart catheterization, echocardiography, and ECG-gated multislice computed tomography of the chest. Patients were divided into three groups: Normal, PH with hemodynamically compensated, and decompensated RV function (PH-C and PH-D, respectively). RV wall thickness (WT) was measured at end-diastole (ED) and end-systole (ES) in three regions: infundibulum, lateral free wall, and inferior free wall. Globally, RV volumes progressively increased from Normal to PH-C to PH-D and RV ejection fraction decreased. Regionally, WT increased and fractional wall thickening (FWT) decreased in a spatially heterogeneous manner. Infundibular wall stress was elevated and FWT was lower regardless of the status of global RV function. In PH, there are significant phenotypic abnormalities in the RV even in the absence of overt hemodynamic RV decompensation. Regional changes in RV structure and function may be early markers of patients at risk for developing RV failure. [source]

Rest and exercise hemodynamics before and after valve replacement-A combined doppler/catheter study

CLINICAL CARDIOLOGY, Issue 1 2000
G. Inselmann M.D.
Abstract Background: Hemodynamic improvement is a common finding following valve replacement. However, despite a normally functioning prosthesis and normal left ventricular ejection fraction, some patients may show an abnormal hemodynamic response to exercise. Methods: In a combined catheter/Doppler study, rest and exercise hemodynamics were evaluated in 23 patients following aortic (n = 12) (Group 1) or mitral valve (n = 11) (Group 2) replacement and compared with preoperative findings. Patient selection was based on absence of coronary artery disease and left ventricular failure as shown by preoperative angiography. Cardiac output, pulmonary artery pressure, pulmonary capillary pressure, and pulmonary resistance were measured by right heart catheterization, whereas the gradient across the valve prosthesis was determined by Doppler echocardiography. Postoperative evaluation was done at rest and during exercise. The mean follow-up was 8.2 ± 2.2 years in Group 1 and 4.2 ± 1 years in Group 2. Results: With exercise, there was a significant rise in cardiac output in both groups. In Group 1, mean pulmonary pressure/capillary pressure decreased from 24 ± 9/18 ± 9 mmHg preoperatively to 18 ± 2/12 ± 4 mmHg postoperatively (p < 0.05), and increased to 43 ± 12/30 ± 8 mmHg with exercise (p < 0.05). The corresponding values for Group 2 were 36 ± 12/24 ± 6 mmHg preoperatively, 24 ± 7/17 ± 6 mmHg postoperatively (p < 0.05), and 51 ± 2/38 ± 4 mmHg with exercise (p < 0.05). Pulmonary vascular resistance was 109 ± 56 dyne·s·cm -5 preoperatively, 70 ± 39 dyne·s·cm -5 postoperatively (p < 0.05), and 70 ± 36 dyne·s·cm -5 with exercise in Group 1. The corresponding values for Group 2 were 241 ± 155 dyne·s·cm -5, 116 ± 39 dyne·s·cm -5 (p < 0.05), and 104 ± 47 dyne·s·cm -5. There was a significant increase in the gradients across the valve prosthesis in both groups, showing a significant correlation between the gradient at rest and exercise. No correlation was found between valve prosthesis gradient and pulmonary pressures. Conclusion: Exercise-induced pulmonary hypertension and abnormal left ventricular filling pressures seem to be a frequent finding following aortic or mitral valve replacement. Both hemodynamic abnormalities seem not to be determined by obstruction to flow across the valve prosthesis and may be concealed, showing nearly normal values at rest but a pathologic response to physical stress. [source]

Rapid assessment and safe management of severe pulmonary hypertension with milrinone during orthotopic liver transplantation

CLINICAL TRANSPLANTATION, Issue 4 2010
Kyota Fukazawa
Fukazawa K, Poliac LC, Pretto EA. Rapid assessment and safe management of severe pulmonary hypertension with milrinone during orthotopic liver transplantation. Clin Transplant 2010: 24: 515,519. © 2009 John Wiley & Sons A/S. Abstract:, The incidence of porto-pulmonary hypertension (PPHN) in patients with end stage liver disease is 8.5%. Evidence indicates that proceeding with orthotopic liver transplantation (OLT) in patients diagnosed with severe PPHN (mean pulmonary artery pressure [mPAP] > 45 mmHg) at the time of OLT surgery is associated with high perioperative mortality. We describe a case of severe PPHN that was diagnosed by right heart catheterization at the time of surgery. We quickly determined the reversibility of PPHN with a bolus of milrinone and proceeded with OLT. Further episodes of pulmonary hypertension were successfully managed with continuous milrinone infusion and transesophageal echocardiography monitoring. Reversibility via vasodilator trial after identification of high pulmonary artery pressures (PAP) may be an important indication of the feasibility of OLT. Milrinone may be useful for the rapid identification of the reversibility of high PAP and may be an effective agent to control abrupt increases in PAP during OLT. [source]

Percutaneous Left and Right Heart Catheterization in Fully Anticoagulated Patients Utilizing the Radial Artery and Forearm Vein: A Two-Center Experience