scholarly journals Effect of Renal and Left Ventricular Function on Serial Pulmonary Arterial Pressure Changes after Device Closure of Atrial Septal Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Chul Shin ◽  
Young Won Yoon ◽  
In-Soo Kim ◽  
Jong-Youn Kim ◽  
Pil-Ki Min ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Pressure ◽  
Septal Defect ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Device Closure ◽  
Pulmonary Arterial ◽  
One Year ◽  
Pressure Changes

Background. The age of candidates for device closure of atrial septal defect (ASD) has been increasing. Thus, concerns exist about dyspnea aggravation or atrial fibrillation development after device closure due to augmentation of left ventricular (LV) and left atrial (LA) preload. This study aimed to examine patterns and determinants of serial pulmonary arterial pressure and left ventricular filling pressure changes after device closure of ASD. Methods. Among the 86 consecutive patients who underwent percutaneous device closure of ASD, those with end-stage renal disease or those without pre- or postprocedural Doppler data were excluded. The clinical, transesophageal, and transthoracic echocardiographic findings of 78 patients were collected at baseline, one-day postprocedure, and one-year follow-up. Results. The mean age of study patients was 49.8 ± 15.0 years, and the average maximal defect diameter and device size were 20.2 ± 6.0 mm and 23.8 ± 6.4 mm. Four patients (5.6%) underwent new-onset atrial fibrillation, and five patients (6.4%) took diuretics within one-year after closure. Some patients (n = 21; 27%) exhibited paradoxically increased tricuspid regurgitant velocity (TRV) one-day postprocedure; they also were older with lower e’, glomerular filtration rate, and LV ejection fraction and a higher LA volume index. However, even in these patients, TRV deceased below baseline levels one-year later. Both E/e’ and LA volume index significantly increased immediately after device closure, but all decreased one-year later. Larger defect size and higher TRV were significantly correlated with immediate E/e’ elevation. Conclusion. In older, renal, diastolic, and systolic dysfunctional patients with larger LA and scheduled for larger device implantation, peri-interventional preload reduction therapy would be beneficial.

scholarly journals Effect of Renal and Left Ventricular Function on Serial Pulmonary Arterial Pressure Changes After Device Closure of Atrial Septal Defect

2020 ◽  
Author(s):  
Chul Shin ◽  
Young Won Yoon ◽  
In-Soo Kim ◽  
Jong-Youn Kim ◽  
Pil-Ki Min ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Septal Defect ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Device Closure ◽  
Post Procedure ◽  
Pulmonary Arterial ◽  
One Year ◽  
Pressure Changes

Abstract Background: The age of candidates for device closure of atrial septal defect (ASD) has been increasing. Thus, concerns exist about dyspnea aggravation or atrial fibrillation development after device closure due to augmentation of left ventricular (LV) and left atrial (LA) preload. This study aimed to examine patterns and determinants of serial pulmonary arterial pressure and left ventricular filling pressure changes after device closure of ASD. Methods: Among the 86 consecutive patients who underwent percutaneous device closure of ASD, those without pre- or post-procedural Doppler data and end-stage renal disease were excluded. The clinical, transesophageal, and transthoracic echocardiographic findings of 78 patients were collected at baseline, one day post-procedure, and one year follow-up. Results: The mean age of study patients was 49.8 ± 15.0 years and the average maximal defect diameter and device size was 20.2 ± 6.0 mm and 23.8 ± 6.4 mm. Some patients (n = 21; 27%) exhibited paradoxically increased tricuspid regurgitant velocity (TRV) one-day post-procedure; they also were older with lower e’, glomerular filtration rate, and LV ejection fraction and a higher LA volume index. However, even in these patients, TRV deceased below baseline levels one-year later. Both E/e’ (9.0 ± 3.5 vs. 11.4 ± 4.3; p < 0.001) and LA volume index significantly increased immediately after device closure, but all decreased one-year later. Larger defect size and higher TRV were significantly correlated with immediate E/e’ elevation. Conclusion: In older, renal, diastolic and systolic dysfunctional patients with larger LA, scheduled for larger device implantation, peri-interventional preload reduction therapy would be beneficial.

scholarly journals Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients

2018 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Citra Dewi Wahyu Fitria ◽  
Azhafid Nashar ◽  
Dyah Wulan Anggrahini ◽  
Anggoro Budi Hartopo ◽  
Hasanah Mumpuni ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Registry Data ◽  
Right Heart ◽  
Eccentricity Index ◽  
Mean Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Background: Secundum type atrial septal defect (ASD) is the most common adult congenital heart disease. Hemodynamically, ASD result in a left-to-right shunt that causes right heart volume overload. This condition affects interventricular septal position and shape. Left ventricular (LV) eccentricity index (EI) suggests right ventricle (RV) overload when this ratio is >1.0. The aim of this study was to assess correlation between LV EI and mean pulmonary arterial pressure (mPAP) in secundum type ASD patients. Methods: We conducted a cross sectional study from ASD patients registry data. We enrolled subjects with secundum type ASD from the complete registry data. The LV EI was calculated from transthoracal echocardiography. The mPAP was measured by right heart catheterization as a gold standart. The correlation was performed by Spearman correlation test. Results: There were 40 adult secundum type ASD patients participated. The mean LV EI in enddiastolic was 1.55±0.39 and LV EI in end-systolic was 1.75±0.58. The median value of mPAP was 29 (12-99) mmHg. There was a moderate strength, positive and significant correlation between LV EI in end-diastolic and mPAP (r=0.37, p=0.018). The correlation was more significant and stronger between LV EI in end-systolic and mPAP (r=0.52, p=0.001). Conclusion: There was sufficiently strong and significant correlation between LV EI in both end-diastolic and end-systolic phase with mPAP in adult secundum type ASD.

MO746CARDIAC REMODELING AND PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ekaterina Borodulina ◽  
Alexander M Shutov
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricular Hypertrophy ◽  
Arterial Pressure ◽  
Ventricular Hypertrophy ◽  
Pulmonary Arterial Pressure ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Hemodialysis Treatment ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Abstract Background and Aims An important predictor of cardiovascular mortality and morbidity in hemodialysis patients is left ventricular hypertrophy. Also, pulmonary hypertension is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and the dynamics of pulmonary arterial pressure during a year-long hemodialysis treatment and to evaluate relationship between pulmonary arterial pressure and blood flow in arteriovenous fistula. Method Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.0 years) were studied. Echocardiography and Doppler echocardiography were performed in the beginning of hemodialysis treatment and after a year. Echocardiographic evaluation was carried out on the day after dialysis. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. Arteriovenous fistula flow was determined by Doppler echocardiography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology. Results Pulmonary hypertension was diagnosed in 47 (53.4%) patients. Left ventricular hypertrophy was revealed in 71 (80.7%) patients. Only 2 (2.3%) patients had LVEF&lt;50%. At the beginning of hemodialysis correlation was detected between systolic pulmonary arterial pressure and LVMI (r=0.52; P&lt;0.001). Systolic pulmonary arterial pressure negatively correlated with left ventricular ejection fraction (r=-0.20; P=0.04). After a year of hemodialysis treatment LVMI decreased from 140.49±42.95 to 123.25±39.27 g/m2 (р=0.006) mainly due to a decrease in left ventricular end-diastolic dimension (from 50.23±6.48 to 45.13±5.24 mm, p=0.04) and systolic pulmonary arterial pressure decreased from 44.83±14.53 to 39.14±10.29 mmHg (р=0.002). Correlation wasn’t found between systolic pulmonary arterial pressure and arteriovenous fistula flow (r=0.17; p=0.4). Conclusion Pulmonary hypertension was diagnosed in half of patients at the beginning of hemodialysis treatment. Pulmonary hypertension in hemodialysis patients was associated with left ventricular hypertrophy, systolic left ventricular dysfunction. After a year-long hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary arterial pressure were observed. There wasn’t correlation between arteriovenous fistula flow and systolic pulmonary arterial pressure.

scholarly journals P1261DIAGNOSTIC VALUE OF TEMPORARY OCCLUSION OF ARTERIO-VENOUS HIGH FLOW FISTULA DURING RIGHT HEART CATHETERISATION IN PATIENTS WITH PULMONARY HYPERTENSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eugene Zeltyn-Abramov ◽  
RUSTAM ISKHAKOV ◽  
NATALYA BELAVINA ◽  
NATALIYA KLOCHKOVA ◽  
NADIA FROLOVA
Keyword(s):  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
High Flow ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Right Heart ◽  
Systolic Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Abstract Background and Aims Pulmonary hypertension (PH) is prevalent in patients with functioning high-flow arterio-venous fistula (HFAVF) and associated with congestive heart failure (CHF). The real incidence and possible causes of this phenomenon is a matter of debate. Hemodynamic effects of HFAVF is considering as one of the reasons for PH formation. The subject of study was the impact of HFAVF on selected parameters of central hemodynamics. In particular, the diagnostic relevance of test of temporary HFAVF occlusion (TTO) was evaluated during right heart catheterization (RHC). Method A total of 13 patients were enrolled: 8 - after kidney transplantation (KT) with preserved allograft function and 5 - on maintenance hemodialysis (HD). All of them demonstrated clinical presentation of CHF III-IV class (NYHA). Severe PH and diastolic disfunction (DD) were observed at a baseline: echocardiographic systolic pulmonary arterial pressure sPAP (mmHg): M=59 (SD 13), ratio of mitral early diastolic inflow velocity (E) (pulsed wave Doppler) to average of septal and lateral mitral annular early-diastolic peak velocity (e′) (tissue Doppler imaging) E/e′ M=18 (SD 5). The ones who have comorbid conditions that cause PH were excluded. All patients bore an upper arm HFAVF, flow of the AVF (Qa) measured by Doppler ultrasonography was markedly high (Qa): M = 3,8 l/min (SD 1,2), the cardio-pulmonary recirculation (Qa/CO): M = 51% (SD 13). All patients underwent RHC and TTO AVF. Echocardiography (Echo) was performed initially and on the follow up (8 weeks after AVF closure/flow reduction). Statistical analysis was performed using the STATISTICA 13 software (Wilcoxon, T-test). Results The results of RHC and Echo data are presented in tables 1, 2. As can be seen from the table data, all cases demonstrated instrumental features of high output CHF (HO CHF) in accordance with patient’s clinical status. TTO of HFAVF resulted in statistically significant decrease in CO and CI values, but no changes in PAP parameters were observed. Taking into account clinical and instrumental features of advanced CHF, HF AVF was closed in 8 patients after KT and in 2 patients on HD. 3 patients on HD underwent AVF flow reduction up to Qa not exceeding 1,1 l/min. Follow-up demonstrated complete resolution of CHF and dramatic improvement of DD, reduction in CO, CI, sPAP, volume parameters. CO, cardiac output; CI, cardiac index; sPAP, systolic pulmonary arterial pressure; meanPAP, mean pulmonary arterial pressure; RAP, mean right atrial pressure; PCWP, pulmonary capillary wedge pressure; LV EDVi, left ventricular end-diastolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; Conclusion PH is a component of AVF-induced HO CHF and could be classified as postcapillary one. TTO confirms significant HFAVF contribution to specific changes of parameters of central hemodynamics due to HO CHF. TTO does not impact on PAP values and therefore is not valid to clarify PH genesis per se.

Atrial septal defect closure with an Amplatzer septal occluder fenestrated with a coronary stent in a child with pulmonary arterial hypertension

2012 ◽  
Vol 23 (5) ◽  
pp. 692-696 ◽  
Author(s):  
Gregory J. Skinner ◽  
Robert M. Tulloh ◽  
Andrew J. Tometzki ◽  
Ingram Schulze-Neick ◽  
Gareth J. Morgan
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Pressure ◽  
Arterial Hypertension ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Arterial Pressure ◽  
Severe Disease ◽  
Idiopathic Pulmonary Arterial Hypertension ◽  
Stent Insertion ◽  
Pulmonary Arterial

AbstractThe presence of an atrial septal defect in pulmonary hypertension has benefits and detractions. Even in idiopathic pulmonary arterial hypertension, a significant left-to-right shunt at atrial level may increase the pulmonary arterial pressure and exacerbate the disease. However, it is well recognised that the presence of an atrial communication may be protective in subgroups with severe disease, allowing maintenance of cardiac output during times of increased pulmonary resistance. In the present paper, we present the case of a young boy with significant idiopathic pulmonary arterial hypertension and an atrial septal defect. We report our technique of septal occlusion using a device to decrease left-to-right shunting with concomitant stent insertion in that device to maintain the potential for right-to-left shunting during times of high pulmonary arterial pressure.

A canine model of neurogenic pulmonary edema

1985 ◽  
Vol 59 (3) ◽  
pp. 1019-1025 ◽  
Author(s):  
M. B. Maron
Keyword(s):  
Arterial Pressure ◽  
Pulmonary Edema ◽  
Pulmonary Arterial Pressure ◽  
Canine Model ◽  
Systemic Arterial Pressure ◽  
Left Ventricular ◽  
Neurogenic Pulmonary Edema ◽  
Lung Water ◽  
Pulmonary Arterial ◽  
Alpha Chloralose

The purpose of this study was to evaluate the usefulness of the intracisternal administration of veratrine as a model of neurogenic pulmonary edema (NPE) in the alpha-chloralose-anesthetized dog. Veratrine (40–60 micrograms/kg) was injected into the cisterna magna of 17 animals, and systemic arterial, pulmonary arterial, and left ventricular end-diastolic (LVEDP) pressures were followed for 1 h. Eleven animals developed alveolar edema. In these animals, systemic arterial pressure increased to 273 +/- 9 (SE) Torr, pulmonary arterial pressure to 74.5 +/- 4.9 Torr, and LVEDP to 42.8 +/- 4.5 Torr, and large amounts of pink frothy fluid, with protein concentrations ranging from 48 to 93% of plasma, appeared in the airways. Postmortem extravascular lung water content (Qwl/dQl) averaged 7.30 +/- 0.46 g H2O/g dry lung wt. Six animals escaped developing this massive degree of edema after veratrine (Qwl/dQl = 4.45 +/- 0.24). These animals exhibited similar elevated systemic arterial pressures (268 +/- 15 Torr), but did not develop the degree of pulmonary hypertension (pulmonary arterial pressure = 52.5 +/- 6.7 Torr, LVEDP = 24.8 +/- 4.0 Torr) observed in the other group. These results suggest that both hemodynamic and permeability mechanisms may play a role in the development of this form of edema and that veratrine administration may provide a useful model of NPE.

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