RESUMO
BACKGROUND: For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity. METHODS: A cohort of 70 patients contributed a total of 110 paired echocardiogram and CPET results to this study, with 1 year interval for repeated examinations. Echocardiography and exercise testing were conducted following standardized procedures, and the data were collected together with clinically relevant indicators for subsequent statistical analysis. Demographic comparisons were performed using t-tests and chi-square tests. Univariate and multivariate analyses were conducted to identify potential predictors of peak oxygen uptake (peak VO2) and the carbon dioxide ventilation equivalent slope (VE/VCO2 slope). Receiver operating characteristic (ROC) analysis was used to assess the performance of the parameters. RESULTS: The ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) was found to be the only independent indicator significantly associated with both peak VO2 and VE/VCO2 slope (both p < 0.05). Additionally, left ventricular ejection fraction (LVEF) and right ventricular fractional area change (FAC) were independently correlated with the VE/VCO2 slope (both p < 0.05). TAPSE/PASP showed the highest area under the ROC curve (AUC) for predicting both a peak VO2 ≤ 15 mL/kg/min and a VE/VCO2 slope ≥ 36 (AUC = 0.91, AUC = 0.90, respectively). The sensitivity and specificity of TAPSE/PASP at the optimal threshold exceeded 0.85 for both parameters. CONCLUSIONS: TAPSE/PASP may be a feasible echocardiographic indicator for evaluating exercise tolerance.
Assuntos
Ecocardiografia , Teste de Esforço , Cardiopatias Congênitas , Curva ROC , Humanos , Feminino , Masculino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/diagnóstico por imagem , Adulto , Tolerância ao Exercício/fisiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Consumo de Oxigênio , Pessoa de Meia-Idade , Adulto Jovem , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/diagnóstico por imagemRESUMO
Pulmonary hypertension (PH) is a syndrome complex that accompanies a number of diseases of different etiologies, associated with basic mechanisms of structural and functional changes of the pulmonary circulation vessels and revealed pressure increasing in the pulmonary artery. The structural changes in the pulmonary circulation vessels are the main limiting factor determining the prognosis of patients with PH. Thickening and irreversible deposition of collagen in the pulmonary artery branches walls leads to rapid disease progression and a therapy effectiveness decreasing. In this regard, histological examination of the pulmonary circulation vessels is critical both in preclinical studies and clinical practice. However, measurements of quantitative parameters such as the average vessel outer diameter, the vessel walls area, and the hypertrophy index claimed significant time investment and the requirement for specialist training to analyze micrographs. A dataset of pulmonary circulation vessels for pathology assessment using semantic segmentation techniques based on deep-learning is presented in this work. 609 original microphotographs of vessels, numerical data from experts' measurements, and microphotographs with outlines of these measurements for each of the vessels are presented. Furthermore, here we cite an example of a deep learning pipeline using the U-Net semantic segmentation model to extract vascular regions. The presented database will be useful for the development of new software solutions for the analysis of histological micrograph.
Assuntos
Aprendizado Profundo , Hipertensão Pulmonar , Artéria Pulmonar , Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Humanos , Microscopia , Circulação PulmonarRESUMO
AIMS: Recent accumulating evidence has recently documented a significant prevalence of right ventricular dysfunction (RVD) in end-stage renal disease (ESRD) patients. Tricuspid annular plane systolic excursion (TAPSE)/pulmonary-artery systolic pressure (PASP) ratio assessed with echocardiography might be a useful clinical index of right ventricular (RV) -pulmonary arterial (PA) coupling. The current study aimed to investigate the value of the TAPSE/PASP ratios in patients on maintenance hemodialysis (MHD). METHODS: We studied 83 times echocardiographic tests from 68 patients with MHD. The associations of TAPSE/PASP ratios with echocardiography variables, clinical characteristics, and biochemical parameters were analyzed, as well as the associations of TAPSE/PASP ratios with odds of all-cause mortality, cardiovascular disease (CVD) events and frequent intermittent dialysis hypotension (IDH). RESULTS: Correlation analysis showed TAPSE/PASP ratios positively correlated with LVEF and negatively correlated with E/A and E/e' values. For clinical and biochemical parameters, TAPSE/PASP ratios negatively correlated with BNP, NT-proBNP, age, CRP, and average interdialysis weight gain (ΔBW) and positively correlated with albumin. Logistic regression analysis, which induced the TAPSE/PASP ratio as a continuous variable (per 0.1 mm/mmHg increase), identified that the TAPSE/PASP ratio was associated with decreased CVD events (OR 0.386 [95% CI 0.231-0.645], p < 0.001) and frequent IDH odds (OR 0.571 [95% CI 0.397-0.820], p = 0.002). Moreover, the TAPSE/PASP ratio independently predicted CVD events (adjusted HR 0.539 [95% CI 0.391-0.743], p < 0.001) during a follow-up period of 12 months. CONCLUSIONS: RVD, assessed by echocardiography TAPSE/PASP ratio, was found to be associated with increased risks of CVD events and frequent IDH in patients with MHD.
Assuntos
Ecocardiografia , Falência Renal Crônica , Diálise Renal , Disfunção Ventricular Direita , Humanos , Masculino , Feminino , Diálise Renal/efeitos adversos , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/diagnóstico por imagem , Pessoa de Meia-Idade , Idoso , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/epidemiologia , Estudos Retrospectivos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Modelos Logísticos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologiaRESUMO
OBJECTIVE: To evaluate the vascular impedance of the pulmonary arteries in fetuses with tetralogy of Fallot (TOF) by Doppler echocardiography. METHODS: A total of 42 fetuses with TOF (TOF group) and 84 gestational age-matched normal fetuses (control group) were prospectively collected from the Second Xiangya Hospital of Central South University from August 2022 to January 2023. The severity of TOF was classified into mild TOF (z score ≥-2), moderate TOF (-4 < z score < -2), or severe TOF (z score ≤-4) according to the z score value of the pulmonary annulus diameter. The pulsatility index (PI) of the main pulmonary artery (MPA), distal left pulmonary artery (DLPA), and distal right pulmonary artery (DRPA) were measured by pulsed-wave Doppler. The differences in clinical data and echocardiographic parameters between TOF group, control group, and TOF subgroups were compared. RESULTS: Compared with the control group, MPA-PI increased significantly, whereas DLPA-PI and DRPA-PI decreased in TOF group (all P < .001). There were no significant differences in MPA-PI and DRPA-PI among mild TOF, moderate TOF, and severe TOF (all P > .05). However, DLPA-PI decreased significantly in severe TOF compared with mild TOF (P < .05). CONCLUSION: Fetuses with TOF presented increased vascular impedance in the pulmonary trunk and decreased impedance in distal pulmonary artery branches. Further large and follow-up studies are needed to demonstrate the associations between those changed vascular impedances and the development of PA in patients with TOF.
Assuntos
Artéria Pulmonar , Tetralogia de Fallot , Ultrassonografia Pré-Natal , Humanos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/embriologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/embriologia , Artéria Pulmonar/fisiopatologia , Feminino , Ultrassonografia Pré-Natal/métodos , Gravidez , Estudos Prospectivos , Resistência Vascular/fisiologia , Adulto , Ecocardiografia Doppler/métodosRESUMO
BACKGROUND: We compared computed tomography (CT) images and holograms (HG) to assess the number of arteries of the lung lobes undergoing lobectomy and assessed easiness in interpretation by radiologists and thoracic surgeons with both techniques. METHODS: Patients scheduled for lobectomy for lung cancer were prospectively included and underwent CT for staging. A patient-specific three-dimensional model was generated and visualized in an augmented reality setting. One radiologist and one thoracic surgeon evaluated CT images and holograms to count lobar arteries, having as reference standard the number of arteries recorded at surgery. The easiness of vessel identification was graded according to a Likert scale. Wilcoxon signed-rank test and κ statistics were used. RESULTS: Fifty-two patients were prospectively included. The two doctors detected the same number of arteries in 44/52 images (85%) and in 51/52 holograms (98%). The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433). In particular, the mean difference in the number of arteries detected in the upper lobes was 0.67 ± 1.08 between surgery and CT images and 0.17 ± 0.46 between surgery and holograms (p = 0.029). Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81) and found holograms easier to evaluate than CTs (p < 0.001). CONCLUSIONS: Augmented reality by holograms is an effective tool for preoperative vascular anatomy assessment of lungs, especially when evaluating the upper lobes, more prone to anatomical variations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04227444 RELEVANCE STATEMENT: Preoperative evaluation of the lung lobe arteries through augmented reality may help the thoracic surgeons to carefully plan a lobectomy, thus contributing to optimize patients' outcomes. KEY POINTS: ⢠Preoperative assessment of the lung arteries may help surgical planning. ⢠Lung artery detection by augmented reality was more accurate than that by CT images, particularly for the upper lobes. ⢠The assessment of the lung arterial vessels was easier by using holograms than CT images.
Assuntos
Realidade Aumentada , Holografia , Neoplasias Pulmonares , Artéria Pulmonar , Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos Prospectivos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Pessoa de Meia-Idade , Holografia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/anatomia & histologia , Imageamento Tridimensional , Padrões de Referência , Pulmão/diagnóstico por imagem , Pulmão/irrigação sanguínea , Pulmão/cirurgiaRESUMO
AIMS: Remote haemodynamic monitoring with an implantable pulmonary artery (PA) sensor has been shown to reduce heart failure (HF) hospitalizations and improve quality of life. Cost-effectiveness analyses studying the value of remote haemodynamic monitoring in a European healthcare system with a contemporary standard care group are lacking. METHODS AND RESULTS: A Markov model was developed to estimate the cost-effectiveness of PA-guided therapy compared to the standard of care based upon patient-level data of the MONITOR-HF trial performed in the Netherlands in patients with chronic HF (New York Heart Association class III and at least one previous HF hospitalization). Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained from the Dutch societal perspective with a lifetime horizon which encompasses a wide variety of costs including costs of hospitalizations, monitoring time, telephone contacts, laboratory assessments, and drug changes in both treatment groups. In the base-case analysis, PA-guided therapy increased costs compared to standard of care by 12 121. The QALYs per patient for PA-guided therapy and standard of care was 4.07 and 3.481, respectively, reflecting a gain of 0.58 QALYs. The resulting incremental cost-effectiveness ratio was 20 753 per QALY, which is below the Dutch willingness-to-pay threshold of 50 000 per QALY gained for HF. CONCLUSIONS: The current cost-effectiveness study suggests that remote haemodynamic monitoring with PA-guided therapy on top of standard care is likely to be cost-effective for patients with symptomatic moderate-to-severe HF in the Netherlands.
Assuntos
Análise Custo-Benefício , Insuficiência Cardíaca , Monitorização Hemodinâmica , Artéria Pulmonar , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Países Baixos , Monitorização Hemodinâmica/métodos , Masculino , Feminino , Artéria Pulmonar/fisiopatologia , Idoso , Cadeias de Markov , Qualidade de Vida , Pessoa de Meia-Idade , Doença CrônicaRESUMO
Pulmonary artery stiffness (PAS) has been shown to be related to pulmonary artery pressure in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. This cross-sectional study was performed on patients with PAH who were confirmed by right heart catheterization and referred to Imam Reza PAH clinic for routine follow-up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow, and velocity time integral, as well as PAS, were measured. All patients performed a 6-minute walk test. Fifty patients with a mean age of 41.90â ±â 14.73 years old participated in this study. The majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and pulmonary artery systolic pressure (râ =â 0.302, Pâ =â .041), second pulmonary valve pulse Doppler velocity (V2) (râ =â -0.461, Pâ =â .003), time from onset of pulmonary flow ejection to V2/first pulmonary valve pulse Doppler velocity (râ =â -0.311, Pâ =â .037) and Z3 ratio (râ =â -0.346, Pâ =â .023). There was no significant correlation between PAS and 6-minute walk test, pulmonary vascular resistance, and tricuspid annular plane systolic excursion (Pâ >â .05). There was a significant correlation between V2 and pulmonary vascular resistance (râ =â 0.359, Pâ =â .049). PAS and first pulmonary valve pulse Doppler velocity are simple, noninvasive, available tools for the evaluation of pulmonary vascular beds and diagnosis of presymptomatic clinical status in patients with PAH.
Assuntos
Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipertensão Pulmonar/diagnóstico por imagem , Teste de Caminhada , Estudos Transversais , Ecocardiografia , Artéria Pulmonar/diagnóstico por imagem , CaminhadaRESUMO
PURPOSE: To evaluate the diagnostic performance and feasibility of a modified computed tomography (CT) scan protocol, we performed a serial assessment of the computed tomography angiography for pulmonary artery (CTA-P) and systemic artery (CTA-S) (CTA-PS) using a reduced contrast agent dose to diagnose systemic artery-to-pulmonary artery shunts (SPSs). MATERIALS AND METHODS: Twenty-five patients who underwent multiphase contrast-enhanced chest CT and conventional chest angiography were included. Three image sets (CTA-P, CTA-S, and CTA-PS) were evaluated by two board-certified radiologists. The visualization of the CT image findings associated with SPSs, such as filling defects and enhancement in the pulmonary arteries, was evaluated using a 5-point scale. RESULTS: The diagnostic performance (sensitivity, specificity, and accuracy) of CT imaging findings associated with SPSs in CTA-P and CTA-PS were as follows: CTA-P, 57.1%, 87.5%, and 62.0%; CTA-PS, 81.0%, 100.0%, and 84.0%. CT findings associated with SPSs in CTA-P were significantly sensitive to the CTA-PS protocol. There were no significant differences between the CTA-S and CTA-PS protocols. The area under the curve (AUC) of the CT imaging findings associated with SPSs in the CTA-P and CTA-PS groups was 0.835 and 0.911, respectively (P = 0.191). The AUC of the CT imaging findings associated with SPSs in CTA-S and CTA-PS were 0.891 and 0.926, respectively (P = 0.373). CONCLUSION: CTA-PS using a reduced contrast agent dose protocol could improve the overall diagnostic confidence of SPSs, owing to better visualization of CT imaging findings associated with SPSs compared to individual assessments of CTA-P or CTA-S. Therefore, CTA-PS can be used as an alternative preembolization evaluation modality to conventional angiography in patients with hemoptysis suspected of having SPSs.
Assuntos
Angiografia por Tomografia Computadorizada , Meios de Contraste , Estudos de Viabilidade , Artéria Pulmonar , Sensibilidade e Especificidade , Humanos , Meios de Contraste/administração & dosagem , Masculino , Feminino , Artéria Pulmonar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Pessoa de Meia-Idade , Idoso , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Reprodutibilidade dos TestesRESUMO
PURPOSE: To determine time to occlusion and procedure costs of embolization of pulmonary arteriovenous malformations (PAVMs) using a polytetrafluoroethylene-covered microplug compared with embolization using detachable coils. MATERIALS AND METHODS: In this prospective study, 37 patients (mean age, 39.1 years [SD ± 17.6]) with 82 PAVMs underwent embolization with microplug or detachable coils between April 2019 and January 2023. Technical success, procedure time intervals, and costs were analyzed. RESULTS: In 37 patients, 82 PAVMs and 101 feeding arteries were successfully treated (microplug, 64; microplug + another device, 5; detachable coils alone, 32). Time from embolic device inserted into the catheter to device deployed and time to occlusion differed significantly between microplug and detachable coil cohorts (P < .0001 for both). Embolization with ≥1 microplug had a significantly shorter occlusion time than embolization with detachable coils (median, 10.0 minutes saved per feeding artery) (P < .0001). Compared with detachable coil embolization, microplug embolization saved a median of 9.0 minutes per feeding artery (P < .0001) and reduced room cost by a median of $429 per feeding artery (P < .0001). Device costs per feeding artery did not differ significantly between microplug ($2,790) and detachable coil embolization ($3,147) (P = .87). CONCLUSIONS: Compared with coils, microplugs had an equally high technical success rate but significant time to occlusion and room costs savings per feeding artery. Total room cost and device cost together did not differ significantly between microplugs and coils. Microplugs may be considered technically effective and at least cost-neutral for PAVM embolization where clinically appropriate.
Assuntos
Fístula Arteriovenosa , Malformações Arteriovenosas , Embolização Terapêutica , Artéria Pulmonar/anormalidades , Veias Pulmonares , Veias Pulmonares/anormalidades , Humanos , Adulto , Estudos Prospectivos , Politetrafluoretileno , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Resultado do TratamentoAssuntos
Humanos , Masculino , Adolescente , Aorta Torácica/fisiopatologia , Artéria Pulmonar/fisiopatologia , Doença de Hodgkin/diagnóstico por imagem , Ecocardiografia/métodos , Radiografia Torácica/métodos , Ultrassonografia Doppler em Cores/métodos , Angiografia por Tomografia Computadorizada/métodos , Monitorização Hemodinâmica , Linfonodos/patologiaRESUMO
Abstract Objective: This study aimed to evaluate the early operative outcomes and to compare the left ventricle and mitral valve functions after initial Takeuchi repair in patients with anomalous left coronary arising from pulmonary artery (ALCAPA). Methods: Fourteen patients (5 males, 9 females; mean age 4.3 years, ranging from 25 days to 34 years) who were operated for ALCAPA between 2007 and 2018 were included in this study. Data were evaluated retrospectively based on our medical records. Results: Hospital mortality rate was 7.1% (n=1). Thirteen surviving patients were kept in follow-up mean 4.3±3.05 years. When compared to preoperative measurements, both left ventricular ejection fraction (LVEF), (P=0.007) and mitral regurgitation (MR) (P=0.001) significantly improved before discharge. Moreover, LVEF values were improved in the late follow-up, considering early postoperative outcomes, and this alteration was significant (P=0.014). Nevertheless, alteration in the degree of MR among patients did not differ in the long-term follow-up (P=0.180). There was no late-term mortality or need for reoperation among patients. Conclusion: Although some centers prefer to direct implantation in ALCAPA, Takeuchi procedure can be accepted as a reliable method that provides satisfactory long-term results, considering that it aids to improve left ventricle ejection fraction and reduced mitral valve regurgitation.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Artéria Pulmonar/anormalidades , Síndrome de Bland-White-Garland/cirurgia , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Estudos Retrospectivos , Resultado do Tratamento , Mortalidade Hospitalar , Procedimentos Cirúrgicos Cardíacos/métodos , Valva Mitral/cirurgiaRESUMO
RESUMEN: Antecedentes: La presión media arterial pulmonar (PMAP) es una variable hemodinámica indispensable para el diagnóstico, clasificación y pronóstico de la Hipertensión Pulmonar (HP). Su cuantificación se realiza en forma invasiva por cateterismo cardíaco derecho (CCD) y no invasivamente por ecocardiografía Doppler. Masuyama propuso su medición mediante el gradiente transvalvular pulmonar diastólico derivado de la velocidad máxima inicial de la regurgitación pulmonar (∆RPi2) correspondiendo cercanamente a la medición invasiva. Objetivos: Revalidar 3 métodos ecocardiográficos que estiman la PMAP y valorar la utilidad del método de Chemla en el Test de Reactividad Vascular Pulmonar (TRVP). Métodos: Estudio prospectivo, observacional, doble ciego divido en dos etapas. A) o I) 30 pacientes se realizó ecocardiografía Doppler diagnóstica en nuestro centro. Se midieron regurgitación tricuspídea (RT) y tiempo de aceleración pulmonar (TAP) para derivar las siguientes ecuaciones: 1) 0.61xPSAP+1.95 (Chemla) 2) Gradiente presión media RT (∆PmRT) +PAD (presión-aurícula derecha) (Aduen) y 3) 79-0.45xTAP o 90-0.60xTAP, según sea el valor del TAP. B) o II) 10 pacientes enrolados para realizar el TRVP comparando la medición ecocardiográfica (Chemla) con CCD. Resultados: En la primera parte del estudio se encontró alta correlación entre las 3 ecuaciones: ChemlaAduen, R2=0.91; Chemla-Kitabatake, R2=0.87; Aduen-Kitabatake, R2=0,91. En la segunda parte comparando la PMAP-Chemla y Cateterismo derecho (CD) obtuvimos alta correlación: en tiempo 0, 30 min y recuperación:(R2=0.87, 0.99, 0.98, respectivamente). Ambas partes del estudio mostraron límites de concordancia satisfactoria con valor medio de la diferencia entre los métodos cercano a 1 en el t30 y tR del TRVP. Conclusión: los métodos dependientes de la medición de la RT son efectivos y confiables para estimar la PMAP. El método de Chemla es útil en el TRVP.
ABSTRACTS: Background: Mean Pulmonary arterial pressure (PMAP)is an indispensable hemodynamic variable for the diagnosis, classification and prognosis of Pulmonary Hypertension (PH). Its quantification is performed invasively by cardiac catheterization and non-invasively by Doppler echocardiography. Masuyama proposed its measurement by the transvalvular diastolic pulmonary gradient derived from the initial maximum velocity of pulmonary regurgitation(ΔPRi2) corresponding closely to the invasive measurement. Objectives: to compare 3 known echocardiographic methods to estimate MPAP and demonstrate the usefulness of the Chemla method in the Pulmonary Vascular Reactivity Test (PVRT). Methods: prospective, observational, double-blind study divided into two stages. A) 30 patients underwent diagnostic Doppler echocardiography. Tricuspid regurgitation (TR) and pulmonary acceleration time (PAT) were measured to derive the equations: 1) 0.61xSPAP + 1.95 (Chemla) 2) Gradient mean pressure TR (ΔPmTR) + RAP (right atrium pressure) (Aduen).3) 79-0.45xPAT o 90-0.60xPAT depending on the value of PAT. B) 10 patients enrolled to PVRT comparing the echocardiographic measurement (Chemla) with right catheterization. Results: in the first part of the study a high correlation between the 3 equations was found : ChemlaAduen, R2 = 0.91; Chemla-Kitabatake, R2=0.87; Aduen-Kitabatake, R2=0.91. In the second part comparing the MPAP-Chemla and RHC we obtained a high correlation in time 0, 30 min and recovery: (R2=0.87,0,99,0.98, respectively). Both parts of the study showed satisfactory limits concordance with mean value of the difference between the methods close to 1 in the t30 and tR of the TRVP. Conclusion: the methods dependent on the measurement of the TR are effective and reliable for estimating MPAP. The Chemla method is useful in the PVRT.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artéria Pulmonar/fisiologia , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar/fisiologia , Hipertensão Pulmonar/diagnóstico , Resistência Vascular , Velocidade do Fluxo Sanguíneo , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Modelos Lineares , Método Duplo-Cego , Interpretação Estatística de Dados , Estudos Prospectivos , Pressão Arterial/fisiologia , Aceleração , Hipertensão Pulmonar/fisiopatologia , Pulmão/fisiologia , Pulmão/irrigação sanguíneaRESUMO
OBJETIVO: Apresentar um modelo experimental de administração de prostaglandina I2 (PGI2) por via inalatória vs. parenteral e avaliar o desempenho funcional dos pulmões em um sistema de perfusão pulmonar ex vivo. MÉTODOS: Quarenta ratos Wistar foram anestesiados, ventilados, submetidos a laparotomia com ressecção do esterno e anticoagulados. O tronco da artéria pulmonar foi canulado. Todos os animais foram submetidos a ventilação mecânica. Os animais foram randomizados em quatro grupos (10 ratos/grupo): salina nebulizada (SN); salina parenteral (SP); PGI2 nebulizada (PGI2N); e PGI2 parenteral (PGI2P). A dose de PGI2 nos grupos PGI2N e PGI2P foi de 20 e 10 µg/kg, respectivamente. Os blocos cardiopulmonares foram submetidos in situ a perfusão anterógrada com solução de baixo potássio e dextrana a 4ºC via artéria pulmonar, extraídos em bloco e armazenados a 4ºC por 6 h. Os blocos foram ventilados e perfundidos em um sistema ex vivo por 50 min, sendo obtidas medidas de mecânica ventilatória, hemodinâmica e trocas gasosas. RESULTADOS: Houve redução da pressão arterial pulmonar média após a nebulização em todos os grupos (p < 0,001), sem diferença entre os grupos. Na perfusão ex vivo, a mecânica ventilatória não diferiu entre os grupos. Houve redução da capacidade relativa de oxigenação ao longo da perfusão nos grupos SN e SP (p = 0,04), e houve aumento significativo da pressão arterial pulmonar no grupo SN. CONCLUSÕES: O modelo experimental de administração de PGI2 na extração pulmonar é exequível e confiável. Na reperfusão, os resultados de hemodinâmica e de trocas gasosas demonstraram tendência a um melhor desempenho com o uso de PGI2 do que com solução salina.
OBJECTIVE:To present a model of prostaglandin I2 (PGI2) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. METHODS: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI2 (IPGI2); and parenteral PGI2 (PPGI2). The dose of PGI2 used in the IPGI2 and PPGI2 groups was 20 and 10 µg/kg, respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4ºC for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. RESULTS: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. CONCLUSIONS: The experimental model of inhaled PGI2 administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI2 than that with the use of saline.
Assuntos
Animais , Masculino , Ratos , Anti-Hipertensivos/administração & dosagem , Epoprostenol/administração & dosagem , Transplante de Pulmão/fisiologia , Relação Ventilação-Perfusão/efeitos dos fármacos , Administração por Inalação , Pressão Sanguínea/fisiologia , Rejeição de Enxerto/prevenção & controle , Infusões Parenterais/métodos , Infusões Parenterais/normas , Modelos Animais , Artéria Pulmonar/fisiologia , Troca Gasosa Pulmonar/fisiologia , Distribuição Aleatória , Ratos Wistar , Mecânica Respiratória/fisiologia , Relação Ventilação-Perfusão/fisiologiaRESUMO
The clinical assessment of pulmonary artery systolic pressure (PASP) by means of heart auscultation may be comparable to the measures obtained by Doppler echocardiography. Aim: To compare PASP estimated by heart auscultation and echocardiography. Material and Methods: Thirty consecutive patients aged 70 ± 16 years (68 percent women) were evaluated prospectively, all of whom had an echocardiogram requested by their attending physician. Echocardiographic evaluation of PASP was made by tricuspid regurgitation velocity plus right a trial pressure estimate. Two trained clinicians, blinded for the clinical history and rest of physical examination, auscultated the patients. PASP was estimated from the auscultatory intensity of the pulmonary component in comparison to the aortic component of the second heart sound and its propagation towards the apex, in accordance to a pre-established algorithm. Correlation between auscultatory and echocardiographic measures of PASP was made by Pearson test. Variability between both methods and among observers was evaluated with Bland-Altman analysis. Results: Fifty two per cent of patients were hypertensive and 20 percent diabetic. Admission diagnoses were heart failure in 50 percent of cases, exacerbation of chronic obstructive pulmonary disease in 20 percent, pulmonary thromboembolism in 10 percent and other clinical entities in 20 percent. A significant correlation was found between auscultatory and echocardiographic estimation of PASP (r = 0.64, p = 0, 01). Bland-Altman analysis showed a mean difference between both determinations of 7.6 ± 7.6 mmHg. Bland-Altman analysis between both operators showed an average difference of 5.4 ± 8.4 mm Hg. Conclusions: Heart auscultatory evaluation allows a precise and reproducible estimation of PASP and compares favorably with echocardiographic assessment.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pressão Sanguínea/fisiologia , Auscultação Cardíaca/métodos , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar , Ecocardiografia Doppler/métodos , Métodos Epidemiológicos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica , Sístole/fisiologiaRESUMO
OBJETIVO: Analisar as características morfométricas das artérias pulmonares centrais e artérias colaterais sistêmico-pulmonares, avaliando a morfologia do suprimento sangüíneo vascular pulmonar, procurando estabelecer suas implicações no tratamento cirúrgico. MÉTODO: Entre janeiro/1990 e junho/2001, foram estudados 40 pacientes, incluíndo-se os que apresentavam estudo cineangiocardiográfico completo e prévio à primeira intervenção cirúrgica. Analisaram-se as características morfométricas das artérias pulmonares centrais e artérias colaterais sistêmico-pulmonares, assim como a distribuição da irrigação sangüínea nos pulmões. Calcularam-se os índices arterial pulmonar (IAAPP), arterial colateral sistêmico-pulmonar (IACSP) e arterial neopulmonar total (IANPT = IAAPP + IACSP). O tratamento cirúrgico foi considerado paliativo (TP), paliativo definitivo (TPD) e definitivo (TD). RESULTADOS: O TP foi predominante. Não houve diferenças estatisticamente significantes entre os pacientes com TP, TPD e TD, em relação ao IAAPP, IACSP e IANPT. Comparando o IAAPP e o IACSP, não houve diferença entre os índices para o TD (p=0,4309), o IACSP foi maior que o IAAPP para o TP (p=0,0176) e descritivamente também maior para o TPD. O IANPT dos pacientes em TD foi maior que os em TP (p=0,0959). Foram identificados cinco subgrupos morfologicamente semelhantes, denominados: B1, B2, B3, B4 e B5. A mortalidade total foi de 17,5 por cento. CONCLUSÃO: A morfologia do suprimento sangüíneo vascular pulmonar das artérias pulmonares centrais e artérias colaterais sistêmico-pulmonares mostrou-se soberana na orientação do tratamento cirúrgico. Independentemente da divisão didática em subgrupos, o TP foi predominante. A mortalidade não apresentou correlação com as características morfométricas.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Circulação Colateral , Comunicação Interventricular/cirurgia , Artéria Pulmonar/anormalidades , Atresia Pulmonar/cirurgia , Circulação Pulmonar/fisiologia , Cineangiografia , Artéria Pulmonar/cirurgia , Resultado do TratamentoRESUMO
Recientemente, un nuevo equipo ha sido desarrollado para la medición del gasto cardiaco (GC) en forma no invasiva, utilizando mecanismos de reinhalacion de CO2. Nosotros comparamos esta técnica con la medición de GC por temodilución en bolos en 23 mediciones. A diferencia de lo estándar, donde se utiliza la presión del capilar pulmonar, la presión venosa central fue utilizada para calcular parámetros derivados de los datos obtenidos del NICO. Las mediciones del GC se correlacionan parcialmente con las mediciones realizadas con termodilución y el monitoreo con NICO podría ser una buena alternativa en la medición del GC. Sin embargo, los datos obtenidos del NICO no pueden ser utilizados para los cálculos de trabajo sistólico del ventrículo izquierdo (TSVI), trabajo sistólico del ventrículo derecho (TSVD) o índices de resistencias vasculares sistémicas (IRVS)...
Assuntos
Débito Cardíaco , Artéria PulmonarRESUMO
Este trabalho analisou as alteraçoes nos diâmetros da artéria pulmonar (AP) após a derivaçao cavopulmonar bilateral (DCPB). Foram incluídos 18 pacientes submetidos a DCPB, no período de março de 1990 a janeiro de 1997 que possuíam exames cineangiográficos disponíveis no período pré e pós-operatório. As medidas da APD e APE foram realizadas em três locais: na origem, imediatamente antes da bifurcaçao e no início da artéria do lobo inferior. Em seguida, os diâmetros de cada local foram indexados a superficie corpórea ou ao diâmetro da aorta, medido em nível do diafragma. Os dados angiográflcos e oximétricos foram submetidos à análise estatística. Quando analisados os diâmetros absolutos observou-se que a maioria sofreu um aumento nao-significante, no período pós-operatório, ao passo que o diâmetro H da APE apresentou uma diminuiçao. Os índices totais I e UI apresentaram diminuiçao significante, no período pós-operatório, e no índice total 11 a reduçao nao foi significante. A análise da variável seguimento pós-operatório demonstrou uma reduçao significativa dos índices totais nos pacientes com seguimento pós-operatório inferior a 23,6 meses. A presença de fluxo sanguíneo adicional determinou o aumento dos índices APD II e IH, e uma pequena reduçao nos outros índices. As medidas da AP indexadas pelo diâmetro da aorta revelou comportamento semelhante à indexaçao pela superfície corpórea. Na ausência de circulaçao venosa colateral (CVC) observou-se aumento significante da saturaçao de 02, por outro lado, a sua presença determinou um aumento nao-significante, durante o período de observaçao
Assuntos
Derivação Cardíaca Direita , Cardiopatias Congênitas , Artéria Pulmonar/anatomia & histologia , Artéria Pulmonar/crescimento & desenvolvimentoRESUMO
Se estudiaron 17 pacientes con diagnostico de infarto agudo del miocardio con extension al ventriculo derecho y que tuvieron datos de falla mecanica de este ultimo, caracterizada por presion de llenado del ventriculo derecho elevada, presion sistolica pulmonar disminuida, junto con datos de bajo gasto cardiaco. A estos enfermos se les infundieron liquidos en la arteria pulmonar como parte del tratamiento del infarto con el fin de mejorar el llenado del ventriculo izquierdo y el gasto cardiaco, sin sobrecargar volumetricamente al ventriculo derecho. Los resultados obtenidos con este sistema de tratamiento por un lapso promedio de 22 horas indican una mejoria significativa en los indices de trabajo de ambos ventriculos y en el gasto cardiaco con una disminucion de las resistencias perifericas, sin evidencia de sobrecarga ventricular. Se analizan los mecanismos fisiologicos que justifican este procedimiento y tambien las complicaciones atribuibles al mismo. Nuestros resultados indican que la infusion de liquidos en la arteria pulmonar mejora las condiciones hemodinamicas de los pacientes y protege a un ventriculo derecho lesionado