MRI评估不同手术阶段功能性单心室心功能

目的用核磁共振影像（MRI）测定不同手术阶段功能性单心室（FSV）心功能,探讨心功能变化原因及相关因素.方法2004年4月至2004年11月,41例FSV病儿分3组行MRI检查：Ⅰ组（未手术者）24例;Ⅱ组（双向腔肺动脉吻合术,BCPC后）9例;Ⅲ组（全腔肺动脉吻合术,TCPC后）8例.6名健康儿为对照.比较各组舒张末容量指数（EDVI）、收缩末容量指数（ESVI）、心搏指数（SVI）、心肌质量指数（MassI）、心指数（CI）、EF和Mass/EDV.结果Ⅰ组和Ⅱ组的EDVI和ESVI显著大于对照;Ⅰ组SVI显著大于Ⅲ组和对照;Ⅰ组CI显著大于其他组;Ⅱ组和Ⅲ组EF显著小于对照;前三组MassI显著大于对照;Ⅲ组Mass/EDV显著大于其他组.结论FSV术前心功能表现与此期血流动力学处于高负荷状态一致.BCPC术和TCPC术后中远期心脏舒缩功能不全与舒张末期容量和心肌质量异常有关.MRI评价FSV心功能更具优势.     

经导管抽吸血栓联合接触性溶栓治疗急性中-高危与高危肺血栓栓塞

目的 观察经导管抽吸血栓联合接触性溶栓（CDT）治疗急性中-高危与高危肺血栓栓塞（PTE）的效果。方法 对28例急性中-高危或高危PTE患者于置入下腔静脉滤器后行经导管抽吸血栓及CDT;观察治疗后临床症状有无改善,对比治疗前及治疗后72 h动脉血气分析、凝血功能、血常规、肺动脉压（PAP）及右心室直径/左心室直径（RV/LV）等,记录治疗相关并发症。随访观察治疗后1、3、6个月及1年PAP及肺动脉血栓清除效果。结果 治疗后26例症状明显改善,2例死于呼吸衰竭。4例穿刺点出血,均经保守治疗后好转。相比治疗前,治疗后72 h,26例存活者血pH、动脉氧分压、血纤维蛋白降解产物及D-二聚体水平均升高,而心率、N-末端B型利钠肽原、PAP及RV/LV均下降（P均<0.05）。治疗后1、3、6个月及1年PAP均较治疗前降低,肺血栓清除率均较治疗前升高（P均<0.05）;未见活动性出血及PTE复发。结论 经导管抽吸血栓联合CDT可安全、有效地治疗急性中-高危与高危PTE。     

二维斑点追踪技术评价麻醉诱导和正压通气对不同容量状态时双心室功能的影响

目的 基于二维斑点追踪技术评价全麻诱导和正压通气对不同容量状态患者双心室功能的影响。
方法 选择择期全麻胃肠手术患者60例,男38例,女22例,年龄50～70岁,ASA Ⅰ或Ⅱ级。入室监护后行容量负荷试验,20 min内静脉输注生理盐水250 ml。于容量负荷试验前、后分别测量左心室流出道（LVOT）直径（D）和主动脉瓣速度时间积分（VTI）,记录容量负荷试验前、后每搏输出量（SV）,并计算ΔSV。根据ΔSV将患者分为两组：容量反应性阳性组（R组,ΔSV≥15%,n=33）和容量反应性阴性组（N组,ΔSV<15%,n=27）。容量负荷试验结束后10 min麻醉诱导前,行第1次经胸超声心动图检查。随后行全麻诱导,气管插管后行肺保护性通气（V_T 7 ml/kg,PEEP 5 cmH₂O,FiO₂ 60%）,待麻醉诱导后10 min血流动力学平稳,行第2次经胸超声心动图检查。记录诱导前和诱导后心肌功能参数,采用二维斑点追踪技术测量左心室整体纵向应变（左心室GLS）和右心室游离壁纵向应变（右心室FWLS）,计算各指标诱导前后的相对变化值。
结果 与诱导前比较,诱导后两组VTI、左心室GLS、三尖瓣环收缩期位移（TAPSE）、右心室FWLS明显降低（P<0.05）;三尖瓣口血流舒张早期峰值速度与三尖瓣环舒张早期峰值速度比值（右心室E/E′）、右心室心肌做功指数（右心室MPI）明显升高（P<0.05）。诱导前后两组左心室射血分数（LVEF）、二尖瓣口血流舒张早期峰值速度与二尖瓣环舒张早期峰值速度比值（左心室E/E′）差异无统计学意义。与N组比较,R组主动脉瓣速度时间积分变化值（ΔVTI）、左心室整体纵向应变变化值（左心室ΔGLS）、三尖瓣环收缩期位移变化值（ΔTAPSE）、右心室游离壁纵向应变变化值（右心室ΔFWLS）明显降低（P<0.05）;左心室做功指数变化值（左心室ΔMPI）、三尖瓣口血流舒张早期峰值速度与三尖瓣环舒张早期峰值速度比值变化值（右心室ΔE/E′）、右心室心肌做功指数变化值（右心室ΔMPI）明显升高（P<0.05）。两组左心室射血分数变化值（ΔLVEF）、二尖瓣口血流舒张早期峰值速度与二尖瓣环舒张早期峰值速度比值变化值（左心室ΔE/E′）差异无统计学意义。
结论 麻醉诱导和正压通气会诱发全麻患者左心室收缩功能及右心室收缩和舒张功能降低,在低血容量患者中尤为显著。     

心脏MR组织追踪技术定量评估心肌淀粉样变性患者心肌应变

目的 观察利用心脏MR组织追踪（CMR-TT）技术定量评估心肌淀粉样变性（CA）患者心肌应变的可行性。方法 对20例免疫球蛋白轻链型心肌淀粉样变性（AL-CA,A组）、20例转甲状腺素蛋白型CA（ATTR-CA,B组）患者及20名健康受试者（C组）采集心脏MRI,以CMR-TT技术获得心肌应变参数;比较3组间左心室心功能参数差异,以及左心室各节段及整体心肌应变参数的差异,包括3D纵向应变（LS）、3D径向应变（RS）及3D圆周应变（CS）。结果 A、B组左心室心功能参数与C组差异均有统计学意义（P均<0.01）,而A与B组间左心室心功能参数差异均无统计学意义（P均>0.05）。除心尖段RS（P=0.81）外,A、B组应变参数均低于C组（P均<0.01）,而A与B组间应变参数差异均无统计学意义（P均>0.05）。结论 CMR-TT技术可用于定量评估CA患者左心室心肌应变。     

靶向紫杉醇纳米晶-胱天蛋白酶-3复合物对肺动脉高压大鼠肺血管重构的影响

目的 观察靶向紫杉醇纳米晶-胱天蛋白酶-3（caspase-3）复合物对肺动脉高压大鼠肺血管重构的治疗效果。
方法 选择SPF级健康成年雄性SD大鼠56只，8周龄，体重220～250 g。随机分为七组：对照组（N组）、模型组（M组）、模型+紫杉醇组（T组）、模型+caspase-3组（C组）、模型+紫杉醇复合caspase-3组（TC组）、模型+靶向紫杉醇纳米晶组（GN1组）和模型+靶向紫杉醇纳米晶-caspase-3复合物组（GN2组），每组8只。N组不建立模型，其余组大鼠颈部皮下注射野百合碱60 mg/kg建立肺动脉高压模型。建模第21、25、29天，T组、C组、TC组、GN1组和GN2组分别经尾静脉注射紫杉醇、caspase-3、紫杉醇复合caspase-3简单混合溶液、靶向紫杉醇纳米晶、靶向紫杉醇纳米晶-caspase-3复合物（紫杉醇所用剂量为0.4 mg/kg，caspase-3为0.04 mg/kg）。于建模第35天测定大鼠平均肺动脉压力（mPAP），分别称取大鼠右心室（RV）、左心室与室间隔（LV+S）的重量，计算右心室肥厚指数［RV/（LV+S）］，Western blot法检测肺组织中转录因子叉头框O1（FoxO1）蛋白含量，肺组织HE染色和α-平滑肌肌动蛋白（α-SMA）免疫组化染色评估肺血管形态，FoxO1和Ki67免疫组化染色分析其在肺血管中膜的阳性细胞百分比。
结果 与N组比较，M组、T组、C组、TC组、GN1组和GN2组mPAP、右心室肥厚指数、血管中膜厚度百分比和肌化血管百分比均明显升高，FoxO1蛋白含量、FoxO1阳性细胞百分比明显降低（P<0.05）。与M组比较，T组、C组、TC组、GN1组和GN2组mPAP、血管中膜厚度百分比、Ki67阳性细胞百分比明显降低，FoxO1蛋白含量明显升高，GN2组右室肥厚指数明显降低，T组、TC组、GN1组和GN2组肌化血管百分比明显降低，T组、TC组、GN1组和GN2组FoxO1阳性细胞百分比明显升高（P<0.05）。与T组比较，GN2组血管中膜厚度百分比和肌化血管百分比均明显降低；C组、TC组、GN1组和GN2组FoxO1蛋白含量明显升高；GN1组和GN2组Ki67阳性细胞百分比明显降低，FoxO1阳性细胞百分比明显升高（P<0.05）。与C组比较，GN2组血管中膜厚度百分比和肌化血管百分比均明显降低；TC组和GN2组FoxO1蛋白含量明显升高；GN1组和GN2组Ki67阳性细胞百分比明显降低，FoxO1阳性细胞百分比明显升高（P<0.05）。与TC组比较，GN2组血管中膜厚度百分比、肌化血管百分比、Ki67阳性细胞百分比均明显降低；GN1组FoxO1蛋白含量明显降低；GN1组和GN2组FoxO1阳性细胞百分比明显升高（P<0.05）。与GN1组比较，GN2组肺组织FoxO1蛋白含量明显升高，Ki67阳性细胞百分比明显降低（P<0.05）。
结论 靶向紫杉醇纳米晶-caspase-3复合物通过上调肺血管中膜FoxO1的表达，改善了野百合碱肺动脉高压大鼠的肺血管重构和右心室肥厚，降低肺动脉压力。     

肺动脉高压的围术期管理进展

肺动脉高压（PH）是指由多种病因和不同发病机制所致的静息状态下肺动脉平均压≥25 mmHg（经右心导管测定）的病理状态。任何引起左心房压力（LAP）升高、心输出量（CO）和肺血管阻力（RVR）增加的因素均可导致PH。PH患病率约为1%，与围术期发病率和死亡率相关。PH患者术前风险评估决定于PH分类、PH功能分级和运动耐量、右心功能状态、合并症及手术风险等诸多因素。右心衰竭（RNF）和PH密切相关，PH患者的围术期管理需要通过改善右心室功能和降低肺血管阻力来优化右心室-肺动脉耦联。本文就PH的定义、分类、病理机制及围术期麻醉管理等方面的研究进展予以综述，为PH患者围术期管理提供参考。     

颈椎韧带骨化特点及其与颈椎活动度的定量关系

目的 探讨颈椎韧带骨化的分布特征、临床特征以及颈椎韧带骨化与颈椎活动度（ROM）的定量关系。方法 纳入2020年1月—2021年10月诊断为后纵韧带骨化（OPLL）的229例患者，其中单纯OPLL患者71例（OPLL组）、OPLL合并前纵韧带骨化（OALL）和/或项韧带骨化（ONL）患者158例（OPLL+组）。同时纳入64例无韧带骨化的脊髓型颈椎病患者作为对照（CSM组）。基于CT评估韧带骨化分布特征。收集各组患者的人口统计学数据、实验室检查结果和影像学资料并进行比较。采用Spearman相关分析检验各指标之间的相关性，采用多元线性回归方法分析影响ROM的因素。结果 OPLL最常发生的节段为C₅，OALL最常发生于C₅/C₆水平，ONL最常发生于C₄/C₅水平。不同韧带骨化组在性别、年龄、体质量指数（BMI）、吸烟史、OPLL指数、最大椎管占位率、ROM和尿酸方面存在差异。OALL指数和OPLL指数均与ROM呈负相关（r=-0.308、-0.261，P<0.05）。OALL指数是ROM降低的危险因素（偏回归系数为-2.47，95%置信区间为-3.52~-1.42，P<0.05）。结论 OPLL、OALL和ONL主要发生在C₅节段周围。OALL指数和OPLL指数与ROM呈负相关，OALL指数是ROM降低的危险因素。     

应用心室压力-容量关系探讨肝移植术中右心室收缩和舒张功能的变化

目的 用容量性肺动脉导管收集右心室收缩末期和舒张末期的压力、容量数据,并计算心室收缩末期弹性(end-systolic elagtance,Ees)、舒张未僵硬度(end-diastolic stiffness,EED)、有效动脉弹性(arterial effective elastance,Ea)、Ees/Ea,借以评价肝移植术中右心室收缩和舒张功能的变化.方法 12例拟行同种异体原位肝移植术的终末期肝病患者.ASA Ⅱ-Ⅳ级;无心脏病史,心功能Ⅰ或Ⅱ级;不合并肺动脉高压[以插入漂浮导管后平均肺动脉压(MPAP)25 mm Hg为标准]及其他肺部疾病.全麻后行右侧颈内静脉穿刺,放置容量性肺动脉导管.于切皮前麻醉稳定时、无肝期10 min、新肝期10 min、术毕缝皮时,4个时点收集数据,包括①记录右心血流动力学参数;②计算Ees、EED、Ea、Ees/Ea.结果 与切皮前相比,无肝期心指数(cardiac index,CI)、右心室舒张末期容积指数(RV ejection fraction,RVEF)、右心室作功指数(fight ventricular stroke work index,RVSWI)、肺动脉楔压(pulmonary artery wedge pressure,PAWP)、中心静脉压(central verous pressure,CVP)、MPAP、每博指数(stroke volume index,SVI)、右心室舒张末期容积指数(RV end-diastolic volume index,RVEDVI)、平均动脉压(mean arterial blood pressure,MAP)等指标均明显下降(P<0.05),新肝期均相应增加.术毕时恢复至切皮前水平.Ees在4个时期未见明显变化(P0.05).EED无肝期显著下降(P<0.05),新肝期显著升高(P<0.05),术毕时恢复至切皮前水平.PVRI与Ea变化趋势一致,无肝期和新肝期增加,但没有显著性.与切皮前相比,无肝期的Ees/Ea比下降(P<0.05).结论 不合并肺动脉高压的肝移植患者术中无肝期和新肝期RVEF下降与前负荷剧降及后负荷增加有关,不代表心肌收缩能力降低.新肝期右心室舒张功能下降,表现为室壁僵硬度增加,EED下降.术毕时,右心室收缩和舒张功能均可恢复至术前水平,并且右心室功能与肺循环的状态能够匹配.     

术中持续输注胰岛素对心肺转流心脏手术患者心肌血流灌注的影响

目的： 探讨术中持续输注胰岛素对心肺转流（CPB）心脏手术患者心肌血流灌注的影响。
方法： 选择择期行CPB心脏手术患者48例,男21例,女27例,年龄55～80岁,BMI 18～28 kg/m²,ASA Ⅱ—Ⅳ级。将患者随机分为两组：胰岛素组（I组,n=25）和对照组（C组,n=23）。两组采用相同麻醉方案。麻醉诱导后I组静脉输注胰岛素30 mU·kg^-1·h^-1、葡萄糖0.12 g·kg^-1·h^-1、氯化钾0.06 mmol·kg^-1·h^-1混合液,C组予以生理盐水10 ml/h输注,均输注至术毕。术中目标血糖值为6.1～11.1 mmol/L。于麻醉诱导后10 min（T₂）和术毕（T₆）行经食管超声心动图（TEE）检测,记录冠状静脉窦（CS）血流频谱、直径及肺静脉血流频谱,并计算CS净向前血流流速时间积分（VTI）。记录T₂、CPB前2 min（T₃）、CPB结束时（T₅₂）和T6时的股动脉平均动脉压（MAP）、中心静脉压（CVP）、每搏量（SV）、心脏指数（CI）及外周血管阻力指数（SVRI）。记录麻醉诱导前5 min（T₁）、T₃、CPB后30 min（T₄）、T₅、T₆、术后6 h（T₇）、术后12 h（T₈）及术后24 h（T₉）时血糖及乳酸浓度。记录术前1 d、术后1、2 d时超敏C反应蛋白（hs-CRP）、高敏肌钙蛋白I（hs-TnI）和肌酸激酶同工酶（CK-MB）水平。
结果： 与C组比较,I组T₆时CS净前向血流VTI及每分钟CS血流量均明显增加（P<0.05）,肺静脉心房收缩期峰值流速（ARp）明显减小（P<0.05）,T₅、T₆时SV和CI明显增大、SVRI明显降低（P<0.05）,T₇、T₈时乳酸浓度明显降低（P<0.05）,术后1、2 d时hs-CRP和CK-MB水平明显降低（P<0.05）,术后2 d时hs-TnI明显降低（P<0.05）。
结论： CPB心脏手术中持续输注胰岛素,同时维持血糖6.1～11.1 mmol/L,可改善心肌血流灌注,减轻术后炎症反应及心肌损伤。     

高低位腰椎椎间盘突出症患者脊柱-骨盆矢状面形态变化

目的 比较高位与低位腰椎椎间盘突出症（LDH）患者脊柱-骨盆矢状面形态学差异，探讨脊柱-骨盆矢状面形态学参数异常与高位LDH发生的关系。方法 纳入2006年1月—2022年1月收治的高位LDH患者53例（高位组），同时期性别、年龄和体质量指数（MBI）匹配的低位LDH患者53例（低位组）及单纯下腰部疼痛的非LDH患者53例（对照组）。在站立位全脊柱侧位X线片上测量3组矢状面平衡（SVA）、胸椎后凸角（TK）、腰椎前凸角（LL）、腰骶前凸角（LSL）、骶骨倾斜角（ST）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）等脊柱-骨盆矢状面参数。结果 高位组SVA、TK明显高于对照组，LL、ST、PI、PT及SS明显低于对照组；高位组TK明显高于低位组，LL、ST及PI明显低于低位组；差异均有统计学意义（P<0.05）。高位组L₁/L₂节段患者的LL、ST较L₂/L₃节段患者有下降趋势，但差异无统计学意义（P>0.05）。结论 骨盆水平化导致的胸腰段过度代偿可能是高位LDH发生、发展的机制之一。     

Assessment of left ventricular contractile characteristics following coronary artery bypass grafting

The present study was designed to assess a left ventricular function, particularly contractile characteristics following coronary artery bypass grafting (CABG). The subject was 29 post-CABG patient consisting of 4 groups; 6 patients with complete revascularization (CR) and no myocardial infarction (MI) (CR.MI(-) group), with CR and MI (CR.MI(+) group), 5 with incomplete revascularization (IR) and no MI (IR.MI(-) group) and 8 with IR and MI (IR.MI(+) group). Ejection fraction (EF), systolic pressure/end-systolic volume index (SP/ESVI) and end-systolic volume index (EDVI) were evaluated utilizing radionuclide angiography at rest and during exercise (Ex). Increase of SP/ESVI and EF and no change of EDVI during Ex were observed in CR.MI(-) group. Increase of SP/ESVI and no change of EF and EDVI in CR.MI(+) group, no change of SP/ESVI, EF and EDVI in IR.MI(-) group and no change of SP/ESVI and EDVI and decrease of EF in IR.MI(+) group were observed. The SP/ESVI and EF of CR.MI(-) group were respectively highest among 4 groups and showed no difference compared with control group during Ex. Ex-induced increase ratio of SP/ESVI had linear correlations with Ex-induced increment of EF (r = 0.81, p less than 0.001) and Ex-induced increase ratio of EFVI (r = 0.54, p less than 0.005). It is concluded that both CR and no MI lead to normalization of EF and SP/ESVI during Ex. Furthermore, in the case of poor contractile reserve, systolic function may deteriorate in spite of increased preload during Ex.     

Evaluation of the effects of coronary artery bypass grafting on left ventricular function in patients with previous myocardial infarction

The present study was designed to assess a left ventricular function following coronary artery bypass grafting (CABG) in patients with previous myocardial infarction (MI). The subject was consisted of 10 patients with MI (MI(+) group) and 6 without it (MI(-) group). Both groups underwent complete revascularization. Stroke index (SI), ejection fraction (EF), systolic pressure/end-systolic volume index (SP/ESVI) and end-diastolic volume index (EDVI) were evaluated utilizing radionuclide angiography at rest and during exercise (Ex) before and after CABG. The influence of size of myocardial infarction on left ventricular function were also analyzed. Preoperatively during Ex, EF showed decrease, SP/ESVI no change and EDVI increase in both MI(+) and MI(-) group compared with those at rest. Postoperatively during Ex, SI, EF and EDVI showed no change and SP/ESVI increase in both MI(+) and MI(-) group compared with those at rest. Ejection fraction and SP/ESVI during Ex in MI(+) group had significant differences compared with those in both MI(-) group and control group. Ejection fraction and SP/ESVI during Ex in MI(-) showed no difference compared with those in control group. The size of MI suggested by ECG scoring system (proposed by Wagner GS et al, Circulation '82) had negative correlations with both Ex-induced increment of postoperative EF and Ex-induced increase ratio of postoperative SP/ESVI. These data indicated that complete revascularization improved EF and SP/ESVI in patients with MI, and moreover normalized those in patients without MI. But in the case of extensive MI, even complete revascularization might not recover poor functional reserve during Ex.     

Change of c-Myc expression and cardiac hypertrophy in patients with aortic valve replacement

BACKGROUND: Long-term volume overload to the left ventricle (LV) due to aortic regurgitation (AR) tends to cause severe impairment in LV function that cannot be reversed even with aortic valve replacement (AVR). Recently, we reported that the protooncogene c-myc is related to the onset of the cardiac hypertrophy and LV dysfunction in patients with chronic AR. However, it is still unclear whether c-myc is related to reversibility of the cardiac hypertrophy or LV dysfunction after AVR. METHODS AND RESULTS: Twenty patients with isolated chronic AR who underwent AVR were included in this study. LV function was calculated before and after AVR. After AVR, end-systolic volume index (ESVI) and enddiastolic volume index (EDVI) were improved, but not mass index (LVMI). However, normalization of ESVI and EDVI was observed only in 12 and 9 patients, respectively. Preoperatively, c-Myc protein was expressed in the myocardium of 16 out of 20 patients with an average point count of 35+/-30%. After AVR, c-Myc protein was observed only in 2 patients. Preoperative ejection fraction (EF), ESVI, and postoperative end-systolic stress (ESS)/ESVI had significant correlation to postoperative cell diameter (CD). Percent c-Myc protein expression before the operation was significantly correlated to postoperative CD, ESVI, and ESS/ESVI. Average c-Myc expression was higher in patients who showed normalization of CD and ESS/ESVI after AVR than the patients who did not. CONCLUSIONS: These data suggest that preoperative expression of c-Myc can be indicative of the reversibility of myocardial cellular hypertrophy and LV dysfunction.     

Effects of dobutamine on right ventricular function and pulmonary circulation in pulmonary hypertension during liver transplantation

INTRODUCTION: In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment. PATIENTS AND METHODS: To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 microg/kg/min) to maintain a cardiac index (CI) >3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, CI, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated. RESULTS: RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased. CONCLUSION: Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.     

Health-Related Quality of Life in a National Cohort of Patients With Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension

BackgroundPatients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) experience impaired health-related quality of life (HRQL). The objective of this study was to evaluate HRQL in a nation-wide sample.MethodsThis is a prospective, multicenter, non-interventional study of HRQL including 139 (89%) PAH and 17 (11%) CTEPH patients (women 70.5%; mean age, 52.2) recruited from 21 Spanish hospitals. 55% had idiopathic PAH, 34% other PAH and 11% CTEPH. HRQL was measured using the Short Form 36 Health Survey (SF-36) and EuroQoL-5D (baseline and after 6 months).ResultsHRQL in the patients with PAH or CTEPH was impaired. The physical component of SF-36 and the EuroQol-5D correlated with the functional class (FC). Mean EuroQol-5D visual analogical scale (EQ-5D VAS) scores were 73.5 ± 18.4, 62.9 ± 20.7 and 51.3 ± 16.0 (P<.0001) in patients with FC I, II and III, respectively. Every increase of one FC represented a loss of 4.0 on the PCS SF-36 and a loss of 9.5 on the EQ-5D VAS. Eight patients who died or received a transplant during the study period presented poorer initial HRQL compared with the rest of the population. No significant changes in HRQL were observed in survivors after 6 months of follow-up.ConclusionsHRQL is impaired in this population, especially in PAH/CTEPH patients near death. HRQL measurements could help predict the prognosis in PAH and CTPH and provide additional information in these patients.     

Characteristics and survival of adult Swedish PAH and CTEPH patients 2000–2014

Objectives: The Swedish Pulmonary Arterial Hypertension Register (SPAHR) is an open continuous register, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients from 2000 and onwards. We hereby launch the first data from SPAHR, defining baseline characteristics and survival of Swedish PAH and CTEPH patients.

Design: Incident PAH and CTEPH patients 2008–2014 from all seven Swedish PAH-centres were specifically reviewed.

Results: There were 457 PAH (median age: 67 years, 64% female) and 183 CTEPH (median age: 70 years, 50% female) patients, whereof 77 and 81%, respectively, were in functional class III–IV at diagnosis. Systemic hypertension, diabetes, ischaemic heart disease and atrial fibrillation were common comorbidities, particularly in those >65 years. One-, 3- and 5-year survival was 85%, 71% and 59% for PAH patients. Corresponding numbers for CTEPH patients with versus without pulmonary endarterectomy were 96%, 89% and 86% versus 91%, 75% and 69%, respectively. In 2014, the incidence of IPAH/HPAH, associated PAH and CTEPH was 5, 3 and 2 per million inhabitants and year, and the prevalence was 25, 24 and 19 per million inhabitants.

Conclusion: The majority of the PAH and CTEPH patients were diagnosed at age >65 years, in functional class III–IV, and exhibiting several comorbidities. PAH survival in SPAHR was similar to other registers.     

Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty

Objective: The aim of this study was to identify predictors of cardiac events after endoventricular circular patch plasty (Dor operation) by analyzing our experience with Dor operation. Methods: Thirty patients with left ventricular aneurysm and/or ischemic cardiomyopathy who underwent Dor operation were included in this study. Hemodynamic and clinical results were analyzed, and the predictors of cardiac events were examined. Results: Hospital mortality was 3.3%. Postoperative clinical status and left ventricular (LV) function in all survivors significantly improved. The survival rates at 1, 3, and 5 years after operation were 93%, 89% and 89%. The corresponding cardiac event-free rates were 75%, 67% and 49%. Pre- and postoperative LV function and volume did not differ significantly between patients with or without cardiac events. However, the proportion of reduced end-diastolic volume index (EDVI) (preoperative EDVI-postoperative EDVI) to preoperative EDVI was significantly higher in patients with cardiac events than in cardiac event-free patients. Postoperative LV volume re-increased in the cases with cardiac events during follow-up. Cox regression analysis confirmed that preoperative clinical premature ventricular contraction and end-systolic volume index (ESVI), postoperative EDVI, ESVL and ejection fraction were independent predictors of late cardiac events. There was a significant positive correlation between preoperative ESVI and postoperative EDVI. Conclusion: Though LV function significantly improved after Dor operation, LV reconstruction with excessive reduction can cause restarting LV remodeling and increasing mortality and morbidity. Therefore, LV reconstruction of appropriate sizes and shapes, considering the function of residual myocardium, has a significant effect on prognosis. It is highly reasonable to expect that preoperative ESVI can predict the optimal size of reconstructed left ventricle. Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Panel Discussion, Tokyo, November 19–21,2003.     

Autologous endothelial progenitor cell therapy improves right ventricular function in a model of chronic thromboembolic pulmonary hypertension

Background

Right ventricular (RV) failure is the main prognostic factor in pulmonary hypertension, and ventricular capillary density (CD) has been reported to be a marker of RV maladaptive remodeling and failure. Our aim was to determine whether right intracoronary endothelial progenitor cell (EPC) infusion can improve RV function and CD in a piglet model of chronic thromboembolic pulmonary hypertension (CTEPH).

Severe Pulmonary Hypertension during Pregnancy: Mode of Delivery and Anesthetic Management of 15 Consecutive Cases

Background: Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only.

Methods: The authors reviewed the charts of all pregnant women with severe PH who were followed up at their institution during the past 10 yr, to assess the multidisciplinary treatment and outcome of these patients.

Results: Fifteen pregnancies in 14 women with severe PH were managed during this period: There were 4 cases of idiopathic pulmonary arterial hypertension (PAH), 6 cases of congenital heart disease-associated PAH, 1 case of fenfluramine-associated PAH, 1 case of mixed connective tissue-associated PAH, 1 case of human immunodeficiency virus-associated PAH, and 2 cases of chronic thromboembolic PH. PH presented during pregnancy in 3 patients. Two patients died before delivery at 12 and 23 weeks' gestation. Four patients had vaginal deliveries with regional anesthesia: One died 3 months postpartum, one worsened, and two remained stable. Four had cesarean deliveries during general anesthesia: One died 3 weeks postpartum, one worsened, and two remained stable. Five had cesarean deliveries during low-dose combined spinal-epidural anesthesia: One died 1 week postpartum, and four remained stable. There were two fetal deaths: one related to therapeutic abortion at 21 weeks' gestation and one stillbirth at 36 weeks' gestation followed by the death of the mother 1 week later.     

Left ventricular pressure-volume loop analysis during continuous cardiac assist in acute animal trials

For better understanding of the interaction between left ventricle and continuous cardiac assist, the effect of different working conditions and support levels on left ventricular pressure-volume (PV) loop was investigated in acute animal experiments. A MicroMed-DeBakey ventricular assist device (MicroMed Cardiovascular Inc., Houston, TX, USA) was implanted in seven healthy sheep (102 +/- 20 kg). Measurements of hemodynamic variables were taken with clamped graft, on minimum, medium, and maximum support, and in pump-off condition (backflow). Each pump condition was studied for different heart rates, central venous pressures, and under pharmacologically altered contractility. End-systolic and end-diastolic volume normalized by the body surface area (BSA) (end systolic volume index [ESVI] and end diastolic volume index [EDVI]) showed significant correlation both within each sheep and in the pooled data. The linear regression for the pooled data was ESVI = 0.845 x EDVI - 15.21, R(2) = 0.924, P < 0.0001, n = 200. EDVI and stroke volume (SV) normalized by BSA (stroke volume index [SVI]) also showed a lower but significant correlation: SVI = 0.155 x EDVI + 15.21, R(2) = 0.291, P < 0.0001, n = 200. An increase of preload due to infusion caused, in the clamped graft condition, an increase in end diastolic volume of 22%, no significant increase in SV, a decrease both of systemic vascular resistance of 30% and ventricular contractility (maximum elastance [E(max)] and peak rate of rise of ventricular pressure [dP/dt(max)] decreasing 38 and 21%, respectively). PV loop analysis in continuous cardiac assist reveals that the ESVI and the EDVI are strongly correlated and that ESVI varies considerably with preload. SVI becomes slightly dependent on EDVI, which may be due to autoregulatory mechanisms.