Anastomosis, Surgical ; Child ; Familial Primary Pulmonary Hypertension ; Humans ; Hypertension, Pulmonary/surgery* ; Pulmonary Arterial Hypertension ; Pulmonary Artery/surgery*

Humans ; Hypertension, Pulmonary/surgery* ; Learning Curve ; Angioplasty, Balloon ; Pulmonary Embolism/therapy* ; Chronic Disease ; Pulmonary Artery/surgery*

Heart Defects, Congenital ; complications ; surgery ; Humans ; Hypertension, Pulmonary ; etiology ; surgery

Objective: To explore the short-term efficacy of fenestrated atrial septal defect (ASD) occulders in the treatment of pulmonary arterial hypertension (PAH). Methods: Thirty-six healthy dogs were divided into the balloon atrial septostomy (BAS)+fenestrated ASD occulders group (n=12), BAS group (n=12) and non-septostomy group (n=12). PAH was induced by intra-atrial injection of dehydrogenized monocrotaline (1.5 mg/kg) in all dogs. Animals in the BAS+fenestrated ASD occulders group underwent atrial septal puncture and fenestrated ASD occulders implantation. Animals in the BAS group underwent balloon atrial septostomy. The non-septostomy group received no surgical intervention. The hemodynamic indexes and blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) of dogs were measured before modeling, 2 months after modeling, 1, 3, and 6 months after surgery, respectively. Echocardiography was performed to observe the patency of the shunt and atrial septostomy of the dogs in the BAS+fenestrated ASD occulders group and BAS group at 1, 3, and 6 months after surgery. Three dogs were sacrificed in each group at 1, 3, and 6 months after surgery, respectively. Atrial septal tissue and fenestrated ASD occulders were removed to observe the patency and endothelialization of the device. Lung tissues were obtained for hematoxylin-eosin (HE) staining to observe the inflammatory cells infiltration and the thickening and narrowing of the pulmonary arterials. Results: Among 36 dogs, 2 dogs died within 24 hours after modeling, and 34 dogs were assigned to BAS+fenestrated ASD occulders group (n=12), BAS group (n=11), and non-septostomy group (n=11). Compared with BAS group, the average right atrial pressure (mRAP) and NT-proBNP of dogs in the BAS+fenestrated ASD occulders group were significantly reduced at 3 months after surgery (P<0.05), and the cardiac output (CO) was significantly increased at 6 months after surgery, arterial oxygen saturation (SaO₂) was also significantly reduced (P<0.05). Compared with non-septostomy group, dogs in the BAS+fenestrated ASD occulders group had significantly lower mRAP and NT-proBNP at 1, 3, and 6 months after surgery (P<0.05), and higher CO and lower SaO₂ at 6 months after surgery (P<0.05). Compared with the non-septostomy group, the dogs in the BAS group had significantly lower mRAP and NT-proBNP at 1 month after surgery (P<0.05), and there was no significant difference on mRAP and NT-proBNP at 3 and 6 months after surgery (P>0.05). Echocardiography showed that there was a minimal right-to-left shunt in the atrial septum in the BAS group at 1 month after the surgery, and the ostomy was closed in all the dogs in the BAS group at 3 months after the surgery. There was still a clear right-to-left shunt in the dogs of BAS+fenestrated ASD occulders group. The shunt was well formed and satisfactory endothelialization was observed at 1, 3 and 6 months after surgery. The results of HE staining showed that the pulmonary arterials were significantly thickened, stenosis and collapse occurred in the non-septostomy group. Pulmonary microvascular stenosis and inflammatory cell infiltration in the pulmonary arterials were observed in the non-septostomy group. Pulmonary arterial histological results were comparable between BAS+fenestrated ASD occulders group and non-septostomy group at 6 months after surgery . Conclusions: The fenestrated ASD occulder has the advantage of maintaining the open fistula hole for a longer time compared with simple balloon dilation. The fenestrated ASD occulder can improve cardiac function, and it is safe and feasible to treat PAH in this animal model.
Animals ; Atrial Septum/surgery* ; Cardiac Catheterization/methods* ; Dogs ; Familial Primary Pulmonary Hypertension ; Heart Septal Defects, Atrial/surgery* ; Hypertension, Pulmonary ; Pulmonary Arterial Hypertension

BACKGROUNDThe best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old.

METHODSWe studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were < 1 year old, 13 were 1 - 3 years old, and 13 were > 3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass.

RESULTSThree operative deaths occurred. Two were in the < 1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6 - 20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension.

CONCLUSIONChildren older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.

Aorta ; surgery ; Child ; Child, Preschool ; Coronary Vessels ; surgery ; Familial Primary Pulmonary Hypertension ; Female ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Hypertension, Pulmonary ; surgery ; Infant ; Male ; Pulmonary Artery ; physiopathology ; surgery ; Transposition of Great Vessels ; surgery ; Treatment Outcome

Objective: To explore the efficacy and safety of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: This prospective single arm study included 19 CTEPH patients (7 male, age(56.3±12.5)years) admitted to Wuhan Asia Heart Hospital from January 2017 to June 2019 and received PTPA interventional therapy. Baseline data, including age, sex, WHO functional class, 6-minute walk distance (6MWD), NT-proBNP, right heart catheterization values, were collected. Patients received single or repeated PTPA. Number of dilated vessels from each patient was analyzed, patients were followed up for 24 weeks and right heart catheterization was repeated at 24 weeks post initial PTPA. All-cause death, perioperative complications, and reperfusion pulmonary edema were reported. WHO functional class, 6MWD, NT-proBNP, right heart catheterization values were compared between baseline and at 24 weeks follow up. Results: Nineteen CTEPH patients received a total of 56 PTPA treatments. The pulmonary artery pressure (mPAP) decreased from (40.11±7.55) mmHg (1 mmHg=0.133 kPa) to (27.53±4.75) mmHg (P<0.001), and the total pulmonary resistance (TPR) decreased from (13.00±3.56) Wood U to (5.48±1.56) Wood U (P<0.001), cardiac output increased from (3.19±0.63) L/min to (5.23±0.94) L/minutes (P<0.01) at 24 weeks post PTPA. The WHO functional class improved significantly (P<0.001), 6MWD increased from (307.08±129.51) m to (428.00±112.64) m (P=0.002), the NT-proBNP decreased at 24 weeks post PTPA (P=0.002). During the follow-up period, there was no death; hemoptysis occurred in 4 patients during the operation, none of which resulted in serious adverse clinical consequences. One patient developed reperfusion pulmonary edema and recovered after treatment. Conclusion: PTPA treatment is safe and can significantly improve the hemodynamics and WHO functional class of patients with CTEPH.
Adult ; Aged ; Angioplasty ; Angioplasty, Balloon ; Chronic Disease ; Humans ; Hypertension, Pulmonary/surgery* ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Artery/surgery* ; Pulmonary Embolism ; Treatment Outcome

Mortality rate for pulmonary embolectomy in critically ill patients still ranges from 30% to 45%. The causes of death in these patients are persistent pulmonary hypertension, pulmonary edema, and massive pulmonary hemorrhage. Residual thrombus and air trapping in peripheral pulmonary artery during pulmonary embolectomy can cause intractable right heart failure and persistent pulmonary hypertension. We report a successful extraction of residual thrombus and air bubbles during pulmonary embolectomy by retrograde pulmonary perfusion. Use of this technique could decrease morbidity and mortality from persistent right heart failure after pulmonary embolectomy in critically ill patients.
Cause of Death ; Critical Illness ; Embolectomy* ; Heart Failure ; Hemorrhage ; Humans ; Hypertension, Pulmonary ; Mortality ; Perfusion* ; Pulmonary Artery ; Pulmonary Edema ; Pulmonary Embolism* ; Thoracic Surgery ; Thrombosis

BACKGROUND: A number of studies have demonstrated that an accurate measurement of the peak tricuspid regurgitation velocity with contimuous wave Doppler, which may predict the right ventricular systolic pressure using the simplified Bernoulli equation. However, the peak velocities are often of low intensity on the spectral Doppler display if the tricuspid regurgitation(TR) is not severe. The aim of this study was to evaluate the usefulness of measuring the time interval from pulmonary closure to the end of tricuspid regurgitation, in predicting peak tricuspid regurgitant velocity and hence derive peak right ventricular systolic and pulmonary artery pressure(PAP). METHODS: We studied 19 patients with normal PAP(group A), and 7 with pulmonary hypertension(group B), 27 with postop state of the open cardiac surgery(group C), who underwent echocardiographic and Doppler assessment. Pulmonary closure(PC) was taken as the closure artifact on the Doppler recording in the main pulmonary artery. Regurgitant flow was identified and recorded in continuous wave mode from the apex. The time interval from end of the TR to PC(TR end PC) was measured, and corrected by 100/min of heart rate. RESULTS: The time interval of corrected “TR and-PC” was 12.95±48.69 msec in group A, 16.8±43.15 msec in group C, where as 72.43±37.71 msec in group B(p < 0.01, comparing with group A). the correlation between TR end-PC and TR gradient was low in group A and C(r=0.12, 0.41 respectively), but high in group B(r=0.73)(TR gradient=0.55×TR end-PC+29.1). CONCLUSIONS: The time interval of TR end-PC in the patients with pulmonary hypertension was higher than normal subjects. And also, we found a good correlation between TR end-PC and TR gradient in patients with pulmonary hypertension. However, in postop state of the open cardiac surgery, there was no significant correlation. The precise explanations of this are by no means clear, but abnormal function of the right ventricle may affect the dynamics of regurgitant flow.
Artifacts ; Blood Pressure ; Echocardiography ; Heart Rate ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery ; Thoracic Surgery ; Tricuspid Valve Insufficiency

Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Intraaortic balloon pump (IABP) is effective and useful device for mechanical assistance for heart. We reported a case of 34-year-old patient who had experienced pulmonary hypertension and right ventricular failure during cholecystectomy for acute cholecystitis after cardiac surgery. Thus, the patient was mechanically supported with IABP and hemodynamics and cardiac function were improved.
Adult ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Heart ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Thoracic Surgery

Mitral stenosis is characterized by chronic pulmonary arterial hypertension. Although it is well recognized that right ventricle can be affected by pressure-overload in patients with mitral stenosis, the study for effects on right ventricular function after relief of pressure overload was difficult after open heart surgery due to paradoxical septal motion and scarring change of pericardium. Recently, percutaneous mitral valvuloplasty(PMV) has been used in patients with mitral stenosis as an alternative to surgical mitral commissurotomy. The present study was designed to demonstrate the difference of right ventricle between normal subjects and patients with mitral stenosis, as well as to investigate the changes of right ventricle before and after PMV with Doppler- echocardiography and isovolumic indices. The results were summarized as follows : 1) Right ventricular emptying fraction which was assumed to be proportional to right ventricular ejection fraction was depressed significantly in patients with mitral stenosis than those of normal subjects. However, there were no sighificant differences in Vpm between the two groups. 2) Right atrial and ventricular areas of patients with mitral stenosis were enlarged significantly than those of normal subjects. Right ventricular diastolic function measured by transtricuspid pulsed Doppler showed relaxation abnormality pattern in patients with mitral stenosis. 3) Enlarged right atrium and ventricular area were decreased significantly after PMV. Depressed right ventricular sytolic and diastolic function were recovered after relief of pressure-overload by PMV. However, there were no significant changes in Vpm after PMV. 4) Right ventricular emptying fraction was inversely correlated with mean pulmonary artery pressure and right ventricular end-diastolic area. Discriminant factor between group with right ventricular diastolic dysfunction and group without diastolic dysfunction was pulmonary vascular resistance. In conclusion, there were right ventricular systolic and diastolic dysfunction without abnormal right ventricular contractility in patients with mitral stenosis, moderate pulmonary hypertension and normal sinus rhythm, and these functional abnormalities were largery reversible after relief of pressure-overload on the right ventricle by PMV.
Cicatrix ; Echocardiography ; Heart Atria ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Stenosis* ; Pericardium ; Pulmonary Artery ; Relaxation ; Stroke Volume ; Thoracic Surgery ; Vascular Resistance ; Ventricular Function, Right*