Imaging of Congenital and Acquired Disorders of the Pulmonary Artery
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Pulmonary vasculature
Pulmonary hypertension has been associated with poor outcome after liver transplantation. We assessed the diagnostic accuracy of Doppler echocardiography in detecting significant pulmonary hypertension. Seventy-four potential liver transplant candidates underwent Doppler echocardiography in which the systolic right ventricular pressure (RVsys) was used to estimate the systolic pulmonary artery pressure (PAsys). Group 1 included 39 consecutive patients with RVsys ≥50 mm Hg who underwent elective right heart catheterization. Group 2 consisted of 35 patients with RVsys <50 mm Hg in whom pulmonary artery pressures were measured at the beginning of the transplantation procedure. The accuracy of the estimates by Doppler echocardiography was assessed against measurements made by direct catheterization. Patients in groups 1 and 2 were comparable in their demographic and liver disease characteristics. There was a strong correlation between RVsys by Doppler echocardiography and PAsys by right heart catheterization (r = .78, P < .01). Of the 39 patients in group 1, 29 (72%) had at least moderate pulmonary hypertension (mean pulmonary artery pressure [MPAP] ≥35 mm Hg), including 12 (30%) with severe pulmonary hypertension (MPAP ≥50 mm Hg). Only 1 of the group 2 patients had MPAP ≥35 mm Hg. Thus, in the diagnosis of moderate to severe pulmonary hypertension, the sensitivity of echocardiography was 97% and specificity was 77%. Doppler echocardiography is an accurate screening test to detect moderate to severe pulmonary hypertension. We advise that liver transplant candidates with RVsys ≥50 mm Hg undergo right heart catheterization to fully characterize pulmonary hemodynamics.
Cardiac catheterization
Portopulmonary hypertension
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Based on analysis of data obtained from multicenter patients with collagen diseases (83 with pulmonary hypertension(PH) and 472 without PH), preliminary criteria for the diagnosis of PH in mixed connective tissue disease (MCTD) were proposed by the Research Committee for MCTD of the Ministry of Health and Welfare of Japan. The diagnosis of PH requires four or more out of six clinical and laboratory findings, including exertional dyspnea, systolic pulsation on the left sternum, increased 2nd pulmonary sound, dilatation of the pulmonary artery on chest X-ray, right ventricular hypertrophy on the electrocardiogram, and right ventricular enlargement on the echocardiogram. Alternatively, either an increase of mean pulmonary artery pressure over 25 mmHg measured by right ventricle catheterization, or the corresponding finding on Doppler echocardiography is also valid for the diagnosis of PH. When these criteria were applied to the patients in this study, the sensitivity was 92% and the specificity 100%, showing that PH may be adequately diagnosed using non-invasive methods. The number of criteria satisfied by patients with PH was well correlated with their mean pulmonary artery pressure measured by heart catheterization.
Right ventricular hypertrophy
Christian ministry
Cardiac catheterization
Pulmonary wedge pressure
Heart catheterization
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Objective:To study the effect of Feixinping on endothelin level in pulmonary artery,NOSmRNA expression in rats with pulmonary hypertension in pulmonary heart disease,and probe in to the action mechanism of Feixinping in treating pulmonary hypertension in pulmonary heart disease.Methods:Rat model of pulmonary hypertension in pulmonary heart disease was duplicated by injection of 2% monocrotaline at dosage of 60mg/Kg peritonially at one time.ET and nitrogen monoxide synthase(NOSmRNA) were determined with RTPCR.Results:Compared to normal group,in model group ETmRNA expression in pulmonary artery increases while NOSmRNA expression decreases;Compared to model group,in Feixingping and Catopril group pulmonary artery ETmRNA expression decrease,increase NOSmRNA expression in pulmonary artery.Conclusion:Feixinping is of good therapeutic effect in treating pulmonary hypertension in pulmonary heart disease.The action of mechanism might be Feixinping can decrease ETmRNA expression in pulmonary artery,increase NOSmRNA expression in pulmonary artery in rats with pulmonary hypertension in pulmonary heart disease.
Pulmonary heart disease
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Pulmonary hypertension (PH) is a progressive disease that leads to cardiopulmonary dysfunction and right heart failure from pressure and volume overloading of the right ventricle (RV). Mechanical cardiopulmonary support has theoretical promise as a bridge to organ transplant or destination therapy for these patients. Solving the challenges of mechanical cardiopulmonary support for PH and RV failure requires its testing in a physiologically relevant animal model. Previous PH models in large animals have used pulmonary bead embolization, which elicits unpredictable inflammatory responses and has a high mortality rate. We describe a step-by-step guide for inducing pulmonary hypertension and right ventricular hypertrophy (PH-RVH) in sheep by left pulmonary artery (LPA) ligation combined with progressive main pulmonary artery (MPA) banding. This approach provides a controlled method to regulate RV afterload as tolerated by the animal to achieve PH-RVH, while reducing acute mortality. This animal model can facilitate evaluation of mechanical support devices for PH and RV failure.
Pulmonary artery banding
Afterload
Right ventricular hypertrophy
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Objective To investigate the relationship between development pulmonary hypertension and vascular endothelial growth factor(VEGF). Method Serum VEGF concentration was measured by using enzyme linked immunosorbent assay. In 23 patients with pulmonary hypertension [mean pulmonary artery pressure was (38 70±10 82)?mm?Hg] and 28 patients without pulmonary hypertension [mean pulmonary artery pressure was (16 42±2 03)mm?Hg].Results Mean concentration of serum VEGF in patients with pulmonary hypertension was (291 70±197 66)?pg/ml, and (38 56±22 25)?pg/ml in patients without pulmonary hypertension. VEGF concentration and pulmonary artery pressure were positively correlated(r=0 714,4). Conclusion The serum VEGF concentration in patients with congenital heart disease associated with pulmonary hypertension is much higher than that in control group (P0 01). VEGF is probably involved in the pathophysiology of pulmonary hypertension.
Pathophysiology
Pathophysiology of hypertension
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Aim: To evaluate whether pulmonary artery size is indicator of pulmonary hypertension in patients with interstitial lung disease.Objective: To measure main pulmonary artery size in interstitial lung disease on CT. To compare these measurements with 2Decho findings in diagnosing the pulmonary hypertension.Materials and Methods Type of study: Prospective studyDuration of study: 1st June 2021 to 1st September 2022 Results and Conclusion: 30 patients with interstitial lung disease with suspicion of pulmonary hypertension were subjected to CT scan Among the 22 patients with dilated pulmonary artery, 64% were found to show signs of probable pulmonary hypertension on 2DEcho and remaining 36% patients were found to be negative.In the remaining 8 patients who were not having dilated pulmonary artery, only one patient showed signs of pulmonary hypertension on 2 Decho. Dilated pulmonary artery was correlated positively with 2Decho findings in pearson correlation of coefficient.Thus, dilated pulmonary artery can raise a suspicion of pulmonary hypertension in interstitial lung diseases. Therefore, pulmonary artery diameter is key for screening of suspected pulmonary hypertension
Right pulmonary artery
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The purpose of the study was to study the pulmonary vessels in patients with pulmonary hypertension using Computed Tomography scan (CT) This is a prospective ,analytical study. this study was conducted at Khartoum Hospital (Sudan); in the period between November 2020 - January 2021 a sample of (100) patients with clinically diagnosed as pulmonary hypertension was enrolled, their mean ages were (47.92 ± 19.03) years, the sample included both genders, (42) patients were females while (58) were males and their ages were ranged from (3 - 80) years old. (CTPA) scans were acquired, all patients were examined by using multislice (CT) scanner, the data collected by special designed sheet from findings and analyzed statistically by using an (SPSS) Statistics software package.
The sample was directed to study the relationship of pulmonary hypertension with the presence of pulmonary vessels measurements; the patient's age and gender correlation with the pulmonary hypertension were investigated. The results find that the right and left main pulmonary arteries diameters changes were found to be significantly related to the presence of pulmonary hypertension, while there was no significant difference in the main pulmonary artery diameters measurements. The study concluded that CT for pulmonary artery plays an important role in the diagnostic evaluation of patients with pulmonary hypertension this due to it is easily accessible and excellent non-invasive method for the visualization and measurement of pulmonary artery and to know the possible cause of pulmonary hypertension.
Pulmonary vasculature
Spiral computed tomography
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Pulmonary hypertension occurs commonly in patients with interstitial lung disease but is frequently not diagnosed or, if diagnosed, not further evaluated. In this study, we wanted to determine the accuracy of right ventricular systolic pressure measured by transthoracic Doppler echocardiography compared with hemodynamic measurements taken at right heart catheterization in patients with idiopathic pulmonary fibrosis who had suspected pulmonary hypertension.Right heart catheterization was conducted if pulmonary hypertension was suggested by echocardiography-right ventricular systolic pressure >40 mm Hg. Pulmonary hypertension was defined by right heart catheterization as mean pulmonary artery pressure > or =25 mm Hg and pulmonary artery occlusion pressure < or =15 mm Hg.Right heart catheterization demonstrated pulmonary hypertension in 75% while no pulmonary hypertension was confirmed in 12%. Correlations existed between right ventricular systolic pressure with pulmonary artery systolic pressure (r=0.66; p<0.0001) and mean pulmonary artery pressure (r=0.69; p<0.0001). Bland-Altman analysis illustrated the mean difference between the two methods was 7.75 mm Hg.Pulmonary hypertension occurs commonly in IPF. Accurate classification of pulmonary hemodynamics and degree of pulmonary hypertension severity require right heart catheterization. Prospective screening Doppler echocardiography and pulmonary hypertension therapeutic interventions warrant further prospective study in idiopathic pulmonary fibrosis.
Cardiac catheterization
Heart catheterization
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