Left Ventricular Shape Deformation and Mitral Valve Prolapse in Chronic Pulmonary Hypertension

Pulmonary Endarterectomy

Chronic thromboembolic pulmonary hypertension (CTEPH) results from recurrent or incomplete resolution of pulmonary embolism. CTEPH is much more common than generally appreciated. Although pulmonary embolism (PE) affects a large number of Americans, chronic pulmonary hypertension (PH) remains underdiagnosed. It is imperative that all patients with PH be screened for the presence of CTEPH since this form of PH is potentially curable with pulmonary thromboendarterectomy (PTE) surgery. The success of this procedure depends greatly on the collaboration of a multidisciplinary team approach that includes pulmonary medicine, cardiothoracic surgery, and cardiac anesthesiology. This review, based on the experience of more than 3000 pulmonary endarterectomy surgeries, is divided into 2 parts. Part I focuses on the clinical history and pathophysiology, diagnostic workup, and intraoperative echocardiography. Part II focuses on the surgical approach, anesthetic management, postoperative care, and complications.

The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis

BACKGROUND

Transthoracic echocardiography is commonly used to estimate pulmonary arterial systolic pressure (PASP) and to diagnose pulmonary hypertension (PH). However, some recent studies have questioned the accuracy of Doppler echocardiography (DE) in the assessment of PASP. The present meta-analysis was performed to estimate the accuracy, sensitivity, and specificity of DE in the assessment of PASP.

METHODS

A literature search and data extraction of English and non-English articles reported from May 1984 to January 2009 was performed independently by 2 investigators using MEDLINE and EMBASE databases. Articles were included if they compared DE with right heart catheterization (RHC) in the assessment of PASP. Nine articles met our criteria and were included in our meta-analysis. We conducted a meta-analysis of the results of these articles using fixed- and random-effect models to estimate the accuracy, sensitivity, and specificity of DE in the assessment of PASP.

RESULTS

The correlation between PASP estimated by DE and RHC ranged from (r = 0.65, P < 0.001) to (r = 0.97, P < 0.001). The pooled sensitivity, specificity, and accuracy of DE for the diagnosis of PH were 88% (95% confidence interval [CI], 84-92%), 56% (95% CI, 46-66%), and 63% (95% CI, 53-73%), respectively.

CONCLUSION

DE is a useful noninvasive modality to screen for PH and can reliably determine whether PASP is normal, mildly elevated, or markedly elevated. However, abnormal results from DE need to be confirmed by RHC.

Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a significant complication of venous thromboembolism and is caused by incomplete resolution of pulmonary emboli. The persistent chronic pulmonary hypertension leads to right-ventricle pressure overload. As a result, there is often significant functional and morphological alteration of both the right and the left ventricle. Transthoracic echocardiography, which allows for the estimation of pulmonary arterial pressures, not only plays an important role in the diagnosis of pulmonary hypertension but also provides insights in the pathophysiology of CTEPH. This article reviews the echocardiographic techniques and findings in CTEPH patients.

Echocardiography in pulmonary vascular disease

The assessment of pulmonary artery pressure, right ventricular function, right ventricular filling pressure, and tricuspid regurgitation provides invaluable information in the care of patients with pulmonary vascular disease. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate these parameters and also provides information on left ventricular and valvular function. Echocardiography has therefore become one of the most commonly performed diagnostic studies in patients with pulmonary vascular disease, and the technique's applications in this area are likely to grow. This article presents an overview of the current uses of echocardiography in pulmonary vascular disease and pulmonary hypertension.