EARLY CHANGES OF RIGHT HEART GEOMETRY AFTER PULMONARY THROMBOENDARTERECTOMY

[摘要] To determine the changes in right heart hemodynamics and geometry early after surgery for chronic pulmonary hypertension due to large vessel thromboembolic occlusion, 30 patients were evaluated 8 .+-. 8 days (mean .+-. SD) before and 6 .+-. 4 days after pulmonary thromboendarterectomy by two-dimensional echocardiography and right heart catheterization. Surgery resulted in an early significant improvement in hemodynamic variables including mean pulmonary artery pressure (48 .+-. 12 to 28 .+-. 8 mm Hg, p < 0.001), right ventricular systolic pressure (76 .+-. 20 to 47 .+-. 15 mm Hg, p < 0.001), pulmonary vascular resistance (935 .+-. 620 to 278 .+-. 252 dynes .cntdot. s .cntdot. cm-5, p < 0.001) and cardiac index (2.0 .+-. 0.5 to 2.9 .+-. 0.6 liters/min per m2, p < 0.001). Similarly, echocardiographic variables of right heart structures, which are well outside the normal range preoperatively, improved significantly early after thromboendarterectomy. These included diameters of the pulmonary artery (2.8 .+-. 0.3 to 2.4 .+-. 0.4 cm, p < 0.001), inferior vena cava (2.9 .+-. 0.6 to 2.2 .+-. 0.4 cm, p < 0.001) and right atrium (6.8 .+-. 1.5 cm, p < 0.001) as well as right ventricular short axis (4.5 .+-. 0.8 to 3.7 .+-. 0.8 cm, p < 0.001) and long axis (8.7 .+-. 0.9 to 8.1 .+-. 0.9 cm, p < 0.001). Both right atrial and right ventricular areas, which were above normal before surgery, decreased significantly after surgery (31 .+-. 12 to 24 .+-. 8 cm2 and 33 .+-. 7 to 24 .+-. 8 cm2, respectively, both p < 0.001). A measure of interventricular septal motion, the eccentricity index, previously described in patients with pressure or volume overload of the right ventricle, was abnormal preoperatively (1.26 .+-. 0.20) and decreased significantly early after surgery (0.94 .+-. 0.12, p < 0.001). Thus, marked reduction in right heart pressure overload is seen early after pulmonary thromboendarterectomy and results in early marked changes in right heart geometry as assessed by two-dimensional echocardiography. The long-term clinical improvement of patients undergoing pulmonary thromboendarterectomy may be in part due to these early cardiac changes.

[发布日期] 1988-05-01