自发性高血压大鼠右心室压、肺动脉压变化的观察

目的观察自发性高血压大鼠右室压、肺动脉压的变化。方法36周鼠龄大鼠wky7只，SHR8只。测定两种大鼠的颈动脉压、右室压、肺动脉压，并进行统计学比较。结果SHR的颈动脉压较WKY非常显著升高（225．3±25．6VS127±15．9mmHg，P〈0．001），右室平均压明显升高（23．1±4．8mmHgVS9．1±2．6mmHg，P〈0．001），SHR肺动脉平均压也明显升高（29．1±8．2VS12．4±2．2mmHg，P〈0．001）。结论36周SHR不仅体动脉压升高，并出现右室压及肺动脉压上升。     

Impact of Pulmonary Artery Stiffness on Right Ventricular Function and Tricuspid Regurgitation after Successful Percutaneous Balloon Mitral Valvuloplasty: The Importance of Early Intervention

Aims: We assessed impact of pulmonary artery stiffness (PAS) on the long‐term right ventricular (RV) function and tricuspid regurgitation (TR) changes after percutaneous balloon mitral valvuloplasty (PBMV). Methods and Results: Using Doppler echocardiography, PAS was calculated by dividing maximal frequency shift of pulmonary flow by the acceleration time, and mitral area, RV function, and degree of TR severity were evaluated before, immediately after, 6 months, and 12 months after successful PBMV in 81 consecutive patients. Compared with control subjects patients with mitral stenosis (MS) had significant higher PAS (P < 0.001). The PAS was significantly lower in patients with progressive RV function improvement and regression of TR (P < 0.001). PAS was significantly correlated with the degree of pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and E/E'm ratio (P < 0.0001, <0.0001, and < 0.001, respectively). Multivariate regression analysis showed that the PAS is an independent predictor of TR regression and sustained RV functional improvement after successful PBMV (P < 0.0001). Conclusions: The changes in RV function and TR after successful PBMV were significantly correlated with the degree of PAS. Despite a sustained increase in mitral valve area, some patients showed no regression of TR, and progressive RV dysfunction suggests a significant role of PAS on RV function and the degree of TR regression in patients with MS suggests that PBMV must be performed early, utilizing PAS as a noninvasive parameter for proper timing for PBMV.     

超声心动图评价肺动脉高压患者右室功能的研究进展

肺动脉高压的发展会导致患者右室功能减低,对肺动脉高压患者右室功能的评价对其预后具有十分重要的临床意义。随着超声技术的不断发展,特别是新型超声技术的出现能敏感、准确地定量反映肺动脉高压患者的右室功能。现就目前超声心动图技术在评价肺动脉高压患者右室功能中的应用做一综述。     

肺动脉高压患者右室功能的多普勒超声评价与进展

肺动脉高压会导致患者右室功能减低,早诊断、早治疗肺动脉高压能明显改善患者的预后。近年来应用多普勒超声技术对肺动脉高压患者右室功能研究的新进展层出不穷,如双多普勒同步技术、Tei指数及三尖瓣环收缩期位移等,均为临床提供了全新的评价肺动脉高压及右室功能的新手段及新参数。     

Echocardiographic Features of Right Heart Failure in Infancy and Childhood

In infants and children, right heart failure is most frequently a consequence of increased afterload (pulmonary hypertension). However, it is also observed as a sequela of congenital cardiovascular surgery. The purpose of this report is to present the causes of right heart dysfunction in children and to define the echo-Doppler methods used in the evaluation of right heart failure.     

Branch Pulmonary Artery Valve Implantation Reduces Pulmonary Regurgitation and Improves Right Ventricular Size/Function in Patients With Large Right Ventricular Outflow Tracts

Objectives

The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position.

Comparison of Right Ventricular Systolic Function in Patients with Low Risk and Intermediate‐to‐High Risk Pulmonary Embolism: A Two‐Dimensional Strain Imaging Study

Aim: Right ventricular (RV) dysfunction is key for risk stratification in pulmonary embolism (PE). The goal of this study was to compare RV strain values between low and intermediate‐to‐high risk PE patients assessed by two‐dimensional (2D) strain imaging. Methods: The inclusion criterion was a diagnosis of PE confirmed by thoracic computed tomography scan with contrast medium, or by scintigraphy perfusion lung scan. Risk stratification of PE was defined as high when there was hemodynamic instability; intermediate when there were signs of RV dysfunction on echocardiography; and/or elevated troponin I and/or brain natriuretic peptide and low when none of these criteria were present. All patients underwent echocardiography at admission. Apical four‐chamber images were analyzed off line using both conventional and 2D strain imaging. Results: Sixty‐two patients (mean age 66 years) were prospectively recruited: 33 with low risk PE, 29 with intermediate‐to‐high risk PE. Global 2D RV strain differed significantly between groups (?13.1% vs. ?18.7%, P < 0.01), as did free wall (?12.7% vs. ?20.2%, P < 0.016) and septal wall (?13.5% vs. ?17.2%, P < 0.01). When the RV was divided into segments, we observed a similar reduction in absolute strain value in the mid and apical free wall segments and in the apical septal wall (?20.3 ± ?7.6 vs. ?11.8 ± 8.9%; P < 0.01 and ?19.6 ± 6.9 vs. ?7.4 ± 9.1%; P < 0.01, and ?17.7 ± 7.0 vs. 9.9 ± 8.0; P < 0.01, respectively). 2D strain and tricuspid annular plane systolic excursion were significantly related (r² = 0.35, P < 0.01). Conclusions: Peak RV longitudinal 2D strain is reduced in patients with intermediate‐to‐high risk PE, especially in the apical and mid segments of the free wall. Global and regional RV longitudinal 2D strain is altered in patients with intermediate‐to‐high risk PE as compared with low risk PE.     

Coexistence of Primary Sarcomatoid Carcinoma of the Right Ventricle and Absence of Right Pulmonary Artery

We describe the imaging features of a 48‐year‐old woman with primary sarcomatoid carcinoma originating from right ventricular outflow tract (RVOT) and isolated absence of right pulmonary artery (RPA). Computed tomography pulmonary angiography (CTPA) demonstrated the absence of RPA. Both transthoracic echocardiography (TTE) and CTPA revealed multiple masses filling and obstructing the RVOT. A palliative operation was performed on the patient, and the postoperative histopathology and immunohistochemical examination confirmed primary sarcomatoid carcinoma originating from the RVOT. The operation also confirmed the absence of RPA.     

Clinical and Electrophysiological Difference Between Idiopathic Right Ventricular Outflow Tract Arrhythmias and Pulmonary Artery Arrhythmias

Characteristics of Pulmonary Artery Arrhythmias. Introduction: The precise incidence and characteristics of ventricular arrhythmias originating from the pulmonary artery have not been fully described. The purpose of this prospective study was to clarify these points. Methods: Thirty‐three consecutive patients with an idiopathic left bundle branch block and inferior‐axis deviation type ventricular arrhythmia were included. All patients underwent detailed electroanatomical mapping (CARTO, Biosense‐Webster, Diamond Bar, CA, USA) during sinus rhythm prior to the catheter ablation. The precise location of the catheter tip at the successful ablation site was confirmed by both electroanatomical mapping and contrast radiography. The clinical and electrophysiological data were compared between the right ventricular outflow tract (RVOT) arrhythmia patients (RVOT group) and PA arrhythmia patients (PA group). Results: Eight patients (8/33 patients: 24.2%) had their ventricular arrhythmias successfully ablated within the PA. The local bipolar electrogram at the successful ablation sites in the PA group exhibited a significantly greater duration (P < 0.05) and lower amplitude (P < 0.05) than did those in the RVOT group (n = 19). In the PA group, all patients exhibited a multicomponent electrograms composed of a spiky potential and a dull potential, which might have consisted of near‐field PA activation and a far‐field ventricular activation, respectively, at the successful ablation site. Direct ablation to the spiky electrogram was able to eliminate the arrhythmias in all the PA group patients. Conclusions: PA arrhythmias may be more common than previously recognized. Careful mapping and interpretation of low amplitude and multicomponent electrograms are important for recognizing ventricular arrhythmias originating from the PA. (J Cardiovasc Electrophysiol, Vol. 21, pp. 163‐169, February 2010)     

缺氧对肺心病患者肺动脉压力以及右心室结构与功能的影响

目的观察肺心病患者不同缺氧程度时肺动脉压力及右心室结构与功能的变化,同时取健康成人作对照,探讨缺氧对肺心病患者肺动脉压力及右心室结构与功能的影响。方法选择80例肺心病患者为病例组,并选取30名健康成人为对照组。测定治疗前以及病情缓解后血气分析、肺动脉压力(PAPS)、右心室前壁厚度(RVAW)、右心室舒张末期内径(EDRV)、右心室射血分数(EFRV)。结果治疗前,肺心病患者病情不同,缺氧程度不同,与健康成人比较,PAPS、RVAW、EDRV、EFRV均明显异常(P<0.01)。治疗后,与健康成人比较,肺心病患者PAPS、RVAW、EDRV、EFRV均明显异常(P<0.01)。缺氧程度不同的患者之间比较发现,PAPS、EDRV、EFRV等指标均有所异常(P<0.05或P<0.01)。结论缺氧对肺心病患者肺动脉压力以及右心室结构与功能有明显的负面影响,改善缺氧有利于降低肺动脉压力,改善右心功能。