Evaluation of pulmonary arterial pressure by Doppler colour flow mapping in patients with a ductus arteriosus

Blood flow in the pulmonary artery was studied by Doppler colour flow mapping and cardiac catheterisation in 19 patients with a ductus arteriosus and different pulmonary artery pressures. In the four patients with normal pulmonary artery pressures colour Doppler flow mapping showed multicoloured wide and long systolic and diastolic jets in the pulmonary artery. In the 15 patients with raised pulmonary arterial pressure the systolic jets varied from multicoloured to red and were thinner: in patients with considerably raised pulmonary arterial pressure the jets became redder during diastole. The Doppler velocity tracings showed that in patients with normal pulmonary artery pressures the mean peak systolic velocity was higher than the mean end diastolic velocity--so that in all four the ratio of peak systolic velocity to end diastolic velocity was less than 2. The mean peak systolic velocity was much higher than the mean end diastolic velocity in 13 of the 15 patients with raised pulmonary artery pressure; this meant that the ratio of peak systolic velocity to end diastolic velocity was greater than 2 in 10 of 11 patients. The end diastolic velocity was significantly lower in those patients with raised pulmonary artery pressure than in those with normal artery pressure. There was an inverse linear correlation between the mean pulmonary artery pressure and end diastolic ductal jet velocity in 17 of the 19 patients. Colour flow mapping and this quantitative Doppler technique can detect pulmonary artery hypertension in patients with a ductus arteriosus.     

Evaluation of pulmonary arterial pressure by Doppler colour flow mapping in patients with a ductus arteriosus.

Blood flow in the pulmonary artery was studied by Doppler colour flow mapping and cardiac catheterisation in 19 patients with a ductus arteriosus and different pulmonary artery pressures. In the four patients with normal pulmonary artery pressures colour Doppler flow mapping showed multicoloured wide and long systolic and diastolic jets in the pulmonary artery. In the 15 patients with raised pulmonary arterial pressure the systolic jets varied from multicoloured to red and were thinner: in patients with considerably raised pulmonary arterial pressure the jets became redder during diastole. The Doppler velocity tracings showed that in patients with normal pulmonary artery pressures the mean peak systolic velocity was higher than the mean end diastolic velocity--so that in all four the ratio of peak systolic velocity to end diastolic velocity was less than 2. The mean peak systolic velocity was much higher than the mean end diastolic velocity in 13 of the 15 patients with raised pulmonary artery pressure; this meant that the ratio of peak systolic velocity to end diastolic velocity was greater than 2 in 10 of 11 patients. The end diastolic velocity was significantly lower in those patients with raised pulmonary artery pressure than in those with normal artery pressure. There was an inverse linear correlation between the mean pulmonary artery pressure and end diastolic ductal jet velocity in 17 of the 19 patients. Colour flow mapping and this quantitative Doppler technique can detect pulmonary artery hypertension in patients with a ductus arteriosus.     

不同肺动脉压力动脉导管未闭患者介入治疗评价

目的探讨经导管介入封堵术治疗不同肺动脉压力动脉导管未闭(PDA)患者的临床疗效,为选择手术时机提供一定的参考依据。方法回顾性分析接受介入封堵治疗的47例PDA患者的临床资料,按术前右心导管测得的肺动脉收缩压分为低压力组(25例)和高压力组(22例),术前行心脏彩色超声检查,术中、术后测肺动脉压力、行主动脉弓造影,出院后随访1个月至7年。结果所有患者PDA封堵均成功。封堵前,低压力组和高压力组肺动脉收缩压分别为(38.72±7.38)mm Hg和(73.68±23.32)mm Hg;封堵后,分别下降至(29.92±5.52)mm Hg和(54.27±17.52)mm Hg,均较封堵前明显下降(均为P<0.05),且高压力组下降更为明显。低压力组患者的总住院时间及术后住院时间较高压力组短[(5.2±1.7)d比(8.2±5.2)d,P<0.05;(2.7±1.0)d比(4.2±2.0)d,P<0.01]。随访期间两组患者的左心室重构和心功能均有一定改善,高压力组患者再入院率较高(18.18%比0,P<0.05)。结论低肺动脉压力患者心功能受损小,住院时间短,术后恢复快,且再入院率低,故应在发现PDA后及时行介入封堵术。     

动脉导管未闭并重度肺动脉高压封堵术后肺动脉压力变化

目的:探讨动脉导管未闭(patent ductus arteriosus,PDA)并发重度肺动脉高压(pulmonary arterial hypertension,PAH)经导管封堵术后肺动脉压力(pulmonary artery pressure,PAP)变化及其与术后PAH的关系。方法:对111例肺动脉平均压(mean pulmonary artery pressure,m PAP)55 mm Hg,肺/体循环血量比值(Qp/Qs)1.5的PDA患者实施封堵术,术中实时监测封堵术前后PAP变化,术后定期随访并行超声心动图检查。结果:所有患者均成功实施封堵术,术后即刻PAP显著降低(P0.05),但m PAP恢复正常仅37例(33.3%),另有轻度、中度和重度PAH患者51(49.5%),14(12.6%)和9例(8.1%)。随访1~8(中位数4)年。术后3个月共24例(21.6%)患者存在PAH,其中9例术后6个月PAP恢复正常,另外15例(13.5%)PAH持续存在。术后PAP最终恢复正常的患者封堵术后即刻m PAP降低(59±10)%,术后存在持续性PAH者仅降低(24±14)%。术后即刻PAP正常和轻度PAH者术后PAP最终均恢复正常,而术后即刻存在重度PAH者随访期间PAH持续存在。结论:在并发重度PAH的PDA患者中,即使Qp/Qs1.5,仍有13.5%的患者存在术后持续性PAH;关闭PDA后导管测量PAP为重度PAH者,术后PAH不可避免;如果术后6个月PAP仍然高于正常,PAH将持续存在。     

肺动脉闭锁合并双侧动脉导管未闭

目的:分析肺动脉闭锁合并双侧动脉导管分别供应双肺血患者的影像学特点及其发生率。方法:回顾82例复杂先天性心脏病合并肺动脉闭锁患者的造影资料,分析肺血来源、肺动脉发育情况及合并畸形。结果:82例肺动脉闭锁患者中确定双侧动脉导管4例,其中病例1及2为肺动脉闭锁合并室间隔缺损,病例3及4为肺动脉闭锁合并无脾综合症。本组患者中双侧动脉导管未闭的总发病率为4.9%,在亚组分析中合并室间隔缺损及合并无脾综合症的发生率分别为3.1%和33.3%。结论:双侧动脉导管在肺动脉闭锁患者中的发生率非常低,明确诊断需要行心导管造影。建议在肺动脉闭锁合并无脾综合症的患者中应将双侧动脉导管作为常见的肺动脉供血方式加以明确。     

动脉导管未闭介入治疗后肺动脉压改变的研究

目的：探讨动脉导管未闭（PDA）患者介入封堵治疗后肺动脉压改变的影响因素。方法：回顾性分析2008年1月至2011年9月在我院行介入封堵治疗的43例PDA患者的临床及介入手术资料。结果：与治疗前比较,PDA患者介入封堵治疗后肺动脉收缩压[PASP,（76±51）mmHg比（46.26±17.26）mmHg]、肺动脉舒张压[PADP,（39.47±17.11）mmHg比（15.84±10.74）mmHg]、平均肺动脉压[MPAP,（54.72±19.21）mmHg比（28.53±14.41）mmHg]均显著降低（P均=0.0001）,PADP下降程度比PASP更明显[（0.54±0.38）比（0.38±0.15）,P=0.012];PDA患者介入治疗后PASP、MPAP下降程度与年龄呈负相关（B=-0.04,P=0.012;B=-0.006,P=0.009）;术后MPAP下降程度与动脉导管管径呈正相关（B=0.022,P=0.01）。结论：介入封堵治疗对动脉导管未闭有益,应在年龄较小时尽早手术。     

Doppler flow characteristics in the assessment of pulmonary artery pressure in ductus arteriosus

The Doppler spectral pattern of flow through the ductus arteriosus was studied in 117 patients. In 37 who underwent catheterisation, Doppler records and aortic and pulmonary artery pressure were available (21 simultaneously with two catheters) for review while the others had surgical ligation of the duct on the basis of the results of non-invasive tests. Four flow patterns were obtained: (a) continuous flow, maximum velocity in late systole with gradual fall throughout diastole; (b) continuous flow, high systolic flow with rapid fall to a very low early diastolic velocity maintained throughout diastole; (c) continuous low velocity, maximum in late diastole; and (d) bidirectional flow. Flow pattern (a) was associated with normal or slightly raised pulmonary artery pressure; (b) with raised pulmonary artery pressure; and (c) and (d) with pulmonary artery pressure at systemic values. Comparison of the Doppler and measured pressure differences between the great arteries was reasonably good for peak values but poor for the trough readings. Doppler ultrasound clearly showed ductal flow; the flow pattern gave an indication of the pulmonary artery pressure, but pressure measurement by application of the Bernoulli equation to the flow velocities cannot yet be regarded as reliable.     

Doppler flow characteristics in the assessment of pulmonary artery pressure in ductus arteriosus.

The Doppler spectral pattern of flow through the ductus arteriosus was studied in 117 patients. In 37 who underwent catheterisation, Doppler records and aortic and pulmonary artery pressure were available (21 simultaneously with two catheters) for review while the others had surgical ligation of the duct on the basis of the results of non-invasive tests. Four flow patterns were obtained: (a) continuous flow, maximum velocity in late systole with gradual fall throughout diastole; (b) continuous flow, high systolic flow with rapid fall to a very low early diastolic velocity maintained throughout diastole; (c) continuous low velocity, maximum in late diastole; and (d) bidirectional flow. Flow pattern (a) was associated with normal or slightly raised pulmonary artery pressure; (b) with raised pulmonary artery pressure; and (c) and (d) with pulmonary artery pressure at systemic values. Comparison of the Doppler and measured pressure differences between the great arteries was reasonably good for peak values but poor for the trough readings. Doppler ultrasound clearly showed ductal flow; the flow pattern gave an indication of the pulmonary artery pressure, but pressure measurement by application of the Bernoulli equation to the flow velocities cannot yet be regarded as reliable.     

Correlation of pulmonary function variables with hemodynamic measurements in patients with pulmonary arterial hypertension

Introduction: A reduced diffusing capacity of the lung for carbon monoxide (DLCO) measured during a pulmonary function test can suggest pulmonary arterial hypertension (PAH). The DLCO has been reported to weakly correlate with pulmonary hemodynamics. Objective: To determine whether the relationship between the DLCO and pulmonary arterial pressures can be strengthened by normalizing the DLCO to spirometric variables. Patient and Methods: Patients were seen at a tertiary care referral center. Consecutive subjects who underwent right heart catheterization (RHC) for the evaluation of suspected PAH from 01 January 1991 through 01 October 2006 were identified. Pulmonary function testing (PFT) data performed within 60 days of the RHC was collected. Spearman rank correlation between PFT and RHC variables was calculated. Results: One hundred thirty‐eight patients who had an RHC performed had complete PFTs available. No significant correlation was identified between the mean pulmonary artery pressure and the pulmonary vascular resistance against the DLCO, nor the DLCO when normalized to: forced expiratory volume in 1 s, forced vital capacity, total lung capacity or alveolar volume. Spirometric subgroups were identified by standard definitions of restrictive and/or obstructive ventilatory defects. Clinical subgroups were classified based on the clinically diagnosed cause of the patient's PAH. Again, no significant correlation was identified between the PFT variables and RHC measurements in these stratified subgroups. Conclusion: In patients with suspected PAH, invasive hemodynamic measurements of PAH do not correlate with PFT variables, even when corrected for spirometric volumes, and regardless of the subgroup of ventilatory physiology or clinical diagnosis. Please cite this paper as: Arunthari V, Burger CD and Lee AS. Correlation of pulmonary function variables with hemodynamic measurements in patients with pulmonary arterial hypertension. Clin Respir J 2011; 5: 35–43.     

Quantitative radiocardiography in patients with patent ductus arteriosus

Analytical models of the analog computer simulation method of radiocardiogram (RCG) were revised to obtain quantitative hemodynamic evaluations in patent ductus arteriosus (PDA). The theoretical and technical aspects are herein outlined, and the effects of clinical application discussed. Twenty-six patients with a left-to-right PDA shunt were studied by the revised RCG models, and the results were compared with oxymetric or echocardiographic data. Between RCG and oxymetry, the systemic blood flow (SBF) findings agreed well (r = 0.91), but in oxymetry, the pulmonary blood flow (PBF) findings were generally seen greater than in RCG (r = 0.81), and the oxymetric shunts appeared larger than in RCG (r = 0.75). This is because oxymetry cannot avoid the direct effects of the uneven partition of shunt flow to the lungs, whereas RCG can, in addition, measure the mean PBFs and SBFs. RCG may thus be said to be superior to oxymetry in assessing PDA shunts. Furthermore, RCG can estimate the mean left and right heart volumes (LHV and RHV) at the same time; the RCG LHV was found to correspond to the echocardiographic left ventricular end-diastolic volume (LVEDV) (r = 0.89). Moreover, the obtained relation between the RHV/LHV (Y) and the shunt ratio (X) proved to be the same that calculated theoretically (Y = -X + 1.0) in uncomplicated patients. Patients not presenting this relation may be assumed to suffer some condition complicating the PDA. In effect, the analog computer simulation method of RCG is a unique non-invasive means of obtaining quantitative analyses in PDA and in other congenital shunt diseases as well.