Right Heart Failure
This article reviews traditional and gold-standard hemodynamic assessments of the right ventricle in health and disease.
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by organized thrombi in the pulmonary arteries leading to right heart failure and death. Impaired angiogenesis and systemic inflammation could be involved in the pathophysiology of this disease. The aim of this study was to determine the angiogenic expression profile in patients with CTEPH.
The distinction between pulmonary hypertension (PH) due to heart failure with left ventricular preserved ejection fraction (HFpEF) and idiopathic pulmonary arterial hypertension (IPAH) has important clinical implications. These distinction between pre and post-capillary PH is based on a cutoff value of pulmonary arterial wedge pressure value (PAPW)>15 mmHg in the latter. However, a value between 12 and 15 mmHg is associated with a higher probability of post-capillary pulmonary hypertension. In addition, the probability of HFpEF may be assessed by the non invasive H2FPEF score.
Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension. In PVOD the pulmonary venous vessels are obliterated resulting in obstructive pulmonary vascular disease, increase in pulmonary vascular resistance, right heart failure and death. Pulmonary hypertension is the most common reason for lung transplant in infants. Lung transplant is the only therapy for PVOD. Prolonged intubation, deconditioning and extra corporeal life support are associated with poor outcomes after lung transplant.
We present the first successful combined heart lung transplant from a DCD donor.
Endothelin-1 (ET-1), a potent vasoconstrictor, is elevated in heart failure as well as in pulmonary arterial hypertension (PAH). To our knowledge little is known about ET-1 level in exercise induced pulmonary hypertension when compared to group 1 and 2 pulmonary hypertension. We aim to assess effect of exercise on ET-1 levels in different types of pulmonary hypertension.
Heart failure (HF) represents a significant cause of morbidity and mortality in the US. Heart transplantation can lead to significant long-term survival. One complication of HF is the presence of pulmonary hypertension (PH) secondary to increased left heart pressures. The presence of fixed PH is a contraindication to heart transplantation. Milrinone is hypothesized to lead to pulmonary vasodilation through its inhibition of PDE-4 and may be the better inotrope in patients with PH being evaluated for transplantation.
Patients with IPF and cardiopulmonary failure caused by secondary pulmonary hypertension have poor prognoses. If lung oxygen exchange capacity is completely lost and secondary heart failure caused by pulmonary exacerbation was appeared, it is difficult to maintain survival via conventional peripheral ECMO alone. We used Oxy-RVAD(RA-PA ECMO) as novel configuration delivered via anterior thoracotomy to treat end-stage IPF patients with RHF.
Secondary mitral regurgitation (MR), not amenable to percutaneous or surgical repair, is common in advanced heart failure patients considered for LVAD implantation. Single center analyses have suggested variable frequency of persistent MR after LVAD implantation and consequent pulmonary hypertension, worse right heart function and more readmissions. The contemporary impact of newer devices such as the HeartMate 3 (HM3) on amelioration of MR post-LVAD implant remains uncertain. In this analysis of the MOMENTUM 3 pivotal trial and its Continued Access Protocol (CAP) study, we propose to assess the burden of significant resid...
Pulmonary hypertension is a common complication of idiopathic pulmonary fibrosis (IPF), which leads to cor pulmonale and right-heart failure. β-blockers have been used extensively for the treatment of left heart disease, yet their use for right-heart failure is controversial. Recent studies have shown that β-blockers may be beneficial for the treatment of pulmonary arterial hypertension. However, whether β-receptors ligands are effecti ve in PH and cor pulmonale associated with lung fibrosis has not been evaluated.
AbstractCongenital heart diseases have varied presentations depending on the age of presentation. Regression of neonatal pulmonary hypertension and the timing of establishment of left to right shunt determines the onset of symptoms. Pre-tricuspid shunts generally remain asymptomatic during the childhood while large post-tricuspid shunts present with heart failure in late neonatal or early infancy period. Admixture lesions have pathophysiology similar to large post tricuspid shunts with additional small right to left shunt causing mild systemic desaturation. Murmurs are prominent in valvular heart diseases. Careful clinical...