Doppler assessment of changes in right-sided cardiac hemodynamics after pulmonary thromboendarterectomy.
It is not known whether Doppler echocardiography can accurately follow changes in right-sided cardiac hemodynamics after a therapeutic intervention in patients with pulmonary artery (PA) hypertension. Therefore, Doppler measurements of the maximal velocity of the tricuspid regurgitant jet and the acceleration time of the PA velocity profile were obtained in 28 patients before and after pulmonary thromboendarterectomy for chronic thromboembolic PA hypertension. Doppler values were compared with hemodynamic variables obtained at cardiac catheterization. Postoperatively, decreases in mean PA pressure (50 +/- 14 to 28 +/- 8 mm Hg), transtricuspid systolic pressure difference (69 +/- 21 to 36 +/- 14 mm Hg) and Doppler measurement of the maximal velocity of the tricuspid regurgitant jet (4.1 +/- 0.7 to 2.7 +/- 0.5 m/s) were noted, while acceleration time increased (57 +/- 16 to 94 +/- 18 ms, all p less than 0.001) compared with preoperative values. For the population as a whole, the calculated systolic transtricuspid pressure difference determined from the maximal velocity of tricuspid regurgitation correlated well with the catheterization systolic transtricuspid pressure difference (r = 0.93, p less than 0.001) and the acceleration time correlated with mean PA pressure (r = -0.81, p less than 0.001). More importantly, the change in the maximal velocity of tricuspid regurgitation for postoperative patients was found to correlate with the change in catheterization systolic transtricuspid pressure difference (r = 0.82, p less than 0.001), while the change in acceleration time correlated weakly with the change in mean PA pressure (r = -0.41, p = 0.053).(ABSTRACT TRUNCATED AT 250 WORDS)
Chow
L C
LC
Department of Internal Medicine, University of California, San Diego Medical Center 92103.
Dittrich
H C
HC
Hoit
B D
BD
Moser
K M
KM
Nicod
P H
PH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002908:Chronic Disease; D004452:Echocardiography; D004691:Endarterectomy; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D013599:Systole; D013927:Thrombosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology; D014655:Vascular Resistance