title: Echocardiographic Evaluation of Patients with Primary Pulmonary Hypertension Before and After Atrial Septostomy.
abstract: OBJECTIVES: To characterize the early changes in right ventricular [right ventricle (RV)] geometry and function, as assessed by two-dimensional (2-D) and Doppler echocardiography, after balloon-dilation atrial septostomy (BDAS) in patients with severe primary pulmonary hypertension (PPH). BACKGROUND: Survival in PPH is to a great extent dependent on the functional status of the RV. BDAS recently has been shown to improve functional class and hemodynamics in patients with PPH nonresponsive to conventional vasodilator treatment. METHODS: Ten patients with severe PPH who underwent BDAS were studied with transthoracic and transesophageal 2-D and Doppler echocardiography. RV dimensions were measured in the apical four-chamber view. Continuous-wave Doppler echocardiography was used to obtain peak velocity of tricuspid regurgitation. Transesophageal echocardiography (TEE) primarily was used for the follow-up of the atrial septal defects (ASDs). RESULTS: In the early post-BDAS studies, right atrial and ventricular dimensions significantly decreased in all patients (P < 0.05). Global right ventricular wall motion (RVWM) also improved. RV percent change in area after septostomy inversely correlated with the changes in RV systolic area (r = -0.75; P < 0.05) and also with the baseline (preprocedure) values of RV percent change in area (r = -0.77; P < 0.05). Neither RV wall thickness nor the degree of tricuspid regurgitation were modified significantly after the procedure. CONCLUSIONS: BDAS in the setting of severe PPH results in moderate and salutary changes in geometry and function of the RV as assessed by 2-D echocardiography. These changes mainly appear to be the result of the decompression effect of atrial septostomy.
authors.affiliation: Department of Echocardiography, Instituto Nacional de Cardiología "Ignacio Chávez," Juan Badiano No. 1, Colonia Sección XVI, Tlalpan 14080, México.
authors.forename: Nilda
authors.initials: N
authors.lastname: Espinola-Zavaleta
authors.forename: Jesus
authors.initials: J
authors.lastname: Vargas-Barrón
authors.forename: Jorge Isaac
authors.initials: JI
authors.lastname: Tazar
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Casanova
authors.forename: Candace
authors.initials: C
authors.lastname: Keirns
authors.forename: Angel Romero
authors.initials: AR
authors.lastname: Cárdenas
authors.forename: Jorge
authors.initials: J
authors.lastname: Gaspar
authors.forename: Julio
authors.initials: J
authors.lastname: Sandoval