title: Perioperative Follow-Up of Patients With Severe Pulmonary Artery Hypertension Secondary to Left Heart Disease: A Single Center, Prospective, Observational Study.
abstract: OBJECTIVE
  A substantial portion of the Indian cardiac surgery population experiences rheumatic valve disease that progresses to severe pulmonary artery hypertension (PAH) in a few patients. Right ventricular (RV) function, particularly in the perioperative period, has been studied sparsely. The authors describe serial RV function and clinical variables in the perioperative period in patients with severe PAH secondary to left heart disease.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients with PAH.
  
  
  METHODS
  The study comprised consecutive patients referred for open cardiac surgery from January 2012 to June 2013 who also had an estimated right ventricular systolic pressure≥50 mmHg on referral echocardiogram. Composite echocardiographic assessment of right ventricular size and linear/two-dimensional tissue Doppler systolic function and diastolic function analysis were performed at predetermined intervals. Data from right heart catheterization, inotrope use, fluid requirements, mechanical ventilation logs, and intensive care stay also were acquired.
  
  
  RESULTS
  A complete dataset was obtained in 20 of 22 patients enrolled in the study. Serial comparison of most RV echocardiographic function variables were noted to be abnormal at baseline, deteriorating further in the immediate postoperative period and trending to a partial recovery at discharge from the intensive care unit, particularly for longitudinal assessment of the RV. Fractional area change, although abnormal, was noted to be preserved. Pulmonary artery systolic pressures registered significantly declined after intervention. The clinical course was largely uneventful.
  
  
  CONCLUSIONS
  Although linear echocardiographic RV function was grossly abnormal in the perioperative period in this patient subset with PAH, there was apparent disjunction with the clinical course.
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sethu
authors.initials: S
authors.lastname: Madhavan
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Puri
authors.initials: P
authors.lastname: Goverdhan Dutt
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Cardiothoracic and Vascular Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shyam
authors.initials: S
authors.lastname: Kumar Singh Thingnam
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Rohit
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: jayant.aveek@gmail.com.
authors.forename: Aveek
authors.initials: A
authors.lastname: Jayant
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: pulmonary artery hypertension; right ventricular function; tricuspid annular plane systolic excursion