0
Clinical Investigations: CARDIOLOGY |

Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension*: Changes After Pulmonary Thromboendarterectomy

Thomas Menzel, MD; Stephan Wagner, MD; Thorsten Kramm, MD; Susanne Mohr-Kahaly, MD; Eckhard Mayer, MD; Susanne Braeuninger, MD; Juergen Meyer, MD
Author and Funding Information

*From the 2nd Medical Clinic, Department of Cardiology (Drs. Menzel, Wagner, Mohr-Kahaly, Braeuninger, and Meyer), and Clinic for Cardiothoracic and Vascular Surgery (Drs. Kramm and Mayer), Johannes Gutenberg University, Langenbeckstrasse 1, D-55101 Mainz, Germany.

Correspondence to: Thomas Menzel, MD, Richard Wagner Strasse 17A, D-65193 Wiesbaden, Germany; e-mail: menzel@mail.uni-mainz.de



Chest. 2000;118(4):897-903. doi:10.1378/chest.118.4.897
Text Size: A A A
Published online

Study objectives: This study sought to evaluate the pathophysiology of left and right heart failure in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were hospitalized to undergo pulmonary thromboendarterectomy (PTE).

Design: Thirty-nine patients (16 women and 23 men; mean ± SD age, 55 ± 12 years) with severe CTEPH were examined before and 13 ± 8 days after PTE by way of transthoracic echocardiography and right heart catheterization.

Measurements and results: Examination results confirmed in all cases that before surgery the right ventricles were enlarged and systolic function was impaired. Moderate to severe tricuspid valve regurgitation was observed. Left ventricular eccentricity indexes reflected a leftward displacement of the interventricular septum. End-diastolic left ventricular size and systolic function had decreased, and the left ventricular filling pattern showed impaired diastolic function. After surgery, mean pulmonary artery pressure was significantly lower (48 ± 10 mm Hg vs 25 ± 7 mm Hg; p < 0.05). The calculated end-diastolic and end-systolic right ventricular areas had decreased: 30 ± 7 cm2 vs 21 ± 5 cm2 (p < 0.05) and 24 ± 6 cm2 vs 14 ± 4 cm2 (p < 0.05), respectively. Right ventricular fractional area change had increased (20 ± 7% vs 33 ± 8%; p < 0.05). Most of the patients exhibited a marked decrease in the severity of tricuspid regurgitation. Septal motion, left ventricular systolic function, and diastolic filling pattern returned to normal values (early to late diastolic left ventricular inflow ratio, 0.70 ± 0.33 vs 1.35 ± 0.51; p < 0.05). The mean cardiac index also improved (2.7 ± 0.6 L/min/m2 vs 3.7 ± 0.8 L/min/m2).

Conclusions: In CTEPH, functions are impaired in the right as well as the left ventricles of the heart. Improved lung perfusion and the reduction of right ventricular pressure overload are direct results of PTE, which in turn bring a profound reduction of right ventricular size and a recovery of systolic function. Normalization of interventricular septal motion as well as improved venous return to the left atrium lead to a normalization of left ventricular diastolic and systolic function, and the cardiac index improves.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543