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Denis Chemla, MD; Philippe Hervé, MD
Author and Funding Information

Affiliations: Hôpital de Bicêtre, Le Kremlin-Bicêtre, France,  Hôpital Marie Lannelongue, Le Plessis-Robinson, France

Correspondence to: Denis Chemla, MD, Service EFCR, Broca 7, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94 275 Le Kremlin Bicêtre, Cedex, France; e-mail: denis.chemla@bct.aphp.fr


The authors have no financial disclosures or conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):1109. doi:10.1378/chest.08-1782
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To the Editor:

We thank Dr. Kothari for commenting on our editorial in CHEST (March 2008).1 We have initially proposed a formula allowing mean pulmonary artery pressure estimation from systolic pulmonary artery pressure in adults.2 This concept has been recently confirmed by others,3 and essentially similar results have been also documented in children.4 We fully agree with the author's statement that the formula may fail in infants with unrestrictive septal defect with low pulmonary vascular resistance and high pulmonary blood flow, resulting in a 90/20 mm Hg systolic/diastolic pulmonary artery pressure. More generally, we are advocating caution when using our formula in patients with pulmonary hypertension associated with “ventricularization” of the pulmonary artery pressure curve, ie, disproportionately low diastolic pulmonary artery pressure. This may include not only the infants described by Dr. Kothari but also patients with severe pulmonary valve insufficiency, and patients with massive proximal pulmonary embolism,5,6 as previously discussed in our initial article.2 Under such conditions, one may observe deviation from the tight relationship between mean and systolic pulmonary artery pressure previously documented in most patients with various forms of pulmonary hypertension.24

Chemla D, Hervé P. Estimation of mean pulmonary artery pressure: simpler than expected. Chest. 2008;133:592-593. [PubMed] [CrossRef]
 
Chemla D, Castelain V, Humbert M, et al. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004;126:1313-1317. [PubMed]
 
Syyed R, Reeves J, Welsh D, et al. The relationship between the components of pulmonary artery pressure remains constant under all conditions in both health and disease. Chest. 2008;133:633-639. [PubMed]
 
Friedberg MK, Feinstein JA, Rosenthal DN. A novel echocardiographic Doppler method for estimation of pulmonary arterial pressure. J Am Soc Echocardiogr. 2006;19:559-562. [PubMed]
 
Agustsson MH, Arcilla RA, Gasul RM, et al. The diagnosis of bilateral stenosis of the primary pulmonary artery branches based on the characteristic pulmonary trunk pressure curves. Circulation. 1962;26:421-427. [PubMed]
 
Morpurgo M, Marzegalli M, Casazza F. “Ventricularization” of the pulmonary artery pressure curve: a hemodynamic sign of proximal pulmonary embolism. Cardiologia. 1998;43:745-748. [PubMed]
 

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References

Chemla D, Hervé P. Estimation of mean pulmonary artery pressure: simpler than expected. Chest. 2008;133:592-593. [PubMed] [CrossRef]
 
Chemla D, Castelain V, Humbert M, et al. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004;126:1313-1317. [PubMed]
 
Syyed R, Reeves J, Welsh D, et al. The relationship between the components of pulmonary artery pressure remains constant under all conditions in both health and disease. Chest. 2008;133:633-639. [PubMed]
 
Friedberg MK, Feinstein JA, Rosenthal DN. A novel echocardiographic Doppler method for estimation of pulmonary arterial pressure. J Am Soc Echocardiogr. 2006;19:559-562. [PubMed]
 
Agustsson MH, Arcilla RA, Gasul RM, et al. The diagnosis of bilateral stenosis of the primary pulmonary artery branches based on the characteristic pulmonary trunk pressure curves. Circulation. 1962;26:421-427. [PubMed]
 
Morpurgo M, Marzegalli M, Casazza F. “Ventricularization” of the pulmonary artery pressure curve: a hemodynamic sign of proximal pulmonary embolism. Cardiologia. 1998;43:745-748. [PubMed]
 
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