Nuclear magnetic resonance (NMR) allows more accurate right ventricle (RV) morphological and functional studies than two-dimensional echocardiography due to the complex geometry of this heart chamber. Patients (pts) affected by chronic thromboembolic pulmonary hypertension (CTEPH) and treated with pulmonary thromboendarterectomy (PTE) experience dramatic changes in pulmonary hemodynamics before and after PTE. The purpose of this study is to assess RV remodeling with NMR in PTE pts and also to validate NMR data with RV hemodynamics.
Of 88 pts who underwent PTE between April 1994 and April 2003, 27 were enrolled in this study since December 2000 (8 pts were excluded for various reasons). All pts had concomitant RV hemodynamics. The table
NMR and RV hemodynamics dataBefore PTEFirst controlThree monthsP < 0.05Right ventricle end- diastolic diameter (mm)423231yesRight ventricle end- diastolic volume (ml)1107166yesRight ventricle end- systolic volume (ml)745041yesTricuspid insufficiency (absent/mild/ moderate/severe)0/5/8/64/9/6/04/14/1/0yesAbnormal septal motion (yes/no)14/52/170/19yesMean pulmonary artery pressure (mmHg)472323yesCardiac output (L/min)3.04.74.7yesPulmonary vascular resistances (dynes*sec*cm-5)1180338341yesshows the NMR and hemodynamic data before PTE.
Operative mortality for study patients is 8.6% (3/35). Kaplan-Maier survival at 3 months and 1 year is 88.6% and 84.4% respectively. Complete follow-up – before discharge from the hospital (first control) and at 3 months from PTE – are available for 19 pts. Both NMR and hemodynamic data show statistically significant changes (table). All changes are maintained in the 11 pts who have undergone follow-up 1 year after PTE.CONCLUSIONS: NMR is a good tool to assess RV remodeling; NMR is consistent with hemodynamics.
After PTE the decrease in pulmonary artery pressure is associated with complete recovery of the morphology and function of the RV.
A.M. D’Armini, None.