Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Am Heart J. 2011 Jun;161(6):1046-52. doi: 10.1016/j.ahj.2011.03.001.
In chronic thromboembolic pulmonary hypertension, right ventricular (RV) pressure overload causes RV remodeling and dysfunction. Successful pulmonary endarterectomy (PEA) initiates restoration of RV remodeling and global function. Little is known on the restoration of systolic and diastolic RV function. Using transthoracic echocardiography, we studied the time course and extent of postoperative restoration of systolic and diastolic RV function.
In chronic thromboembolic pulmonary hypertension (n = 55, 36 women, age 52 ± 14 years), transthoracic echocardiography was performed before PEA (pre-PEA) and 2 weeks, 3 months, and 1 year postoperatively.
Two weeks postoperatively, RV afterload and dimension had decreased significantly, without further improvement during follow-up. Global RV function, expressed by the myocardial performance index, showed a gradual improvement (from pre-PEA 0.58 ± 0.29 to 0.45 ± 0.38, 0.39 ± 0.19, and 0.37 ± 0.18). In contrast, 2 weeks after PEA systolic RV function, as assessed by tricuspid annular plane systolic velocity excursion and peak tricuspid annular systolic velocity of the RV, had worsened, with a subsequent incomplete restoration during follow-up: tricuspid annular plane systolic velocity excursion from 19.3 ± 5.0 to 12.4 ± 2.5, 15.3 ± 3.0, and 16.8 ± 2.9 mm and systolic velocity of the right ventricle from 11.4 ± 3.0 to 9.6 ± 2.0, 10.0 ± 1.8, and 10.3 ± 1.7 cm/s. Postoperative diastolic RV function also showed a biphasic response: tricuspid inflow-to-annulus ratio from 6.1 ± 3.0 to 9.5 ± 3.5, 6.8 ± 2.4, and 6.3 ± 2.2 cm/s. Dynamics and ultimate level of restoration of systolic and diastolic RV function were similar in patients with and without residual pulmonary hypertension.
Postoperative reduction in RV afterload caused an immediate improvement in RV dimension and global function. In contrast, systolic and diastolic RV function deteriorated after PEA with subsequently a gradual yet incomplete restoration during 1-year follow-up.
在慢性血栓栓塞性肺动脉高压中，右心室（RV）压力超负荷导致 RV 重构和功能障碍。肺动脉内膜切除术（PEA）的成功实施启动了 RV 重构和整体功能的恢复。对于 RV 收缩和舒张功能的恢复知之甚少。本研究通过经胸超声心动图，研究了术后 RV 收缩和舒张功能恢复的时间过程和程度。
在慢性血栓栓塞性肺动脉高压患者（n=55，36 名女性，年龄 52±14 岁）中，在 PEA 前（术前）和术后 2 周、3 个月和 1 年进行经胸超声心动图检查。
术后 2 周时，RV 后负荷和大小显著降低，随访期间无进一步改善。整体 RV 功能，以心肌做功指数表示，逐渐改善（从术前的 0.58±0.29 至 0.45±0.38、0.39±0.19 和 0.37±0.18）。相比之下，PEA 后 2 周时，三尖瓣环平面收缩期速度位移和 RV 三尖瓣环收缩期峰值速度评估的 RV 收缩功能恶化，随后在随访期间不完全恢复：三尖瓣环平面收缩期速度位移从 19.3±5.0 至 12.4±2.5、15.3±3.0 和 16.8±2.9mm，右心室收缩速度从 11.4±3.0 至 9.6±2.0、10.0±1.8 和 10.3±1.7cm/s。术后 RV 舒张功能也表现出双相反应：三尖瓣口血流速度与环比值从 6.1±3.0 至 9.5±3.5、6.8±2.4 和 6.3±2.2cm/s。有和无残余肺动脉高压患者的 RV 收缩和舒张功能恢复的动力学和最终水平相似。
术后 RV 后负荷的降低导致 RV 大小和整体功能的立即改善。相比之下，PEA 后 RV 收缩和舒张功能恶化，随后在 1 年随访期间逐渐但不完全恢复。
