Sulpizio Cardiovascular Center University of California San Diego, La Jolla, CA.
Sulpizio Cardiovascular Center University of California San Diego, La Jolla, CA.
J Cardiothorac Vasc Anesth. 2019 Jun;33(6):1498-1503. doi: 10.1053/j.jvca.2018.09.038. Epub 2018 Sep 27.
To assess the change in 3-dimensional (3D) echocardiography-derived right ventricular volumes before and after pulmonary thromboendarterectomy (PTE) and to evaluate the correlation of these variables with right heart catheterization-calculated pulmonary vascular resistance (PVR).
Single university hospitals.
Patients undergoing elective PTE surgery between November 2016 and February 2018.
All patients received a pulmonary artery catheter and arterial line, and transesophageal echocardiographic monitoring was performed. Transesophageal echocardiographic monitoring before surgery (pre-PTE) and postsurgery (post-PTE) included comprehensive 2D examinations and 3D right ventricular data set acquisition for offline volumetric analysis. Right ventricular fractional area of change (RVFAC) was measured from a right ventricular-focused midesophageal 4-chamber view. TomTec-Arena 4D RV-Function 2.0 offline software (TomTec Imaging Systems GmbH, Unterschlessheim, Germany) was used to measure right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), and right ventricular ejection fraction (RVEF). Paired t tests were used to evaluate for differences before and after surgery, and echocardiographic variables versus PVR were analyzed with linear regression.
Forty patients were scheduled for elective PTE surgery; 35 patients had complete hemodynamic profiles and echocardiographic data sets and were included in the evaluation. Mean pulmonary artery pressure decreased from 40 ± 11 to 28 ± 7 mmHg, and PVR decreased from 708 ± 432 to 285 ± 136 dynes*s/cm after PTE. RVEDV decreased from 106 ± 43 to 79 ± 35 cm (p < 0.001), and RVESV decreased from 77 ± 36 to 59 ± 31 cm (p < 0.001). A statistically significant change was not identified in RVEF or RVFAC post-PTE compared with pre-PTE values. All volumetric analyses and RVFAC correlated poorly with PVR (pre-PTE RVEDV correlation to PVR [R = 0.004]; post-PTE RVEDV correlation to PVR [R = 0.024]).
Even though RVEDV and RVESV displayed a statistically significant change after PTE, this study did not identify a correlation between those variables and PVR. In addition, markers of right ventricular systolic function (eg, RVFAC and RVEF) did not correlate with PVR. Therefore, the authors conclude that even though these echocardiographic measurements quantified a statistically significant change after PVR reduction, they cannot be reliably used as a surrogate marker of success immediately after PTE.
评估肺动脉血栓内膜剥脱术（PTE）前后三维（3D）超声心动图右心室容积的变化，并评估这些变量与右心导管计算的肺血管阻力（PVR）的相关性。
单所大学医院。
2016 年 11 月至 2018 年 2 月期间接受择期 PTE 手术的患者。
所有患者均接受肺动脉导管和动脉导管，并进行经食管超声心动图监测。手术前（术前）和手术后（术后）的经食管超声心动图监测包括全面的二维检查和 3D 右心室数据集采集，用于离线容量分析。从右心室中食管 4 腔心切面测量右心室分数变化（RVFAC）。使用 TomTec-Arena 4D RV-Function 2.0 离线软件（TomTec Imaging Systems GmbH，德国 Unter-schlessheim）测量右心室舒张末期容积（RVEDV）、右心室收缩末期容积（RVESV）和右心室射血分数（RVEF）。使用配对 t 检验评估手术前后的差异，并使用线性回归分析超声心动图变量与 PVR 的关系。
40 例患者计划接受择期 PTE 手术；35 例患者有完整的血流动力学特征和超声心动图数据集，并纳入评估。肺动脉平均压从 40±11mmHg 降至 28±7mmHg，PVR 从 708±432dyness/cm降至 285±136dyness/cm。术后 RVEDV 从 106±43cm 降至 79±35cm（p<0.001），RVESV 从 77±36cm 降至 59±31cm（p<0.001）。与术前相比，术后 RVEF 或 RVFAC 无统计学意义的变化。所有容积分析和 RVFAC 与 PVR 相关性较差（术前 RVEDV 与 PVR 的相关性[R=0.004]；术后 RVEDV 与 PVR 的相关性[R=0.024]）。
尽管 PTE 后 RVEDV 和 RVESV 显示出统计学上的显著变化，但本研究并未发现这些变量与 PVR 之间存在相关性。此外，右心室收缩功能标志物（如 RVFAC 和 RVEF）与 PVR 不相关。因此，作者得出结论，尽管这些超声心动图测量在 PVR 降低后量化了统计学上的显著变化，但它们不能作为 PTE 后即刻成功的可靠替代标志物。
