Sudden Death in Primary Pulmonary Hypertension : From the Aspect of Pulmonary Hemodynamics

概要

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To clarify the pathophysiology of sudden death in primary pulmonary hypertension (PPH), the pulmonary hemodynamics of cases of sudden death (Group II, 17 cases) were investigated in comparison with the long term survival group (Group I, 15 cases) and the group which died of right heart failure (Group III, 17 cases). The pulmonary arterial pressure and systemic pressure showed almost the same values in all three groups, but the right ventricular end-diastolic pressures were 7.1±3.7mmHg in Group I, 10.2±6.0mmHg in Group II and 11.8±5.4mmHg in Group III. The values in the latter two groups were significantly elevated. The cardiac indices were 3.59±0.96L/min/m^2, 2.34±0.58L/min/m^2 and 2.56±0.69L/min/m^2 respectively. The values in the latter two groups were significantly lower than that in Group I. The same tendency was found for the right venticular work index. In the case of arteiral blood gas, SaO_2 was 85.1±6.2% and PaO_2 was 53.9±17.1mmHg in the sudden death group, clearly lower than those in the other two groups. From the above results, it appears that sudden death in PPH occurs at the time of right heart failure with a severe decrease in cardiac output and intensive care is necessary when any signs or symptoms of right heart failure are found clinically. Surgical procedures including right heart catheterization and pulmonary angiography are contraindicated under such conditions.
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