Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow Acceleration After Pulmonary Thromboendarterectomy : Implications for Discordant Recovery of Pulmonary Artery Pressure and Compliance

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• Background Pulmonary artery pressure (PAP) is reduced dramatically after pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, it is unclear whether pulmonary artery compliance increases in conjunction with the reduction in PAP. Pulmonary artery compliance may affect right ventricular afterload and prognosis. Methods and Results In 33 patients with CTEPH (9 men, 22-76 years), changes in the tricuspid regurgitation pressure gradient (TRPG) and the acceleration time (ACT) of pulmonary artery flow (a surrogate parameter of pulmonary artery compliance) were examined before and after pulmonary thromboendarterectomy using echocardiography to clarify factors affecting the changes. At 6 months, both TRPG and ACT normalized (≤30mmHg, ≥100ms, respectively) in 25 patients (group A) but not in 8 (group B). In group B, there were 5 with normal TRPG and shortened ACT at 6 months that normalized at 17±3 months. Group A patients showed shorter disease period and shorter period without anticoagulation than group B patients (p=0.04, 0.02 respectively). All patients in group A had the proximal type, and 2 patients of group B had the distal type (p=0.05). Clinical improvement was more remarkable in group A. Conclusions The recovery of PAP and the ACT of pulmonary artery flow was not always concordant after pulmonary thromboendarterectomy, suggesting a presence of a time lag in the recovery between pressure and compliance in some patients. A long period of CTEPH, a long period without anticoagulation and the distal embolism type may be predictive factors of an unfavorable operative result with reduced pulmonary artery compliance, and hence poor recovery of clinical performance. (Circ J 2007; 71: 1771-1775)

• 社団法人日本循環器学会の論文
• 2007-10-20

著者

• Miyashita K

  Department Of Cardiovascular Surgery National Cardiovascular Center

• Kosuge Masami

  Yokohama City University School Of Medicine

• Iwasaka Toshiji

  Second Department Of Internal Medicine Kansai Medical University

• Matsubara Hiroaki

  京都府立医科大学 循環器内科学

• Kitakaze Masafumi

  Nagoya University Graduate School Of Medicine

• Kitakaze Masafumi

  Department Of Cardiology National Cardiovascular Center

• Ogino Hitoshi

  Department of Cardiovascular surgery, National cardiovascular center

• Miyatake Kunio

  Department of Cardiovascular Medicine, National cardiovascular center

• NAKANISHI Norifumi

  Division of Cardiology, National Cardiovascular Center

• Muro K

  国立がんセンター中央病院

• Muro Kei

  Gastrointestinal Oncology Division National Cancer Center Hospital

• Nakatani Satoshi

  国立循環器病センター

• Miyatake Kunio

  Department Of Cardiovascular Surgery National Cardiovascular Center

• Nakanishi Norifumi

  Division Of Cardiology National Cardiovascular Center

• Nakanishi Norifumi

  Department Of Cardiovascular Medicine National Cardiovascular Center

• Nakatani Satoshi

  Department of Cardiology, National Cardiovascular Center

• Miyashita K

  National Cardiovascular Center

• Miyatake Kunio

  国立病院機構大阪南医療センター 循環器科

• Miyatake Kunio

  Department Of Internal Medicine National Cardiovascular Center

• MINATOYA Kenji

  National Cardiovascular Center

• Maeba Hirofumi

  Second Department of Internal Medicine, Kansai Medical University

• Sugawara Motoaki

  Department of Medical Engineering, Himeji Dokkyo University

• Mimura Jun

  Second Department of Internal Medicine, Kansai Medical University

• Nakamura Seishi

  Division Of Cardiology Takarazuka Hospital

• Mimura J

  Cardiovascular Division Department Of Medicine 2 Kansai Medical University

• Matsuura Kaoru

  国立循環器病センター

• Ogino Hitoshi

  Department Of Bioscience National Cardiovascular Center

• Miyatake Kunio

  Hiroshima General Hospital

• Marie Stugaard

  Department Of Medical Engineering Himeji Dokkyo University

• Sugawara Motoaki

  Department Of Medical Engineering Himeji Dokkyo University

• Maeba Hirofumi

  Second Department Of Internal Medicine Kansai Medical University

• Mimura Jun

  Second Department Of Internal Medicine Kansai Medical University

• Mimura Jun

  The Second Department Ofinternal Medicine Kansai Medical University

• Miyashita Kotaro

  Department Of Cardiology National Cardiovascular Center

• Nakatani Satoshi

  Department Of Health Sciences Osaka University Graduate School Of Medicine

• Nakatani Satoshi

  Department Of Cardiology National Cardiovascular Center

• Mani Hiroki

  Cardiovascular Division Department Of Medicine Ii Kansai Medical University

• Kajikawa Mariko

  ABLE Corporation

• Kitakaze Masafumi

  Department Of Cardiovascular Medicine National Cardiovascular Center

• Nakatani Satoshi

  Cardiovascular Division Of Medicine National Cardiovascular Center

• Nakanishi Norifumi

  Department Of Cardiology Jichi Medical School

• Sugawara Motoaki

  Department Of Cardiovascular Science Tokyo Women's Medical University

• Miyatake Kunio

  Department Of Cardiology National Cardiovascular Center

• Miyatake Kunio

  National Hospital Organization Osaka Minami Medical Center

• Kusumoto Miyako

  Cardiac Division National Cardiovascular Center

• Miyashita Kotaro

  National Cardiovascular Center Department Of Cerebrovascular Medicine

• Iwasaka Toshiji

  The 2nd Dept. Of Intern. Med. Kansai Med. School

• Iwasaka Toshiji

  Second Department Of Internal Medicine Division Of Cardiology Kansai Medical University

• Motegi Katsuhiko

  Division Of Cardiology Department Of Internal Medicine And Division Of Cardiac Sugery

• Maeda Jun

  Cardiovascular Center Kansai Medical University

• Nagase Satoshi

  Department Of Cardiovascular Medicine Okayama University Graduate School Of Medicine Dentistry And P

• Miyoshi Hironori

  Cardiovascular Division Department Of Medicine Ii Kansai Medical University

• Kadoma Masaaki

  The First Department Of Medicine Osaka University School Of Medicine

• Nakamura Satoko

  Department Of Internal Medicine National Cardiovascular Center

• Nagase Satoshi

  Department Of Cardiovascular Medicine Okayama University Graduate School Of Medicine Dentistry And P

• Miyatake Kunio

  Devision Of Cardiology National Caediovascular Center

• Maeda Kumiko

  Department Of Medicine Osaka Ekisaikai Hospital

• Miyatake Kunio

  Hospital Osaka

• Miyamoto Koji

  Department Of Cardiology National Cardiovascular Center

• Ogino Hitoshi

  Department of Cardiothoracic Surgery, National Cardiovascular Center

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