Posted in cardiac surgery, Cardiology -Interventional -PCI, Hemodynamics, Uncategorized, tagged 100% oxygen, asd, bi directional shunt, bosentan, cyantoic heart disease, eisenmenger syndrome, heath edwards, irreversible pulmonary hypertension, left to right shunt, mean pulmonary arterial pressure, mean pulmonary artery pressure, oximetry, pah, papp, pda, pht, prostocyclin, pulmonary artery diastolic pressure, pulmonary artery pulse pressure, pulmonary hypertension, pvr vs svr, reversible pulmonary, right to left shunt, sildanefil, tolazoline, vsd on December 20, 2009 |
Leave a Comment »
PAH is the major determinant of surgical outcome of left to right shunts. In this modern era of cardiac care allowing a child with left to right shunt to progress to a stage of Eisenmenger syndrome is considered as a huge medical failure . But , this is still rampant in many of the developing countries .
Cardiologists are divided over the issue of operability of Eisenmenger syndrome .The confusion is largely due to the conflicting data of outcome in these patients. While there is strong data when PVR exceeds SVR , the death is imminent in the post operative period .
What has complicated the issue is there are many case reports where severe PAH patients have been successfully operated. Most would think it is a statistical exception and one can not alter the traditional criteria based on few case reports.
But ,it remains an irony as on 2009 , we do not have a proper methodology to assess reversibility of PAH in Eisenmenger syndrome . Further , there is a significant number of patients with high PVR , who continue to experience an unabated left to right shunting . We do not have an answer for either the mechanism of such shunts and how to manage these patients.
Click over the slide to view full PPT presentation in PDF format .
This short paper was presented in the Annual scientific sessions of cardiological society of India 2009 regarding the usefulness of a new parameter to assess reversibility of PAH. This may not be called as a study rather a report of our experience in five patients with eisenmenger syndrome
Download the full PPT presentation in PDF format.
pulmonary artery pulse pressure
Read Full Post »
Posted in cardiology -congenital heart disease, tagged 100% oxygen, asd, bi directional shunt, biochemical diagnosi of pulmonary hypertension, eisenmengersyndrome, heath edwards, nitric oxide, pd, pht, reversibility of pulmonary hypertension, right to left shunt, severe pulmonary hypertenison, tolazoline, vsd on March 27, 2009 |
Leave a Comment »
Biochemical diagnosis for PHT and Eisenmenger syndrome
Identifying reversibility of pulmonary arterial hypertension remains a difficult clinical problem.Heath edwards grading of pulmonary hypertension is based on lung pathology .Grade 4 and 5 constitute severe obstructive vascular pathology including pulmonary vascular necrosis.
Lung biopsy is an invasive procedure and has a huge risk in patients with elevated pulmonary artery pressure.
Do we have an alternative ?
Does the pulmonary artery sheds necrosed endothelial cells into the circulation ?
Yes it seems so , This month’s Nature cardiology reveals a breakthrough concept
The CEC (Circulating endothelial cells count ) can be used as marker and may be considered a non invasive equivalent of lung biopsy
Read Full Post »