Đánh giá chỉ số áp lực động mạch phổi trên siêu âm tim qua thành ngực đối với bệnh nhân Covid-19

TÓM TẮT Mục tiêu: Đánh giá áp lực động mạch phổi (ALĐMP) ở bệnh nhân Covid-19 mức độ trung bình và nặng. Đặc điểm lâm sàng, cận lâm sàng ở nhóm bệnh nhân Covid-19 mức độ trung bình và nặng có hoặc không có tăng ALĐMP. Phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 200 bệnh nhân nhiễm SARS-CoV-2 đang được điều trị tại khu thoát hồi sức và khu nguy kịch trung tâm hồi sức tích cực người bệnh COVID-19 trực thuộc bệnh viện trung ương Huế tại thành phố Hồ Chí Minh từ ngày 12/8/2021 đến ngày 15/11/2021. Kết quả: Tuổi trung bình trong nhóm nghiên cứu là 57,38 ± 17,62 tuổi với 47,5% nam giới. Thời gian khởi bệnh là 6,92 ± 3,9 ngày. Qua đánh giá bằng siêu âm tim phát hiện có 28 (14%) bệnh nhân có biểu hiện tăng ALĐMP với độ tuổi trung bình là 67,04 ± 13,50 tuổi cao hơn so với nhóm không tăng ALĐMP 55,8 ± 17,75 tuổi và có các bệnh kèm theo thường xuyên hơn ĐTĐ (35,7%), THA (50%), BMV (6%), đồng thời chỉ số BMI cũng cao hơn 26,02 ± 3,68 kg/m2. Mức tăng ALDMP trung bình là 44,50 ± 8,19 mmHg, TAPSE ở bệnh nhân Tăng ALĐMP là 19,96 ± 2,36 mmHg thấp hơn ở bệnh nhân không tăng 25,51 ± 1,19 mmHg. Các đường kính đáy giữa và dọc của thất phải đều cao hơn đáng kể ở các bệnh nhân tăng ALĐMP, diện tích nhĩ phải cũng vậy 17,57 ± 2,23mm so với 13,33 ± 1,14mm ở bệnh nhân không có tăng ALĐMP. Tăng áp phổi ở các bệnh nhân đang điều trị Covid đa phần là ở mức độ nhẹ 85,7%, mức độ vừa và nặng chỉ chiếm tỷ lệ nhỏ 10,7% và 3,6%, chủ yếu ở khu vực bệnh nặng 78,6%, khu vực thoát hồi sức ít hơn chỉ có 21,4%. Bệnh nhân có tăng ALĐMP cho thấy có số lượng bạch cầu cao 16,21 ± 7,19 K/µL, D-Dimer cao 4508 ± 7208 ng/mL, Ferritin cao 1163 ± 738 ng/mL, CRP cao 111,4 ± 77,9 mg/L K/µL so với nhóm không có tăng ALĐMP. Kết luận: Siêu âm tim là phương pháp đơn giản, nhanh chóng giúp phát hiện, theo dõi và đánh giá tình trạng tăng áp phổi trong quá trình điều trị bệnh nhân COVID-19. ABSTRACT EVALUATION OF PULMONARY ARTERY PRESSURE INDEX ON ECHOCARDIOGRAPHY IN PATIENTS WITH COVID-19 Objectives: Evaluation of pulmonary artery pressure in moderate and severe Covid-19 patients. Clinical and subclinical characteristics in moderate and severe Covid-19 patients with or without pulmonary arterial hypertension. Methods: A cross - sectional descriptive study was performed on 200 Covid-19 patients who were treated in the recovery and critical areas of the COVID-19 Intensive care center of Hue Central Hospital in Ho Chi Minh City from August 12, 2021 to November 15, 2021. Results: The mean age in the study group was 57.38 ± 17.62. The time of onset was 6.92 ± 3.9 days. Underechocardiographic assessment, 28 (14%) patients showed an increase of PAP with an average age of 67.04 ± 13.50, which was higher than the group without an increase of PAP of 55.8 ± 17.75 and had comorbidities more often than diabetes (35.7%), hypertension (50%), CVD (6%), and BMI was also higher than 26.02 ± 3.68. The mean increase of PAP was 44.50 ± 8.19 mmHg, TAPSE in patients with increased PAP was 19.96 ± 2.36 lower than in patients without an increase of 25.51 ± 1.19. The medial and longitudinal basal diameters of the right ventricle were both significantly higher in patients with increased PAP, as was the area of the right atrium 17.57 ± 2.23 mm compared with 13.33 ± 1.14 mm in patients without increased PAP. Pulmonary arterial hypertension in COVID-19 patients is mostly mild at 85.7%, moderate and severe only account for a small proportion of 10.7% and 3.6%, mainly in severe illness areas. 78.6%, less in the recovery area with 21.4%. Patients with increased PAP showed a high white blood cell count of 16.21 ± 7.19 K/µL, a high D-Dimer 4508 ± 7208 ng/mL, a high Ferritin 1163 ± 738 ng/mL, a high CRP of 111.4 ± 77.9 ng/mL compared with the group without increased PAP. Conclusion: Echocardiography is a simple and quick modality to detect, monitor and evaluate pulmonary hypertension during the treatment of COVID-19 patients. Key words: SARS-CoV-2, COVID-19, Pulmonary arterial pressure.

Results of aortopulmonary collateral arteries coil embolization in pre-fontan patients

Background: Aortopulmonary collateral arteries (APCAs) are common pulmonary blood supply in the group of congenital heart disease with functionally single ventricle. APCAs causes loss of aortic outflow, increase in pulmonary arterial hydrostatic pressure, reducing blood flow from the SVC and IVC to the pulmonary artery (in patients after Glenn and Fontan operations). Therefore, the closure of APCAs is vital in the management of single ventricle patients before and during Fontan operation. The technique of percutaneous APCAs occlusion with coils is a new, effective and better method of control of APCAs, excluding the need for surgical ligation of the APCAs.. Objectives: To evaluate results of aortopulmonary collateral arteries coil embolization in pre-fontan patients Methods: This is the descriptive clinical and retrospective study Result: 29 patients with average age of 7.9 underwent cardiac catheterization with APCAs coil embolization successfully before the Fontan surgery. Complication rate was very low. This method effectively reduced mean pulmonary artery pressure with statistical significance. The results of Fontan surgery of this group were better than that in other studies in the rate of diaphragmatic paralysis and chylous effusion Conclusions: The technique of percutaneous APCAs occlusion with coils before Fontan surgery is safe, effective in reducing mean pulmonary artery pressure and improving results of Fontan surgery.

Poor Tricuspid Regurgitation Signal on Echocardiogram: How Does It Correlate with Pulmonary Artery Pressure as Measured by Right Heart Catheterization?

BackgroundTricuspid Regurgitation (TR) gradient on echocardiogram is used to approximate pulmonary artery pressure (PAP) on echocardiography. A common dilemma is encountered when PAP measurement is indeterminate due to poor TR signal. We hypothesized that patients with poor TR signal would be unlikely to have pulmonary hypertension (PH) on right heart catheterization (RHC). MethodsWe performed a retrospective analysis of 141 patients who underwent RHC and had a corresponding echocardiogram showing poor TR signal within 2 months of RHC. A cutoff of 25 mm Hg was used as the upper limit of normal to define PH. ResultsFifty percent of patients had mean PAP (mPAP) greater than 25 mm Hg. 82% of values were 35 mm Hg or below. ConclusionsPoor TR signal does not rule out PH but may indicate lower likelihood of severe PH.

Exercise-Induced Pulmonary Hypertension: How to Define, Diagnose, and Treat At-Risk Patients

Introduction Pulmonary hypertension is a devastating disease with a rapid progression of symptoms leading to high patient mortality. It is characterized by high blood pressure in the pulmonary vasculature and poor pulmonary perfusion, resulting in patient fatigue, dyspnea, and syncope, especially upon physical exertion. A sub-clinical form of pulmonary hypertension also exists which is referred to as exercise induced pulmonary hypertension, where patients display normal resting hemodynamic properties but abnormal pulmonary responses to exercise. Discussion Recent evidence suggests early intervention and treatment of pulmonary hypertension can improve patient outcomes. However, there is a lack of clinical evidence supporting effective treatments for exercise induced pulmonary hypertension (EIPH), arguably the earliest stage of pulmonary hypertension. This is due in part to the removal of EIPH from official guidelines such as the European Respiratory Society in 2008. EIPH was removed from clinical guidelines due to a lack of consensus on the definition and standardized testing procedures for diagnosing EIPH. Emerging evidence suggests that exercise testing following a standardized protocol of stress echocardiography or right heart catheterization of patients may allow for the classification of EIPH as a mean pulmonary artery pressure/cardiac output slope > 3 mmHg/L/min, and/or mean pulmonary artery pressure > 30 mmHg with a pulmonary vascular resistance > 3 Wood Units. Conclusion Providing evidence for a consensus definition of EIPH, along with a validated, standardized testing procedure, will hopefully foster the progression of research on EIPH and further the development of treatments and improve patient outcomes for people with pulmonary hypertension.

A gray zone in the literature: indications, options, and outcomes for surgical repair of pulmonary artery aneurysms

Pulmonary artery aneurysms are rare. They are characterised by an aneurysmatic dilatation of the pulmonary vascular bed, including the main pulmonary artery or the accompanying pulmonary artery branches. Increases in pulmonary flow and pulmonary artery pressure increase the risk of rupture: when these conditions are detected, surgical intervention is necessary. This study is a retrospective analysis of 33 patients treated in our paediatric cardiac surgery clinic from 2012 to 2020. Aneurysms and pseudoaneurysms in patients who were patched for right ventricular outflow tract reconstruction and corrected with a conduit were excluded from the study. Seventeen (51.5%) of the patients included in the study were female and 16 (48.5%) were male. The patients were aged between 23 and 61 years (mean 30.66 ± 12.72 years). Graft interpositions were performed in 10 patients (30.3%) and pulmonary artery plications were performed in 23 patients (69.7%) to repair aneurysms. There was no significant difference in mortality between the two groups (p > 0.05). Pulmonary artery aneurysm interventions are safe, life-saving treatments that prevent fatal complications such as ruptures, but at present there is no clear guidance regarding surgical timing or treatment strategies. Pulmonary artery interventions should be performed in symptomatic patients with dilations ≥5 cm or asymptomatic patients with dilations ≥8 cm; pulmonary artery pressure, right ventricular systolic pressure, and pulmonary artery aneurysm diameter must be considered when planning surgeries, their timing, and making decisions regarding indications. Experienced surgical teams can achieve satisfactory results using one of the following surgical techniques: reduction pulmonary arterioplasty, plication, or graft replacement.