1,721,190 research outputs found
Confirmation of survival prediction based on 2022 ESC/ERS pulmonary hypertension guidelines new haemodynamic thresholds
No full textIn the past decades, different haemodynamic definitions of pulmonary hypertension (PH) have been proposed and based on studies assessing the upper limit of normal pulmonary arterial pressure (PAP) in healthy subjects,1–3 and by studies investigating the prognostic relevance of increased PH.4–7 Despite the large interest in this topic, specific studies validating the reliability of the different definitions are lacking
Extracorporeal cardiopulmonary support in acute high-risk pulmonary embolism: Still waiting for solid evidence
No full textThis editorial refers to ‘Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases’†, by N.Meneveau et al., onpage 4196
Evaluation of pulmonary arterial hypertension.
No full textAbstract
PURPOSE OF REVIEW:
Pulmonary arterial hypertension (PAH) is defined as a group of diseases characterized by a progressive increase of pulmonary vascular resistance leading to right ventricular failure and premature death. The purpose of this review is to analyze the current knowledge of the evaluation of PAH patients.
RECENT FINDINGS:
Recently, the diagnostic approach has been more clearly defined according to the new clinical classification and with consensus reached on algorithms of various investigative tests and procedures that exclude other causes and ensure an accurate diagnosis of PAH. The diagnostic procedures include clinical history and physical examination, ECG, chest radiography, transthoracic Doppler echocardiography, pulmonary function tests, arterial blood gases, ventilation and perfusion lung scan, high-resolution CT of the lung, contrast-enhanced spiral CT of the lung and pulmonary angiography, blood tests and immunology, abdominal ultrasound scan, exercise capacity assessment, and hemodynamic evaluation.
SUMMARY:
Invasive and noninvasive markers of disease severity, either biomarkers or physiologic parameters and tests that can be widely applied, have been proposed to reliably diagnose PAH and monitor the clinical course
Progressi nel trattamento delle malattie della circolazione polmonare
No full textMultiple progresses have been achieved in pulmonary vascular diseases in the last decades, including the areas of pulmonary hypertension and pulmonary thromboembolic disease. The increase in knowledge has been accomplished in pathophysiological, clinical and treatment domains and has included as examples the discovery of gene mutations related to the hereditary forms of pulmonary arterial hypertension and the proposals of personalized treatment algorithms in patients with acute pulmonary embolism, chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension, validated in this specific area by more than 45 randomized controlled trials. The diagnostic processes have been refined, increasing the awareness that appropriate and precise diagnosis is essential for the optimal treatment strategy. The drugs approved for pulmonary arterial hypertension are recommended in this group and in specific patients with chronic thromboembolic pulmonary hypertension but are contraindicated in patients with pulmonary hypertension due to left heart and lung diseases. In pulmonary vascular diseases, the therapy cannot be considered as a simple prescription of medications and interventions but is a complex strategy which includes baseline patients' risk stratification, initial therapy, long-term follow-up and treatment adjustments when required. Today, computed tomography pulmonary artery angiography is the gold standard for diagnosis in both acute pulmonary embolism and chronic thromboembolic pulmonary hypertension. In this last condition, the combination with data derived from the right heart catheterization and the traditional pulmonary artery angiography, allows to a team of experts to decide if the patient is a candidate to surgical pulmonary endarterectomy or to percutaneous pulmonary artery balloon angioplasty which may improve symptoms, quality of life and prognosis
Early invasive strategy (< 24 hours) in patients with acute coronary syndromes: Weighing the evidence
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An overview of the 6th World Symposium on Pulmonary Hypertension
No full textState of the art summary on diagnosis, prognosis, therapy and future perspectives of pulmonary hypertensio
Balloon pulmonary angioplasty in patients with CTEPH
No full textThe only curative treatment currently available for chronic thromboembolic pulmonary hypertension (CTEPH) is surgical pulmonary endoarterectomy (PEA). However, several patients may have high risk factors for surgery, or a peripheral disease not amenable to surgical treatment; or else a residual pulmonary hypertension after PEA. Balloon pulmonary angioplasty (BPA) was recently developed to offer an alternative treatment for these patients. Extensive data has since confirmed the efficacy and relative safety of this procedure. However, there are several technical issues that have yet to be resolved. In addition, many cardiologists and pneumologists still know very little about the procedure itself and its potential. Exploring the clinical indications and technical aspects of BPA, this book offers a valuable reference guide for all those who would like to introduce or improve a BPA program, and for all those whose work involves treating this complex patient population
Pulmonary Arterial Hypertension: Combination Therapy in Practice
No full textCombination therapy is now regarded as the standard of care in pulmonary arterial hypertension (PAH) and is becoming widely used in clinical practice. Given the inherent complexities of combining medications, there is a need for practical advice on implementing this treatment strategy in the clinic. Drawing on our experience and expertise, within this review, we discuss some of the challenges associated with administration of combination therapy in PAH and how these can be addressed in the clinic. Despite their differing modes of action, all of the currently available classes of PAH therapy induce systemic vasodilation. In initial combination therapy regimens in particular, this may lead to additive side effects and reduced tolerability compared with monotherapy. However, approaches such as staggered treatment initiation and careful up-titration may reduce the risk of additive side effects and have been used successfully in clinical practice, as well as in clinical trials and registry studies. When combination therapy regimens are initiated, it is important that patients are monitored regularly for the presence of any side effects and that these are then managed promptly and appropriately. For patients to attain the best outcomes, the treatment regimen must be tailored to the individual’s specific needs, including consideration of PAH etiology, the presence of comorbidities and concomitant medications beyond PAH therapy, and patient lifestyle and preference. It is also vital that individuals are managed at expert care centers, where multidisciplinary teams have a wealth of specialist experience in treating PAH patients. Adherence to therapy can be a concern in a chronic disease such as PAH, and as treatment regimens become increasingly complex, maintaining good treatment adherence may become more challenging. It is essential that patients are educated on the importance of treatment adherence, and this is a key role for the PAH nurse specialist. For patients who are managed carefully in expert centers with combination therapy regimens that are tailored to their specific needs, a favorable benefit–risk ratio can be achieved. With individual and carefully managed approaches, the excellent results observed with combination therapy in clinical trials can be obtained by patients in a real-world setting
Pulmonary endarterectomy: is there an alternative to profound hypothermia with cardiocirculatory arrest?
No full textThe current surgical strategy for pulmonary endarterectomy (PEA) involves the
use of extracorporeal circulation and hypothermic circulatory arrest (HCA). The
aim of the present study was to test the feasibility of a different strategy of
extracorporeal circulation, which could prevent bronchial back bleeding and
allow a bloodless operating field, avoiding the risks associated with HCA in
patients undergoing pulmonary endarterectomy. Between June 2004 and September
2005, eight patients underwent PEA without HCA. We introduced a double venting
of the left heart sections, utilizing two cannulas placed in the left ventricle
and atrium. Both vent cannulas are connected with vacuum device to prevent
back-bleeding and left heart distension from the large amount of bronchial flow.
We were able to perform pulmonary endarterectomy avoiding circulatory arrest and
deep hypothermia without sacrificing the effectiveness of the procedure. The
initial encouraging results have convinced us to apply systematically this
technique in the cases operated in our center, even though further
investigations are necessary to fully examine this techniqu
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