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Query: UMLS:C0020538 (hypertension)
170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The usefulness of doppler-echocardiography for the assessment of pulmonary arterial hypertension in patients with chronic respiratory failure was evaluated in 24 consecutive patients with chronic obstructive lung disease. Seventeen of these 24 patients (71 p. 100) who had tricuspid valve regurgitation analysable by the continuous wave doppler technique were selected as study group; they included 15 men and 2 women aged from 33 to 78 years (mean 63 years). The highest maximum velocity value (method A) or the maximum velocity value averaged on several cycles (method B) of the tricuspid regurgitation jet was used to calculate the right ventriculo-atrial pressure gradient, using Bernouilli's equation. Right atrial pressure was determined by three methods: haemodynamic measurement, clinical evaluation or attribution of an arbitrary 10 mmHg value. The pulsed doppler study of the pulmonary ejection flow included measurement of the acceleration time and calculation of the acceleration time/ejection time ratio. The usual echocardiographic parameters were measured. Catheterization was performed 2.5 days on average after the doppler study. Correlations between doppler examination and catheterization to evaluate the right ventricular systolic pressure were significant (p less than 0.001) and better with method B than with method A. Depending on the method employed to evaluate the right atrial pressure, the correlation coefficients obtained with method B were: 0.93 (haemodynamic measurement), 0.91 (clinical evaluation) and 0.88 (arbitrary value of 10 mmHg). The right ventricular systolic pressure evaluated by doppler ultrasound using method B and by clinical evaluation of the right atrial pressure was 47 +/- 12 mmHg (22 to 70 mmHg), as against 51 +/- 13 mmHg (28 to 74 mmHg) measured by catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of pulmonary arterial hypertension by Doppler echocardiography in chronic respiratory insufficiency]. 251 Jun 78

Pulsed Doppler echocardiography of the inferior vena cava is an accurate method for the diagnosis of tricuspid regurgitation and impaired right ventricular compliance, two features of pulmonary hypertension. The purpose of this study was to assess the value of Doppler echocardiography of the inferior vena cava for the detection of pulmonary arterial hypertension in patients with chronic obstructive lung disease. Pulse Doppler echocardiography of the inferior vena cava and right heart catheterisation were performed in 29 patients with severe chronic obstructive lung disease. The mean pulmonary arterial pressure was 27 (10) mm Hg for the entire group; 62% of patients (18/29) had pulmonary arterial hypertension (mean pulmonary arterial pressure greater than 20 mm Hg). An adequate Doppler signal could be obtained in 25 of the 29 patients (86%). Pulsed Doppler echocardiography of the inferior vena cava gave normal results in 10 patients and disclosed tricuspid regurgitation in seven patients, impaired right ventricular compliance in seven patients, and both of these abnormalities in one patient. An abnormal Doppler echocardiogram of the inferior vena cava (tricuspid regurgitation or impaired right ventricular compliance, or both) predicted the presence of pulmonary arterial hypertension with a sensitivity of 87% and a specificity of 80%. These results suggest that pulsed Doppler echocardiography of the inferior vena cava may be a useful though imperfect method of detecting pulmonary arterial hypertension in patients with chronic obstructive lung disease.
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PMID:Detection of pulmonary hypertension by Doppler echocardiography of the inferior vena cava in chronic airflow obstruction. 276 38

A prospective study was performed in our center on 60% (n = 36) of patients with systemic lupus erythematosus (SLE) to determine the prevalence and severity of pulmonary hypertension. Twenty-six healthy subjects of similar age and sex served as controls. Pulmonary artery systolic pressure was calculated from the sum of the peak tricuspid insufficiency Doppler pressure gradient and an estimate of right atrial pressure based on inferior vena cava size and its degree of inspiratory collapse. Five patients with SLE (14%) had pulmonary hypertension, defined as pulmonary artery systolic pressure greater than 30 mm Hg. Cardiac indices determined by planimetry of biplane apical 2-dimensional echocardiographic images were low or normal in the patients with pulmonary hypertension implying increased pulmonary vascular resistance as the etiology for elevated pulmonary artery pressure. The mean pulmonary artery systolic pressure in patients with SLE was 25 +/- 10 mm Hg vs 20 +/- 2 in controls (p = 0.002). No control had a pulmonary artery systolic pressure greater than 23 mm Hg. Patients with pulmonary hypertension had a shorter duration of SLE and steroid therapy and a higher prevalence of cytotoxic treatment and Raynaud's phenomenon in comparison to those with normal pulmonary artery pressures. The prevalence of systemic hypertension, interstitial lung disease, pleurisy, pericarditis, cutaneous manifestations, arthritis, renal disease, central nervous system involvement, and hematologic abnormalities was similar in patients with SLE with normal and elevated pulmonary artery pressure. Our study suggests that pulmonary hypertension in SLE is common but usually mild.
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PMID:Pulmonary hypertension in systemic lupus erythematosus. 233 68

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.
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PMID:[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases]. 309 83

It is not known whether Doppler echocardiography can accurately follow changes in right-sided cardiac hemodynamics after a therapeutic intervention in patients with pulmonary artery (PA) hypertension. Therefore, Doppler measurements of the maximal velocity of the tricuspid regurgitant jet and the acceleration time of the PA velocity profile were obtained in 28 patients before and after pulmonary thromboendarterectomy for chronic thromboembolic PA hypertension. Doppler values were compared with hemodynamic variables obtained at cardiac catheterization. Postoperatively, decreases in mean PA pressure (50 +/- 14 to 28 +/- 8 mm Hg), transtricuspid systolic pressure difference (69 +/- 21 to 36 +/- 14 mm Hg) and Doppler measurement of the maximal velocity of the tricuspid regurgitant jet (4.1 +/- 0.7 to 2.7 +/- 0.5 m/s) were noted, while acceleration time increased (57 +/- 16 to 94 +/- 18 ms, all p less than 0.001) compared with preoperative values. For the population as a whole, the calculated systolic transtricuspid pressure difference determined from the maximal velocity of tricuspid regurgitation correlated well with the catheterization systolic transtricuspid pressure difference (r = 0.93, p less than 0.001) and the acceleration time correlated with mean PA pressure (r = -0.81, p less than 0.001). More importantly, the change in the maximal velocity of tricuspid regurgitation for postoperative patients was found to correlate with the change in catheterization systolic transtricuspid pressure difference (r = 0.82, p less than 0.001), while the change in acceleration time correlated weakly with the change in mean PA pressure (r = -0.41, p = 0.053).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Doppler assessment of changes in right-sided cardiac hemodynamics after pulmonary thromboendarterectomy. 336 63

Closed mitral valvotomy for rheumatic mitral stenosis was performed on 126 pregnant women (average duration of pregnancy c. 21 weeks), 91% of whom were in NYHA functional class III or IV. Associated functional tricuspid regurgitation was present in 47 (37%) of the women, and 102 (81%) had critical mitral stenosis (digitally assessed valve area less than 1 cm2). There was no surgical mortality. Postoperatively 84% of the women were in NYHA class I. Clinical evidence of pulmonary artery hypertension and tricuspid regurgitation regressed postoperatively in most patients. Full-term normal delivery was achieved in 82% of the pregnancies, with total fetal mortality 6%. There were no congenital abnormalities and the infants' progress was normal. At 5-year follow-up 86% of the women were in NYHA class I or II and at 10 years the figure was 60%. The restenosis rate was 2%/year and the late mortality 3.3%. Closed mitral valvotomy during pregnancy thus was safe and reliable, giving significant functional and clinical improvement without adversely affecting the fetus.
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PMID:Closed mitral valvotomy during pregnancy. A 20-year experience. 338 43

This paper presents a 51 year old black female with known hypertension and an acute illness characterized by aortic regurgitation, cerebrovascular insufficiency, renal insufficiency, aortic valvular insufficiency, mediastinal widening and other features characteristic of acute Type I aortic dissection. An unusual feature in this individual is dissection extending into the membranous septum of the heart and into the aorto-atrial space with large hematoma, which partially disrupted the conduction system as well as dislodging the tricuspid septal leaflet in such fashion that major tricuspid regurgitation was present and interfered with termination of cardiopulmonary bypass. This patient presents a very unusual complication of which we wish to inform the readers.
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PMID:Tricuspid incompetence resulting from retrograde aortic dissection. 365 43

Closed-chest trauma in a young man was followed by rupture of a right ventricular papillary muscle and bifascicular block. This produced signs and symptoms of tricuspid regurgitation and recurrent syncope. Treatment by valve replacement and pacemaker implantation was successful. Review of 30 cases of traumatic tricuspid regurgitation reveals that this patient had characteristic findings: adult onset of isolated tricuspid regurgitation, a history of trauma, right bundle branch block, and cardiomegaly without signs of left ventricular failure. In addition, right atrial hypertension of longstanding may produce cyanosis because of right-left shunting through a patent foramen ovale.
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PMID:Chronic tricuspid regurgitation and bifascicular block due to blunt chest trauma. 394 68

Despite recent renewed interest in the detection of tricuspid valve regurgitation by echocardiographic and Doppler techniques, little morphologic information is available on dysfunctioning tricuspid valves. This report describes 45 necropsy patients with clinical and morphologic evidence of pure (no element of stenosis) tricuspid regurgitation and provides morphometric observations (anular circumference, leaflet area) of the tricuspid valve useful in determining the etiology of pure tricuspid regurgitation. Of 45 patients, 24 (53%) had pure tricuspid regurgitation resulting from an anatomically abnormal valve (prolapse in 7, papillary muscle dysfunction in 6, rheumatic disease in 5, Ebstein's anomaly in 3, infective endocarditis in 2, carcinoid tumor in 1), and 21 (47%) had an anatomically normal valve with systolic pulmonary artery hypertension (cor pulmonale in 12, mitral stenosis in 9). Anular circumference was dilated (greater than 12 cm) in patients with various causes of pulmonary hypertension, floppy valve and Ebstein's tricuspid anomaly. Leaflet area was increased in floppy valve and Ebstein's anomaly. Of the 45 patients, 24 had pulmonary systolic artery pressure measurements available for correlation with tricuspid valve morphology. Pulmonary artery pressures accurately predicted morphologically normal from abnormal valves in 16 patients (89%). Morphologic overlap occurred in six patients with pulmonary pressures of 41 to 54 mm Hg. Of these six, the additional knowledge of normal or dilated anular circumference correctly separated valves with normal and abnormal leaflets.
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PMID:Etiology of pure tricuspid regurgitation based on anular circumference and leaflet area: analysis of 45 necropsy patients with clinical and morphologic evidence of pure tricuspid regurgitation. 395 62

We studied inferior vena cava contrast echocardiography after upper extremity injection in 70 subjects; 59 were patients and 11 were controls. Inferior vena cava contrast was seen in 35 patients and in 1 control. "A-wave synchronous pattern" of contrast appearance was observed in 13 patients and 1 normal subject. The pattern did not depend upon the height of right atrial a-wave pressure or the right ventricular (RV) end-diastolic pressure, but was related to the respiratory cycle. A "random pattern" of contrast appearance was seen in 3 patients with cardiac arrhythmia and normal right heart hemodynamics. One patient with ventricular premature beats showed both "a-wave synchronous" and "random" patterns. A "v-wave synchronous pattern" was found in 20 patients, of which 17 had tricuspid regurgitation. Persistence of inferior vena cava contrast correlated with the height of right atrial v-wave (r = 0.87, p less than 0.001) and the severity of tricuspid regurgitation estimated from RV cineangiography. The differences of RV systolic pressure and echocardiographic right ventricular dimension between the study patients with and without tricuspid regurgitation did not reach statistical significance. We conclude: the echocardiographic RV dimension and the degree of RV hypertension are not predictors for the presence of tricuspid regurgitation and its severity; inferior vena cava contrast echocardiography may be used to estimate the severity of tricuspid regurgitation.
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PMID:Assessment of right heart hemodynamics by contrast echocardiography. 648 Jan 61


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