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

Based on the relation between the impedance to right ventricular ejection and ejection fraction of the right ventricle (RVEF) we tested the hypothesis that radionuclide RVEF correlates inversely with pulmonary artery pressure and allows the noninvasive prediction of pulmonary hypertension. A recently developed improved equilibrium right ventricular blood pool imaging technique using ultrashort-lived krypton-81m and simultaneous right heart catheterization were combined for assessment of right ventricular systolic performance in relation to right ventricular loading in a heterogeneous group of cardiopulmonary disorders. The study group included 9 patients with pulmonary artery hypertension secondary to left ventricular dysfunction, 5 with primary pulmonary hypertension, 5 with corrected tetralogy of Fallot, and 10 normal subjects. Linear regression analysis between radionuclide RVEF and simultaneously recorded hemodynamic measurements of right ventricular loading revealed a significant inverse correlation with mean PA pressure (r = -0.87; P less than 0.001), with total pulmonary resistance index (r = -0.81; P less than 0.001) and with pulmonary vascular resistance index (r = -0.78, P less than 0.01). The sensitivity and specificity of a resting RVEF less than 40% to indicate pulmonary hypertension (mean PA pressure greater than 20 mmHg) were 71% and 100%, respectively; positive and negative predictive values were 100% and 80%, respectively. Thus, radionuclide RVEF as a parameter of right ventricular systolic performance is predominantly dependent on right ventricular afterload and has the potential for the noninvasive prediction of pulmonary hypertension in a heterogeneous group of cardiopulmonary disorders.
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PMID:Right ventricular ejection fraction from equilibrium krypton-81m blood pool scans: a noninvasive predictor of pulmonary arterial hypertension. 358 88

Records of 34 patients with established causes of pulmonary arterial hypertension were retrospectively reviewed. The ventilation-perfusion scans were blindly classified according to standardized criteria as normal or high, low, or intermediate probability of pulmonary embolism as the cause of pulmonary arterial hypertension. Twelve of 13 patients with primary pulmonary hypertension had normal or low-probability scans, but the perfusion pattern was not helpful in distinguishing between histologic subtypes. All eight patients with large-vessel thromboembolic hypertension had high-probability scans; however, three of 13 patients with nonembolic secondary pulmonary hypertension also had high-probability scans. While a normal or low-probability scan excluded proximal pulmonary emboli as a cause of pulmonary hypertension, a high-probability scan may be associated with a variety of other nonembolic causes of secondary pulmonary hypertension.
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PMID:Pulmonary arterial hypertension: value of perfusion scintigraphy. 361 69

A 50-year-old woman with unexplained pulmonary hypertension had normal findings on six-view lung perfusion scan prior to open lung biopsy. The biopsy demonstrated old organized thrombi. The patient expired and autopsy disclosed extensive thromboembolic disease, both old and new. A six-view lung scan may not distinguish primary pulmonary hypertension from thromboembolic hypertension when diffuse symmetrical thrombi are present. Under such conditions, when invasive diagnostic procedures have an unacceptable morbidity, empiric anticoagulation should be considered.
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PMID:Normal lung perfusion scan with extensive thromboembolic disease. 362 37

We have analyzed the safety of doing pulmonary angiography in 67 consecutive patients with moderate-to-severe primary pulmonary hypertension or hypertension secondary to chronic thromboembolic occlusions of the pulmonary arteries. The average (+/- SD) pulmonary arterial systolic and diastolic pressures were 74 +/- 19 and 34 +/- 10 mm Hg, respectively. Fourteen patients had a right ventricular end-diastolic pressure of 20 mm Hg or more. Selective left and right main pulmonary artery injections were done using ionic contrast agents in 56 patients and nonionic contrast agents in 11. No major rhythm disturbances or systemic hypotension requiring therapy occurred, and there were no deaths. Thrombotic occlusions of the pulmonary arteries were identified in 52 patients and confirmed in all 42 of those who had a thromboendarterectomy. At autopsy, 3 of the 15 patients who had normal angiograms were found not to have had thrombotic occlusions. We conclude that pulmonary angiography can be done safely despite the presence of severe pulmonary hypertension and right ventricular failure, and that the procedure leads to the identification of chronic, major-vessel thromboembolic pulmonary hypertension that may be alleviated by thromboendarterectomy.
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PMID:Pulmonary angiography in severe chronic pulmonary hypertension. 363 91

Selected cases of severe primary pulmonary arterial hypertension and associated pulmonary vascular disease have been related to the oral ingestion of aminorex fumarate, an anorexigen obviously responsible for an epidemic of primary pulmonary hypertension in Western Europe between 1967 and 1970. This report describes a fifteen year follow-up of a female patient with aminorex fumarate related pulmonary hypertension and the uncommon finding of the formation of an excessive fusiform pulmonary trunk aneurysm in the late stage of the disease process. The progressive clinical course was followed by serial chest x-ray films and repeat right heart catheterization. The diagnosis of a main stem pulmonary artery aneurysm was noninvasively established by two-dimensional echocardiography and confirmed by contrast-enhanced computed tomography and radionuclide blood pool imaging. The patient is alive, thus no histologic correlate of this entity is available at present.
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PMID:Development of pulmonary aneurysm in primary pulmonary hypertension: a case report. 371 97

Four cases of pulmonary veno-occlusive disease are described. Two patients, who were brothers, had respiratory tract infections. The third patient had chronic active hepatitis and coeliac disease suggesting an abnormality of the immune system; the fourth patient had no obvious cause but presented initially with systemic hypertension. Three of the cases had been diagnosed initially as primary pulmonary hypertension either on open lung biopsy or clinically. In all cases the pulmonary arteries were abnormal with medial hypertrophy, intimal fibrosis and, in some cases, thrombosis in elastic pulmonary arteries. These findings suggest that pulmonary veno-occlusive disease is not confined to veins and should be considered as a widespread pulmonary vascular disease. The range of aetiological factors indicate that it should not be considered as a single disease entity.
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PMID:Pulmonary veno-occlusive disease. A report of four cases. 378 91

The favourable effect of long-term (36 months) treatment with nifedipine in a case of primary pulmonary hypertension is described. While clinical improvement was quick, pulmonary hemodynamic data were unchanged after 3 months of treatment, when acute administration of the drug showed a significant fall in pulmonary resistances. After 16 months of treatment a consistent decrease of pulmonary artery pressure was found, suggesting a selective favourable effect of the drug on the pulmonary circulation. The association with systemic arterial hypertension, whose onset was near contemporaneous with pulmonary hypertension, might indicate a common vasoconstrictive pathogenetic mechanism.
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PMID:Long-term favourable effect of nifedipine in primary pulmonary hypertension. Report of a case with hemodynamic evaluation after 3 and after 16 months and with clinical follow-up during 36 months. 383 Jul 69

Of eight patients with pulmonary arterial hypertension, final diagnosis established by autopsy or angiography, four had primary hypertension and four hypertension from thromboembolism. The perfusion lung scan was distinctly different in the two groups. The lung scan in primary pulmonary hypertension was associated with nonsegmental, patchy defects of perfusion, while in thromboembolic hypertensives it was characterized by segmental and/or lobar defects of perfusion with or without subsegmental defects. The perfusion lung scan is a valuable, noninvasive study in the evaluation of the patient with pulmonary hypertension of undetermined cause and in the exclusion of occult large-vessel pulmonary thromboembolism.
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PMID:Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension. 387 Nov 43

Differentiation of thrombi from slow flow in the pulmonary arteries, sometimes observed in the presence of pulmonary arterial hypertension, can be equivocal. Magnetic resonance (MR) imaging was performed in a patient with chronic pulmonary thromboembolism and pulmonary arterial hypertension using an electrocardiographically gated technique that allowed visualization of the pulmonary arteries at the end of diastole and multiple times during systole. These images were compared with those of a patient with primary pulmonary hypertension and those of healthy subjects. Thrombi were discrete structures, seen throughout the cardiac cycle on both the first and second spin-echo images, and decreased in signal intensity on the second image. Slow flow increased in signal intensity and changed in structure during the cardiac cycle and was seen best on the second image. MR may play an important role in excluding large central thrombi as the cause of pulmonary arterial hypertension. It is a noninvasive method for defining pulmonary arterial wall thickness and for direct visualization of chronic pulmonary thrombus.
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PMID:Central thrombi in pulmonary arterial hypertension detected by MR imaging. 394 Mar 86

Two patients with left recurrent laryngeal nerve paralysis in association with pulmonary artery hypertension are described. One had primary pulmonary hypertension and the other had patent ductus arteriosus. The greatly dilated pulmonary artery in these patients resulted in compression of the left recurrent laryngeal nerve and produced a cardiovocal (Ortner's) syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography. In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension.
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PMID:Left recurrent laryngeal nerve palsy associated with primary pulmonary hypertension and patent ductus arteriosus. 397 79


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