Objectives: Chronic thrombo-embolic pulmonary arterial hypertension causes right ventricular failure. We studied the effect of pulmonary endarterectomy on the time course of restoration of right ventricular (RV) remodeling.
Methods: In 22 patients (60.3 yr ± 12.8; F/M = 8/14; NYHA III n = 17 - NYHA II n = 5) echocardiography, magnetic resonance imaging (MRI) and catheterization were performed before and after pulmonary endarterectomy (PEA) to evaluate restoration of right ventricular function (pulmonary artery pressure (PAP), right ventricular end-diastolic volume (EDV); right ventricular ejection fraction (EF); septal inversion).
Results: One patient died 14 days after PEA due to persistent RV failure in combination with pneumonia. Pulmonary vascular resistance and cardiac index improved immediately after PEA to remain stable up to 6 months [Fig 1]. PAP, EF, EDV and septal inversion followed the same time course after PEA [Fig 2]. The decrease in PVR after six months correlated well with the increase in EF at 6 months (r = -0.75, p = 0.027).
Conclusions: PEA resulted in a substantial haemodynamic improvement up to six months after PEA. We demonstrated that the observed RV remodeling (RV dilatation, septal inversion) reversed after PEA. The increase in RV function correlated with the decrease in PVR after PEA at six months.
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