HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andrea M. D’Armini Mario Viganò Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Armini, A. M. Articles by Viganò, M. Search for Related Content PubMed PubMed Citation Articles by D’Armini, A. M. Articles by Viganò, M. Related Collections Cardiac - physiology Cardiac - other Congestive Heart Failure Related Article

J Thorac Cardiovasc Surg 2007;133:162-168
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reverse right ventricular remodeling after pulmonary endarterectomy

^a Division of Cardiac Surgery, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
^b Division of Cardiology, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
^c Institute of Radiology, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
^d Biostatistics Unit, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 24, 2006; revisions received August 27, 2006; accepted for publication August 31, 2006.

^_* Address for reprints: Andrea M. D’Armini, MD, Division of Cardiac Surgery, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Piazzale Golgi 19, 27100 Pavia, Italy. (Email: darmini{at}smatteo.pv.it).

OBJECTIVES: We sought to evaluate the capability of the right ventricle to regain normal morphology and function after pulmonary endarterectomy, to correlate right ventricular reverse remodeling with functional status, and to identify independent predictors of clinical failure after surgical intervention.

METHODS: From December 2000 through August 2003, 45 patients underwent isolated pulmonary endarterectomy. Morphology and function of the right ventricle were studied by using a combination of right heart catheterization, cardiac magnetic resonance, and transthoracic echocardiography. Functional status was evaluated by using New York Heart Association class. Full preoperative data were available for 37 candidates. All patients were evaluated before discharge, at 3 months, and at 1, 2, and 3 years postoperatively using the same modalities.

RESULTS: Immediately after surgical intervention, right ventricular cavitary dimensions decreased significantly, and tricuspid regurgitation radically improved. Right ventricular ejection fraction and functional status improved and right ventricular hypertrophy reversed over a longer time period. Higher ventricular dimensions and lower ejection fraction of the right ventricle were associated with poorer functional status at any time postoperatively. At discharge, pulmonary vascular resistance of greater than 509 dyne · sec · cm^–5 and right ventricular ejection fraction of 24% or less predicted clinical failure at 12 months’ follow-up.

CONCLUSIONS: After pulmonary endarterectomy, the right ventricle recovers and maintains normal architecture and function over time, regardless of the severity of preoperative disease. Accurate preoperative evaluation of the hemodynamics and anatomy of the thromboembolic lesions are mandatory. If pulmonary endarterectomy is not expected to decrease pulmonary vascular resistance to less than 509 dyne · sec · cm^–5, indication for surgical intervention needs to be carefully evaluated.

Related Article

Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 168. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S Giusca, V Dambrauskaite, C Scheurwegs, J D'hooge, P Claus, L Herbots, M Magro, F Rademakers, B Meyns, M Delcroix, et al. Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring Heart, February 1, 2010; 96(4): 281 - 288. [Abstract] [Full Text] [PDF]

				X. Jais, A. M. D'Armini, P. Jansa, A. Torbicki, M. Delcroix, H. A. Ghofrani, M. M. Hoeper, I. M. Lang, E. Mayer, J. Pepke-Zaba, et al. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2127 - 2134. [Abstract] [Full Text] [PDF]

				A. G. Corsico, A. M. D'Armini, I. Cerveri, C. Klersy, E. Ansaldo, R. Niniano, E. Gatto, C. Monterosso, M. Morsolini, S. Nicolardi, et al. Long-term Outcome after Pulmonary Endarterectomy Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 419 - 424. [Abstract] [Full Text] [PDF]