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J Thorac Cardiovasc Surg 2007;133:58-64
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Reverse right ventricular remodeling after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: Utility of magnetic resonance imaging to demonstrate restoration of the right ventricle

Herre J. Reesink, MDa,1, J. Tim Marcus, PhDb, Igor I. Tulevski, MD, PhDc, Stuart Jamieson, MDd, Jaap J. Kloek, MDe, Anton Vonk Noordegraaf, MD, PhDf, Paul Bresser, MD, PhDa,*

a Department of Pulmonology of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
c Department of Cardiology of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
e Department of Cardiothoracic Surgery of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
b Department of Physics and Medical Technology of the Free University Medical Center, Amsterdam, The Netherlands
f Department of Pulmonology of the Free University Medical Center, Amsterdam, The Netherlands
d Department of Cardiothoracic Surgery of the University of California San Diego, San Diego, Calif.

Received for publication March 31, 2006; revisions received August 14, 2006; accepted for publication September 11, 2006.

* Address for reprints: P. Bresser, MD, PhD, Academic Medical Center, University of Amsterdam, Department of Pulmonology, F5-144, PO Box 22700, 1100 DE Amsterdam, the Netherlands. (Email: P.Bresser{at}amc.uva.nl).

OBJECTIVES: Pulmonary arterial hypertension causes right ventricular remodeling; that is, right ventricular dilatation, hypertrophy, and leftward ventricular septal bowing. We studied the effect of pulmonary endarterectomy on the restoration of right ventricular remodeling in patients with chronic thromboembolic pulmonary hypertension by magnetic resonance imaging.

METHODS: In 17 patients with chronic thromboembolic pulmonary hypertension, before and at least 4 months after pulmonary endarterectomy, and in 12 healthy controls, right ventricular and left ventricular end-diastolic and end-systolic volumes (milliliters) and mass (grams per meter squared) and leftward ventricular septal bowing (1 divided by the radius of curvature in centimeters) were determined by magnetic resonance imaging.

RESULTS: Before pulmonary endarterectomy, right ventricular volumes, left ventricular end-diastolic volume, right ventricular mass, and leftward ventricular septal bowing differed significantly between patients with chronic thromboembolic pulmonary hypertension and healthy control subjects. After pulmonary endarterectomy, pulmonary hemodynamics improved, and right and left ventricular volumes and leftward ventricular septal bowing normalized; right ventricular mass decreased significantly (46 ± 14 to 31 ± 9 g · m–2, P< .0005), but did not completely normalize. The change in total pulmonary resistance correlated with the change in right ventricular ejection fraction (r = 0.50, P < .05), right ventricular mass (r = 0.63, P < .01), and leftward ventricular septal bowing (r = 0.50, P < .05).

CONCLUSIONS: Right ventricular remodeling was observed in patients with chronic thromboembolic pulmonary hypertension and restored almost completely after a hemodynamically successful pulmonary endarterectomy. Magnetic resonance imaging is a valuable tool to evaluate cardiac remodeling and function in patients with chronic thromboembolic pulmonary hypertension, both before and after pulmonary endarterectomy.

Abbreviations and Acronyms CTEPH = chronic thromboembolic pulmonary hypertension; EDV = end-diastolic volume; EF = ejection fraction; ESV = end-systolic volume; LV = left ventricle (ventricular); LVSB = leftward ventricular septal bowing; mPAP = mean pulmonary artery pressure; MRI = magnetic resonance imaging; PEA = pulmonary endarterectomy; RV = right ventricle (ventricular); TPR = total pulmonary resistance




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