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      Pulmonary Hypertension in Cardiac Surgery

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          Abstract

          Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented.

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          Survival in patients with primary pulmonary hypertension. Results from a national prospective registry.

          G D'Alonzo, R Barst, S. Ayres … (1991)
          To characterize mortality in persons diagnosed with primary pulmonary hypertension and to investigate factors associated with survival. Registry with prospective follow-up. Thirty-two clinical centers in the United States participating in the Patient Registry for the Characterization of Primary Pulmonary Hypertension supported by the National Heart, Lung, and Blood Institute. Patients (194) diagnosed at clinical centers between 1 July 1981 and 31 December 1985 and followed through 8 August 1988. At diagnosis, measurements of hemodynamic variables, pulmonary function, and gas exchange variables were taken in addition to information on demographic variables, medical history, and life-style. Patients were followed for survival at 6-month intervals. The estimated median survival of these patients was 2.8 years (95% Cl, 1.9 to 3.7 years). Estimated single-year survival rates were as follows: at 1 year, 68% (Cl, 61% to 75%); at 3 years, 48% (Cl, 41% to 55%); and at 5 years, 34% (Cl, 24% to 44%). Variables associated with poor survival included a New York Heart Association (NYHA) functional class of III or IV, presence of Raynaud phenomenon, elevated mean right atrial pressure, elevated mean pulmonary artery pressure, decreased cardiac index, and decreased diffusing capacity for carbon monoxide (DLCO). Drug therapy at entry or discharge was not associated with survival duration. Mortality was most closely associated with right ventricular hemodynamic function and can be characterized by means of an equation using three variables: mean pulmonary artery pressure, mean right atrial pressure, and cardiac index. Such an equation, once validated prospectively, could be used as an adjunct in planning treatment strategies and allocating medical resources.
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            The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials.

            Michael Altman, Thomas K F Schulz, D Moher … (2001)
            To comprehend the results of a randomised controlled trial (RCT), readers must understand its design, conduct, analysis, and interpretation. That goal can be achieved only through total transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by use of a checklist and flow diagram. The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, and Discussion. The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect, or because the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of a trial (enrollment, intervention allocation, follow-up, and analysis). The diagram explicitly shows the number of participants, for each intervention group, included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have done an intention-to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
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              Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure.

              Norbert F. Voelkel, Robert Quaife, Leslie Leinwand … (2006)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Cardiol Rev
                Journal ID (publisher-id): CCR
                Title: Current Cardiology Reviews
                Publisher: Bentham Science Publishers Ltd.
                ISSN (Print): 1573-403X
                ISSN (Electronic): 1875-6557
                Publication date (Print): February 2010
                Volume: 6
                Issue: 1
                Pages: 1-14
                Affiliations
                []Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
                Author notes
                [* ]Address correspondence to this author at the Institut de Cardiologie de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada; Tel: (514) 376-3330; Ext: 3732; Fax: (514) 376-8784; E-mail: andre.denault@ 123456umontreal.ca
                Article
                Publisher ID: CCR-6-1
                DOI: 10.2174/157340310790231671
                PMC ID: 2845789
                PubMed ID: 21286273
                SO-VID: 58daba89-c50f-44fd-8524-58ac25941852
                Copyright © © 2010 Bentham Science Publishers Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 December 2008
                Date revision received : 20 March 2009
                Date accepted : 31 March 2009
                Categories
                Subject: Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pulmonary hypertension,cardiac surgery,pharmacological therapy.
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pulmonary hypertension, cardiac surgery, pharmacological therapy.

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