TY - JOUR
T1 - Selective pulmonary vasodilation improves ventriculovascular coupling and gas exchange in a patient with unrepaired single-ventricle physiology
AU - Rischard, Franz P.
AU - Vanderpool, R.
AU - Jenkins, I.
AU - Dalabih, M.
AU - Colombo, J.
AU - Lax, D.
AU - Seckeler, M.
N1 - Funding Information:
Source of Support: There were no direct funding sources for this project. FR is funded in other research projects by U01 grant HL125208-01 from the National Heart, Lung, and Blood Institute and by the United Therapeutics Corporation.
Publisher Copyright:
© 2015 by the Pulmonary Vascular Research Institute. All rights reserved.
PY - 2015/4/29
Y1 - 2015/4/29
N2 - We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.
AB - We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.
KW - Congenital heart disease
KW - Pulmonary hypertension
KW - Treatment effect
KW - Ventricular/vascular coupling hemodynamics
UR - http://www.scopus.com/inward/record.url?scp=85026341310&partnerID=8YFLogxK
U2 - 10.1086/681269
DO - 10.1086/681269
M3 - Article
C2 - 26064468
AN - SCOPUS:85026341310
SN - 2045-8932
VL - 5
SP - 407
EP - 411
JO - Pulmonary Circulation
JF - Pulmonary Circulation
IS - 2
ER -