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

Reesink, Herre J.; Marcus, J. Tim; Tulevski, Igor I.; Jamieson, Stuart; Kloek, Jaap J.; Noordegraaf, Anton Vonk; Bresser, Paul

doi:10.1016/j.jtcvs.2006.09.032

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 1 , Pages 58-64, January 2007

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, MD
- Department of Pulmonology of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Herre J. Reesink was supported by a grant from Actelion Pharmaceuticals Nederland bv, Woerden, The Netherlands.
J. Tim Marcus, PhD
- Department of Physics and Medical Technology of the Free University Medical Center, Amsterdam, The Netherlands
Igor I. Tulevski, MD, PhD
- Department of Cardiology of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Stuart Jamieson, MD
- Department of Cardiothoracic Surgery of the University of California San Diego, San Diego, Calif.
Jaap J. Kloek, MD
- Department of Cardiothoracic Surgery of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Anton Vonk Noordegraaf, MD, PhD
- Department of Pulmonology of the Free University Medical Center, Amsterdam, The Netherlands
Paul Bresser, MD, PhD
- Department of Pulmonology of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 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.

Received 31 March 2006; received in revised form 14 August 2006; accepted 11 September 2006.

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.

CTSNet classification: 11, 17, 18

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