HIGH GRADE PULMONARY HYPERTENSION: OPPROTUNITIES OF ECHOCARDIOGRAPHY IN ASSESSING FAULTS IN CARDIAC FUNCTION AND PROGNOSIS OF THE CLINICAL COURSE

Abstract

High grade pulmonary hypertension (HGPH) determines invalidization, low quality of life and causes fatal outcomes. Aim of the study: to use echocardiography to evaluate the morphological and functional condition of ventricular myocardium and criteria determining prognosis. Materials and methods: 40 patients with HGPH aged 3 to 56 underwent echocardiography for the period of 1999-2000 in the Center and were divided into the following groups: 1) patients with congenital heart disease and Eisenmenger complex (22); 2) patients with progressing pulmonary hypertension after a vicium cordis is corrected; 3) patients with primary pulmonary hypertension (PLH) (11). Echocardiography was used to evaluate: systolic function – ejection fraction for each ventricle, fractional change in right ventricle, cardiac index of the greater circle; diastolic function of the ventricles, LV excentricity index, reflecting septum geometry, the degree of RV hypertrophy, end diastolic square of the right ventricle, hemodynamics of the lesser circle. Results: in patients with progressing pulmonary hypertension after a vicium is corrected and in patients with pulmonary hypertension we have revealed RV dysfunction and decreased cardiac index of the greater circle which defines a severe clinical course of the disease. In a group with NYHA IV we observed a marked decrease in RV systolic function, impaired RV diastolic function in a restrictive way and decreased cardiac index of the greater circle. In patients with a septum defect and Eisenmenger complex RV diastolic function was not impaired in a restrictive way (end diastolic pressure in RA and RV not increased), despite significantly dilated right heart chambers, decreased RV systolic function and cardiac index of the greater circle. Therefore we draw a conclusion that a defect levels RV failure defining a favorable prognosis. Preserved ventricular systolic function, their hypertrophy and normal cardiac index of the greater circle is typical in most cases of septum defects, persisting ductus arteriosus and Eisenmenger complex. The severe clinical course is defined by a significant hypoxemia, playing an important role in the impairment of either ventricle.