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Heart Disease in Pregnancy - part 3

người phụ nữ có tăng huyết áp động mạch phổi dẫn đến từ một khiếm khuyết vách ngăn tâm nhĩ với sinh lý học của hội chứng Eisenmenger, chứng minh song phương, giãn, vôi hóa động mạch phổi với phì đại tâm thất phải. | 64 Chapter 6 Figure 6.2 A 12-lead ECG from a 31-year-old woman with pulmonary arterial hypertension caused by hemoglobin SC disease demonstrating right atrial enlargement right ventricular hypertrophy and right axis deviation. Figure 6.3 a Posteroanterior and b lateral chest radiographs from a 45-year-old woman with pulmonary arterial hypertension resulting from an atrial septal defect with physiology of Eisenmenger syndrome demonstrating bilateral dilated calcified pulmonary arteries with right ventricular enlargement. Pregnancy and pulmonary hypertension 65 Figure 6.4 Cardiac Doppler ultrasonography in a patient with severe pulmonary arterial hypertension. Tricuspid regurgitant velocity of 4.9 m s is measured. By application of the modified Bernoulli equation and assuming a right atrial pressure of 10mmHg right ventricular systolic pressure is estimated at 4 4.9 2 10 106mmHg. Echocardiogram Echocardiography is the pivotal screening procedure in the evaluation of possible PAH. Transthoracic Doppler echocardiography TTE estimates pulmonary artery systolic pressure PASP 16 and can provide additional information about the cause and consequences of PH. The PASP is equivalent to the right ventricular systolic pressure RVSP in the absence of pulmonary outflow obstruction. The RVSP is approximated by adding the measured systolic regurgitant tricuspid flow velocity V to an estimate of the right atrial pressure RAP applied in the modified Bernoulli equation Figure 6.4 RVSP 4v2 RAP. RAP is either a standardized or an estimated value from characteristics of the inferior vena cava or internal jugular venous distension.17 Pulmonary hemodynamics can also be estimated from the pulmonary regurgitant Doppler signal right ventricular outflow patterns and time intervals including pre-ejection period acceleration and deceleration times and relaxation and contraction times. Right heart catheterization Right heart catheterization is required to confirm the diagnosis of PAH and this can