Teste de vasorreatividade pulmonar

Abstract

disease, pulmonary vasculitis, collagenoses, or pulmonary thromboembolism.In cases of idiopathic PAH (IPAH), one-, three-, and five-year survival rates after symptom onset are 68%, 48%, and 34%, respectively.(3) Calcium antagonist drugs have a known pulmonary vasodilator effect, decreasing pulmonary pressure and increasing the survival and quality of life of patients with IPAH.(4) However, less than 20% of these patients, corresponding to those that present pulmonary vasoreactivity, should use this medication.(5) For patients not presenting pulmonary vasoreactivity, the use of calcium IntroductionPulmonary arterial hypertension (PAH) is defined as mean pulmonary artery pressure (MPAP) > 25 mmHg at rest and > 30 mmHg during exercise.(1) Observations suggest that vasoconstriction plays an important role in the pathogenesis of PAH. This disease is characterized by medial hypertrophy of pulmonary arterioles, decreased endothelial production of vasoconstrictors (prostacyclin and nitric oxide), and increased production of the vasoconstrictor endothelin.(2) Pulmonary arterial hypertension (PAH) is classified as idiopathic, when the cause is unknown, or secondary, when it is associated with pulmonary parenchymal diseases, heart Testing pulmonary vasoreactivity* AbstractPulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases). Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due to its specific pulmonary effect and very short half-life (5-10 s). The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary arterial hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.Keywords: Hypertension, pulmonary/diagnosis; Nitric oxide/diagnostic use; Administration, inhalation. ResumoA hipertensão arterial pulmonar é classificada como idiopática ou secundária (associada a colagenoses, cardiopatias, hipertensão portal, tromboembolismo pulmonar e doenças da vasculatura pulmonar). O teste de vasorreatividade pulmonar é indicado para definir a melhor opção terapêutica. Muitas drogas têm sido utilizadas para a realização desse teste, sendo o óxido nítrico inalado a melhor opção, por apresentar ação específica pulmonar e meia vida muita curta (5-10 s). O resultado desse teste identifica candidatos à cirurgia cardíaca nas cardiopatias congênitas e candidatos ao uso de antagonista de cálcio nas outras formas de hipertensão pulmonar. A realização e interpretação do teste de vasorreatividade pulmonar exigem grande responsabilidade, e erros podem levar a decisões erradas e à ocorr...

Congenital Supravalvar Mitral Ring – A Case Report

“…The distinction between pulmonary vasoconstriction and pulmonary vascular occlusive disease will influence the prediction as to whether a child with PH in association with CHD will respond to the management strategies [13] . The pulmonary vasoreactivity test should be done to define the best candidates for heart surgery among patients with CHD and pulmonary arterial hypertension [14] .…”

Acute vasoreactivity test results in severe pulmonary hypertension patients with chronic obstructive pulmonary disease: our experience with 29 cases

“…Acute vasoreactivity is observed in less than 20% of patients with idiopathic PH and these cases display better functional class and hemodynamic profile and have superior survival rates compared with non-responders even under treatment with other agents. 1 – 4 Most of responders to AVT will have idiopathic PH or familial PH and some PH experts advocate that such testing be done in all patients receiving a new diagnosis of idiopathic or familial PH. 2 , 3 …”

“…Such factors include acidosis, systemic arterial hypotension or hypertension, changes in temperature, arrhythmias, pulmonary ventilation asymmetry, and variations in the level of sedation during the measurements. 3 , 4 The interpretation of the results of tests used to determine pulmonary vasoreactivity in cases of idiopathic PH or in PH associated with systemic diseases should focus on changes in pulmonary and systemic pressures. However, in cases of congenital heart disease, alterations in resistances and in pulmonary and systemic outputs must be taken into account.…”

“…AVT is performed for three reasons in pulmonary hypertension (PH): 1) identification of patients who may display a favorable long-term response to channel blocker treatment, 2) gathering prognostic information, 3) scientific research purposes. 2 – 4 In PH patients with COPD, AVT usually yields positive results. The response rate in an adult population is reported to vary between 13% and 35% in different series.…”

“…These cases not only display better functional class and hemodynamics, but they also have superior survival rates compared to non-responders. 1 , 3 , 4 …”