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Pulmonary Functionsl in Children with Interstitial Lung Disease
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Therapeutically little can be done for the victims of either the rapidly or slowly progressive forms of ILD. A distinct effect of corticosteroids had been observed on the inflammatory alveolar and bronchiolar pathology, much less so on the interstitial component and on the development of fibrosis. The changes produced by such treatment are measurable by simple tests20,33 which help reassure the patient and the physician. One may also use such tests for determining the desirable endpoint of the treatment schedule. This would be of significant help when dealing with a, by itself, not innocuous therapy. The beneficial effect of oxygen inhalation on an around-the-clock basis, nocturnally, or during physical activities will be clinically detectable, therefore, documenting it would be superfluous. The increased pulmonary vascular resistance is only reversible by increased environmental O2 in certain stages of the disease. It is wiser to document this effect by indirect cardiological means (e.g., echocardiography), than by heart catheterization.
Management of scleroderma
Published in Aparna Palit, Arun C. Inamadar, Systemic Sclerosis, 2019
All patients of SSc with PAH are advised to maintain an active life-style. For patients with NYHA functional class I/II, an oral therapy with either of sildenafil, bosentan, or ambrisentan is started. Some authors prefer to use sildenafil at this stage because of its milder side-effects.10 Patients who failed to respond to oral monotherapy and those with NYHA functional class III/IV should be managed with a combination therapeutic approach.11,16 Intravenous epoprostenol has been recommended as the treatment of choice in these cases. A combination of sildenafil and bosentan may also be used, though drug interaction is a concern and there are chances of hepatotoxicity.10 Major therapeutic alterations can be decided based on a repeat right heart catheterization.10
Pulmonary angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Hong Jun Yun, Syed Sohail Ali, Paul Michael Grossman
Pulmonary angiography is usually performed in the acute setting for evaluation and catheter-directed treatment of massive or submassive PE. Close invasive blood pressure and ECG monitoring are required for early detection of hypotension, bradyor tachyarrhythmias, and atrioventricular (AV) block during the procedure. Angiography is initiated by performing complete right heart catheterization. Special considerations are made depending on the measured PA and right ventricular end-diastolic pressures. In the presence of a properly placed IVC filter, safe transfilter angiography using the transfemoral approach can be applied by carefully passing a J-tipped wire followed by the catheter through the filter. A long sheath with its tip beyond the filter may be inserted to prevent filter dislodgement.
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Right-heart catheterization is an essential component of the pre-pregnancy assessment to establish baseline hemodynamics and guide treatment. Right-heart catheterization is also required for the diagnosis of PAH in patients presenting during pregnancy and can be performed safely in experienced hands under minimal or no fluoroscopy [7,24]. In pregnant women with an established diagnosis of PAH, repeat right-heart catheterization may be considered if there is clinical deterioration and the multidisciplinary team decides that the information obtained would be essential for guiding management, including escalation of therapy and early delivery [53,54]. Right-heart catheterization is generally associated with a low morbidity and mortality in PH, however, it does carry a small risk of arrhythmia, thrombosis, bleeding, and infection [19,55,56]. In pregnancy, it may be preferable to use the arm or neck (internal jugular vein) approach, rather than femoral venous access. Shielding of the uterus is recommended. Medical professionals should be prepared to address any potential complications that may arise for the mother or fetus, including the need for an urgent delivery, depending on the stage of pregnancy [16,23,41,57].
Canadian lung tissue biobank with associated clinical data supporting respiratory research for four decades
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
D. P. Sutherland, D. M. Vasilescu, E. T. Osei, N. E. Coxson, C. X. Yang, S. Booth, H. O. Coxson, W. M. Elliot, P. D. Paré, J. C. Hogg, T. L. Hackett
Clinical and physiological data entered into the registry include demographics, lung function, blood cell counts, blood chemistry and imaging studies performed in the days preceding the lung surgery as a standard of care. In some cases, additional research-specific pre-operative tests are performed including body plethysmography, cardiopulmonary exercise testing and heart catheterization. The patients are also interviewed about their medical, smoking and occupational history.14 The data collected includes; age, sex, height, weight, ethnicity, symptoms of cough, phlegm, hemoptysis, wheeze, shortness of breath, co-morbidities, the parent or sibling allergy and asthma, smoking history, smoke exposure in the home, occupational history and exposures, medications and the presentation of the lung problems indicating surgery. Donors’ privacy and the confidentiality of data are preserved at all times. To protect patient confidentiality, all donated lung tissues to the registry are assigned a unique, de-identified registry barcode and data are then stored in an encrypted database. The JHLR adheres to best practices for sample collection, preservation, storage and distribution recommended by The Canadian Tissue Repository Network.15
The clinical associations with cardiomegaly in patients undergoing evaluation for pulmonary hypertension
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Benjamin Daines, Sanjana Rao, Omid Hosseini, Sofia Prieto, John Abdelmalek, Mohamed Elmassry, Pooja Sethi, Victor Test, Kenneth Nugent
Information was collected from electronic medical records on patients referred to the Pulmonary Vascular Disease Clinic in the Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas, who underwent right heart catheterization at University Medical Center in Lubbock between 1 January 2019 and 20 May 2020. This retrospective study included all patients undergoing right heart catheterization during this time interval. There were no exclusions. Demographics, clinical information, laboratory results, chest x-rays, echocardiograms, and right heart catheterization hemodynamic parameters were recorded. Cardiomegaly was defined radiographically as a heart size that exceeded 50% of the internal diameter of the thorax on the posterior-anterior film; these calculations were made by the senior author (KN, a pulmonary physician with more than 40 years of experience in clinical medicine). A hemodynamic composite score based on a recent publication was calculated using right heart catheterization data (Table 1) [8]. All cardiac catheterizations were done by one author (VT, a pulmonary physician with 21 years of experience in performing and interpreting right heart catheterizations).