Evaluation of pulmonary artery pressure by color Doppler echocardiography

This article was professionally consulted by a Doctor of Radiology, Department of Radiology - Vinmec Central Park International General Hospital.

What is pulmonary artery pressure? Pulmonary arterial pressure is a quantity used for diagnosis, prognosis, treatment indications and assessment of treatment results for cardiovascular diseases. Pulmonary hypertension is when mean pulmonary artery pressure is ≥ 25 mmHg. Causes of pulmonary hypertension can be primary or pathological: left heart failure, congenital heart disease, some genetic mutations, heart valve disease, thoracic malformations, drugs, parasites...
There are 3 degrees of pulmonary carotid hypertension:
Mild pulmonary hypertension in cases where the systolic pulmonary artery pressure is from 25 to 45 mmHg; Increased mean pulmonary artery pressure in case of pulmonary systolic pressure from 46 to 65 mmHg; Severe pulmonary hypertension in case systolic pulmonary artery pressure > 65 mmHg. And there are 3 parameters of pulmonary artery pressure:
Pulmonary systolic pressure; Mean pulmonary arterial pressure Diastolic pulmonary artery pressure

To assess pulmonary carotid pressure, the most accurate way is to measure pulmonary artery pressure directly through a catheter in the catheterization room. However, currently, the most common and most common method of measuring pulmonary artery pressure is calculating pulmonary artery pressure through color Doppler echocardiography. The color Doppler echocardiography method has the advantages of being easy to perform and having high accuracy.

There are 3 parameters of pulmonary artery pressure to be evaluated as follows:
Evaluation of pulmonary systolic pressure through analysis of tricuspid regurgitation spectrum:
When there is no right ventricular outflow tract stenosis or pulmonary stenosis, Pulmonary artery pressure equals right ventricular pressure during systole. When measuring the pressure difference between the right ventricle and the right atrium, ask the patient to lie on the left side, take a four-chamber cut from the apex and confirm the tricuspid regurgitation by color Doppler echocardiography, then turn on the continuous Doppler mode to Locate in the middle of the color spectrum of tricuspid regurgitation and record a continuous Doppler spectrum. Estimating Right Atrial Pressure: Since the right atrium receives blood from the inferior vena cava, right atrial pressure will have a direct effect on the size of the inferior vena cava. When the right atrial pressure is high, the size of the inferior vena cava increases. The inferior vena cava will vary with the respiratory cycle and will reflect the index of collapse of the inferior vena cava.

Evaluation of diastolic pulmonary artery pressure through analysis of pulmonary valve regurgitation spectrum:
On echocardiography, diastolic pulmonary artery pressure is calculated by the formula: Diastolic pulmonary artery pressure equals the difference in pressure between pulmonary artery and right ventricular end diastole along with right ventricular pressure. During diastole, the right ventricular pressure will be equal to the right atrial pressure. Therefore, it is also possible to replace the right ventricular pressure with the right atrial pressure according to the above formula. Calculate the end-diastolic pulmonary and right ventricular gradient as follows: Take a transverse axial cut of the left sternal side, then confirm pulmonary valve regurgitation by color Doppler echocardiography. Enable continuous color Doppler to locate in the middle of the pulmonary regurgitation spectrum. And finally, measure the end-diastolic gradient of the pulmonary regurgitation spectrum once obtained. Mean pulmonary artery pressure through analysis of pulmonary carotid regurgitation spectrum:
On echocardiography, mean pulmonary artery pressure is calculated by the formula: mean pulmonary artery pressure equals the difference in pressure between arteries pulmonary and right ventricular end-diastolic with right ventricular pressure. Calculation of the mean difference in pressure between the pulmonary artery and the right ventricle is done as follows: Take a transverse cut of the left parasternal axis, then determine the pulmonary valve regurgitation by color Doppler echocardiography. Continuous Doppler on, to locate in the middle of the pulmonary regurgitation spectrum. Then measure the peak pressure gradient of the pulmonary regurgitation spectrum when obtained.

Treatments for pulmonary arterial hypertension include:
Supportive treatment with exercise avoidance. Oral anticoagulants, diuretics

Give the patient continuous oxygen when the arterial oxygen partial pressure is < 60 mmHg or < 90% and must maintain oxygen saturation > 90%. Use Digoxin to increase cardiac output Treat arrhythmias if present. Treatment of diseases causing pulmonary hypertension Specific treatment drugs: Calcium channel blockers (indicated for primary pulmonary hypertension; Phosphodiesterase-5 enzyme inhibitors (indicated for patients with arterial hypertension) pulmonary vascular disease with dyspnea NYHA II, III); Bosentan endovascular receptor antagonists to improve symptoms and exercise tolerance; Prostacyclins Lung transplantation: Lung transplantation should be considered for patients unresponsive to prostacyclin infusion. Cardiac - lung transplant, 1 lung or 2 lung transplant can be used. Echocardiography is a way to help detect and diagnose some diseases quickly and effectively. Coming to Vinmec International Hospital System, as one of the leading prestigious hospitals in the country, Vinmec uses the most modern generations of color ultrasound machines today in examining and treating patients. One of them is GE Healthcarecar's Logig E9 ultrasound machine with full options, HD resolution probes for clear images. sharp, accurate assessment of damage. In addition, a team of experienced doctors and nurses will greatly assist in the early diagnosis and early detection of abnormal signs of the body in order to provide a treatment method for carotid hypertension. lungs in time.