INFLUENCE OF PULMONARY DENERVATION ON THE MECHANICAL FUNCTION OF THE RIGHT HEART CHAMBERS IN PATIENTS WITH PULMONARY HYPERTENSION

Aim. To estimate mechanical function of the right heart chambers after the pulmonary denervation in comparison with the sham procedure using right heart catheterization (RHC) and echocardiography.

Methods. Twelve patients with different clinical types of pulmonary hypertension were included in the study. All patients were randomized into two groups: Group I patients (n = 6) underwent the pulmonary denervation, Group II patients (n = 6) had sham procedure. All the patients had functional class 3 pulmonary hypertension. The patient screening was performed using echocardiography findings, and the final decision was made after RHC. After including in the study the RHC was done three times: before the procedure, immediately after it, and on the 12th months of the follow-up. Echocardiographic measurement of the right heart parameters was performed four times: a day before the procedure, immediately after it, on the 5th day and on the 12th months of the follow-up.

Results. No complications during the procedure and the follow-up were registered. There were no statistically significant differences in any of the RHC parameters between groups at the second and the third control points. The same findings were determined after echocardiographic analysis.

Conclusion. Pulmonary denervation does not have statistically significant effect on the mechanical function of the right heart chambers within the 12-months follow-up.

1. Hakkila J., Siltanen P.K., Pietilä K.A. Incidence of heart disease in a mass radiophotography survey of adults. Ann Med Intern Fenn 1965; 54(4): 149-56.

2. Galiè N., Humbert M., Vachiery J.L. Gibbs S., Lang I., Torbicki A., Simonneau G. et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016; 37(1): 67-119. doi: 10.1093/eurheartj/ehv317.

3. Chazova I.E., Arkhipova O.A., Valieva Z.S., Nakonechnikov S.N., Martynyuk T.V. Pulmonary hypertension in Russia: The first results of the national register. Terapevticheskii arkhiv 2014; 9: 56-64 (In Russ)

4. Rothman A.M., Arnold N.D., Chang W., Watson O, Swift A.J., Condliffe R., Elliot C.A., Kiely D.G., Suvarna S.K., Gunn J., Lawrie A. Pulmonary artery denervation reduces pulmonary artery pressure and induces histological changes in an acute porcine model of pulmonary hypertension. Circ Cardiovasc Interv 2015; 8(11): e002569. doi: 10.1161/ CIRCINTERVENTIONS.115.002569.

5. Chen S.L., Zhang Y.J., Zhou L., Xie D.J., Zhang F.F., Jia H.B., Wong S.S., Kwan T.W. Percutaneous pulmonary artery denervation completely abolishes experimental pulmonary arterial hypertension in vivo. EuroIntervention. 2013; 9(2): 269-76. doi: 10.4244/EIJV9I2A43.

6. Chen S.L., Zhang H., Xie D.J., Zhang J., Zhou L., Rothman A.M., Stone G.W. Hemodynamic, functional, and clinical responses to pulmonary artery denervation in patients with pulmonary arterial hypertension of different causes: phase II results from the Pulmonary Artery Denervation-1 study. Circ Cardiovasc Interv 2015; 8(11): e002837. doi: 10.1161/ CIRCINTERVENTIONS.115.002837.

7. S.E. Mamchur, E.V. Tokmakov, O.A. Nagirniak, E.A. Khomenko, T.Y. Chichkova, N.S. Bokhan, M.P. Romanova, I.N. Mamchur. Pulmonary artery ganglionic plexi radiofrequency ablation using non-fluoroscopic navigation for the treatment of pulmonary hypertension: a pilot study. Complex Issues of Cardiovascular Diseases. 2018; 7 (4S): 24-46. DOI: 10.17802/2306-1278-2018-7-4S-36-46 (In Russ)

8. Osorio J, Russek M. Reflex changes on the pulmonary and systemic pressures elicited by stimulation of baroreceptors in the pulmonary artery. Circ Res 1962; 10: 664-7.

9. Mamchur S.E., Berdnikov S.V., Mamchur I.N., Khomenko E.A., Bokhan N.S., Scherbinina D.A. Relationship between human left atrial load and contractility in vivo. Complex Issues of Cardiovascular Diseases 2014; 1: 47-51

10. Soto F.J., Hanania N.A. Selective phosphodiesterase-4 inhibitors in chronic obstructive lung disease. Curr Opin Pulm Med 2005; 11(2): 129-34