Hemodynamic profile of pulmonary arterial hypertension in a Tunisian center

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Published Nov 18, 2023
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Vol. 101 No. 10 (2023): Tunis med oct 2023

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Amira Jamoussi
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
https://orcid.org/0000-0001-5183-9672
Nacef Ben Mrad
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Emna Rachdi
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Fatma Jarraya
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Sarra Zairi
Department of Thoracic Surgery, Abderrahmen Mami hospital, Ariana / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Kais Ben Romdhane
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Mohamed Besbes
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Samia Ayed
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia
Jalila Ben Khelil
Medical Intensive Care Unit, Abderrahmen Mami hospital, Ariana/ Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Ministry of higher education and scientific research/ Faculty of Medicine of Tunis University of Tunis EI Manar, Tunis, Tunisia

Abstract

Introduction: Pulmonary hypertension (PH) management can only be conceived in a specialized center. We aimed to report the experience of a Tunisian ICU about PH invasive hemodynamic exploration and to describe consequent therapeutic decisions.


Methods: Retrospective descriptive study including all patients admitted to the medical ICU of Abderrahmen Mami Hospital for right heart catheterization (RHC), between 2005 and 2019 as part of the investigation of PH. Patients’ characteristics, procedure safety and arising therapeutic decisions were then reported.


Results: Forty patients were admitted for hemodynamic evaluation. RHC confirmed PH in 31 patients and exploration was then completed with NO reactivity test. Mean age was 41.3±15 years, gender ratio M/F was 1.06. PH was classified into: group 1 (n=13), group 2 (n=14), group 4 (n=2) and group 5 (n=2). NO vasoreactivity test was positive in 50% of post-capillary PH and in 28% of pre-capillary PH. The therapeutic decision following the reversibility test was: prescription of calcium channel blockers (n=5), a specific pulmonary vasodilator (n=10), operability (n=6), heart-lung transplant (n=3) and therapeutic abstention (n=7). Two minor complications were reported.


Conclusion: The medical ICU in Abderrahmen Mami Hospital represents an experienced team in hemodynamic investigations despite low annual RHC number. NO reactivity test is an indispensable tool that enables important decisions during PH management.

Keywords:

Pulmonary hypertension, right heart catheterization, vasoreactivity test , referral center, ICU

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