We previously described a high prevalence of functional tricuspid regurgitation (TR) in patients with severely symptomatic primary pulmonary hypertension (PPH). 1 Hinderliter A.L. Willis P.W. Barst R.J. Rich S. Rubin L.J. Badesch D.B. Groves B.M. McGoon M.D. Tapson V.F. Bourge R.C. et al. Effects of long-term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in PPH. Circulation. 1997; 95: 1479-1486 Crossref PubMed Scopus (279) Google Scholar We report the relations of TR to right ventricular (RV) size and geometry, tricuspid annulus diameter, tricuspid leaflet displacement, hemodynamics, and exercise capacity in these patients.

OBJECTIVES The aim of this study was to evaluate the relationships between echocardiographic findings and clinical outcomes in patients with severe primary pulmonary hypertension (PPH).BACKGROUND Primary pulmonary hypertension is associated with abnormalities of right heart structure and function that contribute to the poor prognosis of the disease. Echocardiographic abnormalities associated with PPH have been described, but the prognostic significance of these findings remains poorly characterized.METHODS Echocardiographic studies, invasive hemodynamic measurements and 6-min walk tests were performed and outcomes prospectively followed in 81 patients with severe PPH. Subjects were participants in a 12-week randomized trial examining the effects of prostacyclin plus conventional therapy compared with conventional therapy alone.RESULTS During the mean follow-up period of 36.9 +/- 15.4 months, 20 patients died and 21 patients underwent transplantation. Pericardial effusion (p = 0.003) and indexed right atrial area (p = 0.005) were predictors of mortality. Pericardial effusion (p = 0.017), indexed right atrial area (p = 0.012) and the degree of septal shift in diastole (p = 0.004) were predictors of a composite end point of death or transplantation. In multivariable analyses incorporating clinical, hemodynamic and echocardiographic variables, pericardial effusion and an enlarged right atrium remained predictors of adverse outcomes. Six-minute wall, results, mixed venous oxygen saturation and initial treatment randomization were also independently associated with a poor prognosis.CONCLUSIONS Pericardial effusion, right atrial enlargement and septal displacement are echocardiographic abnormalities that reflect the severity of right heart failure and predict adverse outcomes in patients with severe PPH. These characteristics may help identify patients appropriate for more intensive medical therapy or earlier transplantation. (C) 2002 by the American College of Cardiology Foundation.

Pericardial effusion was noted in 43 of 79 patients (54%) with severe primary pulmonary hypertension. Larger effusion was associated with hemodynamic and echocardiographic evidence of right heart failure, impaired exercise tolerance, and a poor 1-year prognosis.

GAS-bacillus infection of the biliary tract after surgery is a relatively rare occurrence and is stated by Adams1 to have occurred in his experience three times in 4221 operations on the biliary tract. Various authors have disagreed about the incidence of other types of infection in the biliary tract. Mirizzi2 studied the bacteriology of the common bile duct and found it to be sterile in most cases. Twiss3 was able to obtain positive cultures of different bacteria from the duodenum in 28 of 120 patients and later verified at operation the fact that all these patients showed stones. Zollinger and . . .