ABSTRACTS
Sessions
Abstracts of the Netherlands Society of Thoracic Surgery (NVT) 19 May 2006, Mercure Hotel Nieuwegein
Degeneration of the Pulmonary Autograft an explant study
29 Years of experience with surgical correction of atrioventricular septal defects
P.H. Schoof 3.J.M. Takkenberg ', R.J. van Suylen d, P.E. Zondervan M.G. Hazekamp , R.A.E. Dion A.J.J.C. Bogers Departments of Cardlothoracdc Surgery University Medical Center Leiden, ' Cardiothoracic Surgery and' Pathology Erasmus Medical Center, Rotterdam dPathology University Hospital Maastricht
G.]. Hoohenkerk (1), P. Schoof (1), E. Bruggemans (1), M. Rijlaarsdam (2), M. Hazekamp (1) Departments of cardiothoracic surgery (1) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands.
Objactive: To identify risk factors for mortality and reoperation after AVSD repair.
Introduction: To determine the histologic features of pulmonary autografts explanted after the Ross operation.
Methods: Histologic sections of 30 explanted autografts as well as of normal heart valves were assessed and semiquantitatively scored by a blinded cardiovascular pathologist. Patient characteristics at autograft implant and explant were evaluated.
Results: Pulmonary autografts (n=30) were explanted on average 6.1 * 0.6 years (median 6.6, range 0.1-11.7) after the Ross operation (n=28) or removed at autopsy (n=2). Twelve of the reoperated patients (43%) had no or negligible autograft insufficiency on early transthoracic echocardiography, 12 had grade 1 (43%) and 4 had grade 1-2 (14%). Valve regurgitation (>grade 2) with root dilatation (> 40 mm) was the most common indication (n=26, 93%) for reoperation after root replacement, and regurgitation (n=2, 7%) after subcoronary implanted autografts. A valved conduit was used in 18 patients (64%) (mechanical 15, bioprosthesis 2, allograft 1) to replace the autograft root, isolated autograft valve replacement with preservation of the autograft root was done in 8 (29%) (mechanical 7, bioprosthesis 1) and 2 patients had a valve sparing procedure (7%). All patients survived the autograft reoperation. Microscopy revealed normal laminar architecture and cellularity of both autograft wall and valve. Wall specimens were characterized by reduced and fragmented elastin and increased collagen (fibrosis) which are the typical early features of aneurysmal degeneration in general. Medial elastin changes were associated with the presence of hypertrophic smooth muscle cells. Fibrosis was most severe in the adventitia. Intimal thickening was a common finding. Valve explants showed significant thickening due to tissue on the ventricular surface and marked thickening of the free margin. An autopsy explant with normal function before death showed similar features.
Patients and Methods: In 1977-2005, 307 patients underwent surgery for complete AVSD (n=207; 67%), intermediate AVSD (n=25; 8.2%) and partial AVSD (n- 75; 24.8%). Patients with tetralogy of Fallot (n=23), coarctation (n=8), and LVOT obstruction (n= 2)) were included. Median age was 6 months (range: 23 days -18 years), 199 (75%) patients were younger than 6 months. 157 had Down's syndrome. Preoperatively 197 (64%) patients had significant AV-valve regurgitation. In 31 (10%) patients, valve dysplasia was recorded. In 234 (76%) cleft closure was performed. Results: There were 27 (9%) in-hospital deaths and three (1%) late deaths. Follow- up was complete in all (mean = 131 months; range: 1-336 months). Actuarial survival at one year was 91%, at 10 years 90% and at 20 years 87%. Complete AVSD (p-0.038) and AV-valve regurgitation (p=0.004) were risk factors for mortality. 48 patients required reoperation. Risk factors for reoperation were AV-valve dysplasia (p 40 mm) was the most common indication (n=26, 93%) for reoperation after root replacement, and regurgitation (n=2, 7%) after subcoronary implanted autografts. A valved conduit was used in 18 patients (64%) (mechanical 15, bioprosthesis 2, allograft 1) to replace the autograft root, isolated autograft valve replacement with preservation of the autograft root was done in 8 (29%) (mechanical 7, bioprosthesis 1) and 2 patients had a valve sparing procedure (7YO). All patients survived the autograft reoperation. Microscopy revealed normal laminar architecture and cellularity of both autograft wall and valve. Wall specimens were characterized by reduced and fragmented elastin and increased collagen (fibrosis) which are the typical early features of aneurysmal degeneration in general. Medial elastin changes were associated with the presence of hypertrophic smooth muscle cells. Fibrosis was most severe in the adventitia. Intimal thickening was a common finding. Valve explants showed significant thickening due to tissue on the ventricular surface and marked thickening of the free margin. An autopsy explant with normal function before death showed similar features.
Conclusions: Pulmonary autograft explants are characterized by severe aneurysmal degeneration of the wall with intimal thickening, medial elastin fragmentation and adventitial fibrosis. Valve leaflets were thickened. The presence of these features in a non-failing explant suggests that these degenerative changes represent a common mode of adaptation.
Mitral valve replacement In neonates and young Infants with appropriately sized prosthese has low mortality R&.aQ (1), P. Schoof(1), G. Hoohenkerk (1), R. Bokenkamp (2), S. Starreveld (2), M. Hazekamp (1) Departments of cardlothoracic surgery(l) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands Introduction Evaluating the dinical results of prosthetic mitral valve replacement (MVR) in children less than 4 months of age. Valve replacement In neonates and young children Is associated with a considerable operative risk that is related to oversizing of the prosthesis. We avoided this by use of custom-made 15 mm and normal 17 mm prostheses.
Methods Retrospective analysis of patient data. Seven patients had MVR at a median age of 2.1 months (range 1 day - 3.6 months) between 2002 and 2005. Primary cardiac diagnosis included Shone's syndrome (3), congenital mitral insufficiency (3) and mitral stenosis (1). The dominant lesion indicating valve replacement was regurgitation In 6 and stenosis in 1. Five patients required preoperative ventilator support. All patients had attempts at mitral valve repair prior to valve replacement. Associated procedures performed were coarctation resection (1)
and Ross-Konno procedure (1). Bileaflet mechanical prostheses (St Jude Medical, St Paul, MN, USA) 15 mm (5) or 17 mm (2) were used for MVR and were implanted at the annular level. All patients received coumarins after the operation.
Rsults
There was no early or late mortality. Reoperation was necessary for periprosthetic leak (2), prosthesis dislocation (1) and prosthesis related subvalvular aortic stenosis (1). One patient had a pacemaker implantation. Anticoagulation-related bleeding occurred in two (subdural hematoma, nasal bleeding). Patients are in NYHA dass 1.
Conclusion Smaller-sized prostheses should be readily available in any pediatric cardiac surgical unit for MVR.
29 Years of experience with surgical correction of atrioventricular septal defects G.]. Hoohenkerk (1), P. Schoof (1), E. Bruggemans (1), M. Rijlaarsdam (2), M. Hazekamp (1) Departments of cardiothoracic surgery (1) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands.
Objective: To identify risk factors for mortality and reoperation after AVSD repair.
Patients and Methods: In 1977-2005, 307 patients underwent surgery for complete AVSD (n=207; 67%), intermediate AVSD (n=25; 8.2%) and partial AVSD (n= 75; 24.8%). Patients with tetralogy of Fallot (n=23), coarctation (n=8), and LVOT obstruction (n= 2)) were included. Median age was 6 months (range: 23 days -18 years), 199 (75%) patients were younger than 6 months. 157 had Down's syndrome. Preoperatively 197 (64%) patients had significant AV-valve regurgitation. In 31 (10%) patients, valve dysplasia was recorded. In 234 (76%) cleft closure was performed. Results: There were 27 (9%) in-hospital deaths and three (1%) late deaths. Follow- up was complete in all (mean = 131 months; range: 1-336 months). Actuarial survival at one year was 91%, at 10 years 90% and at 20 years 87%. Complete AVSD (p=0.038) and AV-valve regurgitation (p=0.004) were risk factors for mortality. 48 patients required reoperation. Risk factors for reoperation were AV-valve dysplasia (p0.05) respectively. Although not significant, the prevalence of atrial flutter was lower in the BM-group (4%) than in the PVI- (17%) and LSM-group (11%). Multivariate analysis showed that preoperative mitral valve disease (p=0.038, OR 4.04, 95% CL 1.08-15.14) and male gender (p-0.007 OR 0.162, 95% CL 0.044-0.607) were predictors for AF at end of FU.
Conclusion:
Left sided modifled maze procedures are as effective in terminating AF as biatrial maze procedures. However, omission of right sided lesions resulted in a higher prevalence of atrial flutter.
Cox Maze III surgery In patients with symptomatic Idiopathic atrial fibrillation: favorable long-term efficacy, cardiac performance and quality of life YL Gu, MEW Hemels, AE Tuinenburg, PW Boonstra, ACP Wiesfeld, MP van den Berg, DJ van Veldhuisen, IC van Gelder. Departmnents of Cardiology and Thoracic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
Introduction. Rhythm control is Indicated in patients suffering from intractable idiopathic atrial fibrillation (AF) but remains difficult to establish. The Cox Maze III procedure Is a well-known surgical option in treating these AF patients. However, little is known about the long-term cardiac performance and quality of life in patients undergoing this procedure. In this study, we investigated the long-term treatment efficacy, cardiac performance as well as quality of life in patients with symptomatic Idiopathic AF undergoing Cox Maze III surgery. Methods. Patients were included with a history of symptomatic paroxysmal or persistent AF (1) refractory for at least 2 dass I or III anti-arrhythmic drugs and (2) without structural heart disease or bradyarrhythmias. All patients underwent Cox Maze III surgery. Complete success was defined as freedom of AF without anti-arrhythmic drugs beyond 3 months after surgery. Left ventricular and atrial function using echocardiography, exercise testing and quality of life using the SF36 questionnaire were assessed during and at the end of fdlow up. Results. A total of 29 patients were induded (mean age 48*6 years, 27 males). Major complications included reoperations for postoperative bleeding (n-3), pericardieal effusion (n-3) and mediastinitis (n-1). After a mean follow up of 4.8*2.4 years, 79% of patients had complete success, and 7% were free of AF with anti-arrhythmic drugs. At the end of follow up, fractional shortening was signiflcantiy improved (from 31*10% to 39*8%, p-0.002), left atrial function was comparable and exercise capadty was within normal ranges. Quality of life in successfully treated patients was similar to that of healthy controls.
Conclusion. Cox Maze III surgery Is an effective therapy for patients with drugrefractory idiopathic AF and is associated with a favorable cardiac performance and quality of life.
pulmonary
The influence of oxygen concentration and Inflation preseure during lschema on lung lschemia reperfusion Injury
H.J. Reesink*, P. Symerskyl, J.T. Marcus', I.I. Tuievskil, A. Vonk Noordegraaf', 3. . Kloek' P. Bresser* Depts. of Pulmonology*, Cardiothoradc Surgery' and Cardiology Academic Medical Center, University of Amsterdam. Dept. of Physiology' and Pulmonologyi Free University Medical Center Amsterdam, the Netherlands.
N.P. van der Kaali', J. Kluin', R.A. Lachmann2, M.A. den Bakker3, J.J. Haitsma2, B.N. Lrambrecht4, R.W.F. de Bruin%, B. Lachmann2, A.J.J.C. Bogers' Department of 'Cardlo-Thoradc Surgery, 2Anestheslology, 3Pathology, 'Pulmonary Diseases, 5Surgery, Erasmus MC Rotterdam, and Cardio-Thoradc Surgery UMC Utrecht.
Reverse right ventricular remodeling endarterectomy assesead by MRI
after
Introduction. Pulmonary hypertension causes right ventricular (RV) remodeling, I.e. RV dIlatatIon, hypertrophy and left ventricular (LV) septum deviation. We studied the effect of pulmonary endarterectomy (PEA) on restoration of RV remodeling in chronic thromboembolic pulmonary hypertension (CTEPH). Methods. In 17 CTEPH patients, before and after PEA, and 12 healthy controls, ventricular end diastolic and systolic volumes (EDV/ESV, ml.m'2), mass (g.m2) and septum deviation (1/radius, cm') were determined by magnetic resonance imaging (MRI, 1.5 T, Sonata, Siemens, Germany) using MASS software (MEDIS, the Netherlands). Results. Before PEA, RV ESV, mass and septum deviation dlffered significantly between patients and healthy controls. LV mass was similar. Upon PEA, cardiac MRI parameters (Table 1) and pulmonary hemodynamics improved signlficantly. The decrease (A) in RV mass correlated with A total pulmonary resistance
(r=0.64, p
Sessions
Abstracts of the Netherlands Society of Thoracic Surgery (NVT) 19 May 2006, Mercure Hotel Nieuwegein
Degeneration of the Pulmonary Autograft an explant study
29 Years of experience with surgical correction of atrioventricular septal defects
P.H. Schoof 3.J.M. Takkenberg ', R.J. van Suylen d, P.E. Zondervan M.G. Hazekamp , R.A.E. Dion A.J.J.C. Bogers Departments of Cardlothoracdc Surgery University Medical Center Leiden, ' Cardiothoracic Surgery and' Pathology Erasmus Medical Center, Rotterdam dPathology University Hospital Maastricht
G.]. Hoohenkerk (1), P. Schoof (1), E. Bruggemans (1), M. Rijlaarsdam (2), M. Hazekamp (1) Departments of cardiothoracic surgery (1) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands.
Objactive: To identify risk factors for mortality and reoperation after AVSD repair.
Introduction: To determine the histologic features of pulmonary autografts explanted after the Ross operation.
Methods: Histologic sections of 30 explanted autografts as well as of normal heart valves were assessed and semiquantitatively scored by a blinded cardiovascular pathologist. Patient characteristics at autograft implant and explant were evaluated.
Results: Pulmonary autografts (n=30) were explanted on average 6.1 * 0.6 years (median 6.6, range 0.1-11.7) after the Ross operation (n=28) or removed at autopsy (n=2). Twelve of the reoperated patients (43%) had no or negligible autograft insufficiency on early transthoracic echocardiography, 12 had grade 1 (43%) and 4 had grade 1-2 (14%). Valve regurgitation (>grade 2) with root dilatation (> 40 mm) was the most common indication (n=26, 93%) for reoperation after root replacement, and regurgitation (n=2, 7%) after subcoronary implanted autografts. A valved conduit was used in 18 patients (64%) (mechanical 15, bioprosthesis 2, allograft 1) to replace the autograft root, isolated autograft valve replacement with preservation of the autograft root was done in 8 (29%) (mechanical 7, bioprosthesis 1) and 2 patients had a valve sparing procedure (7%). All patients survived the autograft reoperation. Microscopy revealed normal laminar architecture and cellularity of both autograft wall and valve. Wall specimens were characterized by reduced and fragmented elastin and increased collagen (fibrosis) which are the typical early features of aneurysmal degeneration in general. Medial elastin changes were associated with the presence of hypertrophic smooth muscle cells. Fibrosis was most severe in the adventitia. Intimal thickening was a common finding. Valve explants showed significant thickening due to tissue on the ventricular surface and marked thickening of the free margin. An autopsy explant with normal function before death showed similar features.
Patients and Methods: In 1977-2005, 307 patients underwent surgery for complete AVSD (n=207; 67%), intermediate AVSD (n=25; 8.2%) and partial AVSD (n- 75; 24.8%). Patients with tetralogy of Fallot (n=23), coarctation (n=8), and LVOT obstruction (n= 2)) were included. Median age was 6 months (range: 23 days -18 years), 199 (75%) patients were younger than 6 months. 157 had Down's syndrome. Preoperatively 197 (64%) patients had significant AV-valve regurgitation. In 31 (10%) patients, valve dysplasia was recorded. In 234 (76%) cleft closure was performed. Results: There were 27 (9%) in-hospital deaths and three (1%) late deaths. Follow- up was complete in all (mean = 131 months; range: 1-336 months). Actuarial survival at one year was 91%, at 10 years 90% and at 20 years 87%. Complete AVSD (p-0.038) and AV-valve regurgitation (p=0.004) were risk factors for mortality. 48 patients required reoperation. Risk factors for reoperation were AV-valve dysplasia (p 40 mm) was the most common indication (n=26, 93%) for reoperation after root replacement, and regurgitation (n=2, 7%) after subcoronary implanted autografts. A valved conduit was used in 18 patients (64%) (mechanical 15, bioprosthesis 2, allograft 1) to replace the autograft root, isolated autograft valve replacement with preservation of the autograft root was done in 8 (29%) (mechanical 7, bioprosthesis 1) and 2 patients had a valve sparing procedure (7YO). All patients survived the autograft reoperation. Microscopy revealed normal laminar architecture and cellularity of both autograft wall and valve. Wall specimens were characterized by reduced and fragmented elastin and increased collagen (fibrosis) which are the typical early features of aneurysmal degeneration in general. Medial elastin changes were associated with the presence of hypertrophic smooth muscle cells. Fibrosis was most severe in the adventitia. Intimal thickening was a common finding. Valve explants showed significant thickening due to tissue on the ventricular surface and marked thickening of the free margin. An autopsy explant with normal function before death showed similar features.
Conclusions: Pulmonary autograft explants are characterized by severe aneurysmal degeneration of the wall with intimal thickening, medial elastin fragmentation and adventitial fibrosis. Valve leaflets were thickened. The presence of these features in a non-failing explant suggests that these degenerative changes represent a common mode of adaptation.
Mitral valve replacement In neonates and young Infants with appropriately sized prosthese has low mortality R&.aQ (1), P. Schoof(1), G. Hoohenkerk (1), R. Bokenkamp (2), S. Starreveld (2), M. Hazekamp (1) Departments of cardlothoracic surgery(l) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands Introduction Evaluating the dinical results of prosthetic mitral valve replacement (MVR) in children less than 4 months of age. Valve replacement In neonates and young children Is associated with a considerable operative risk that is related to oversizing of the prosthesis. We avoided this by use of custom-made 15 mm and normal 17 mm prostheses.
Methods Retrospective analysis of patient data. Seven patients had MVR at a median age of 2.1 months (range 1 day - 3.6 months) between 2002 and 2005. Primary cardiac diagnosis included Shone's syndrome (3), congenital mitral insufficiency (3) and mitral stenosis (1). The dominant lesion indicating valve replacement was regurgitation In 6 and stenosis in 1. Five patients required preoperative ventilator support. All patients had attempts at mitral valve repair prior to valve replacement. Associated procedures performed were coarctation resection (1)
and Ross-Konno procedure (1). Bileaflet mechanical prostheses (St Jude Medical, St Paul, MN, USA) 15 mm (5) or 17 mm (2) were used for MVR and were implanted at the annular level. All patients received coumarins after the operation.
Rsults
There was no early or late mortality. Reoperation was necessary for periprosthetic leak (2), prosthesis dislocation (1) and prosthesis related subvalvular aortic stenosis (1). One patient had a pacemaker implantation. Anticoagulation-related bleeding occurred in two (subdural hematoma, nasal bleeding). Patients are in NYHA dass 1.
Conclusion Smaller-sized prostheses should be readily available in any pediatric cardiac surgical unit for MVR.
29 Years of experience with surgical correction of atrioventricular septal defects G.]. Hoohenkerk (1), P. Schoof (1), E. Bruggemans (1), M. Rijlaarsdam (2), M. Hazekamp (1) Departments of cardiothoracic surgery (1) and pediatric cardiology (2), Center of Congenital Anomalies of the Heart Amsterdam - Leiden, The Netherlands.
Objective: To identify risk factors for mortality and reoperation after AVSD repair.
Patients and Methods: In 1977-2005, 307 patients underwent surgery for complete AVSD (n=207; 67%), intermediate AVSD (n=25; 8.2%) and partial AVSD (n= 75; 24.8%). Patients with tetralogy of Fallot (n=23), coarctation (n=8), and LVOT obstruction (n= 2)) were included. Median age was 6 months (range: 23 days -18 years), 199 (75%) patients were younger than 6 months. 157 had Down's syndrome. Preoperatively 197 (64%) patients had significant AV-valve regurgitation. In 31 (10%) patients, valve dysplasia was recorded. In 234 (76%) cleft closure was performed. Results: There were 27 (9%) in-hospital deaths and three (1%) late deaths. Follow- up was complete in all (mean = 131 months; range: 1-336 months). Actuarial survival at one year was 91%, at 10 years 90% and at 20 years 87%. Complete AVSD (p=0.038) and AV-valve regurgitation (p=0.004) were risk factors for mortality. 48 patients required reoperation. Risk factors for reoperation were AV-valve dysplasia (p0.05) respectively. Although not significant, the prevalence of atrial flutter was lower in the BM-group (4%) than in the PVI- (17%) and LSM-group (11%). Multivariate analysis showed that preoperative mitral valve disease (p=0.038, OR 4.04, 95% CL 1.08-15.14) and male gender (p-0.007 OR 0.162, 95% CL 0.044-0.607) were predictors for AF at end of FU.
Conclusion:
Left sided modifled maze procedures are as effective in terminating AF as biatrial maze procedures. However, omission of right sided lesions resulted in a higher prevalence of atrial flutter.
Cox Maze III surgery In patients with symptomatic Idiopathic atrial fibrillation: favorable long-term efficacy, cardiac performance and quality of life YL Gu, MEW Hemels, AE Tuinenburg, PW Boonstra, ACP Wiesfeld, MP van den Berg, DJ van Veldhuisen, IC van Gelder. Departmnents of Cardiology and Thoracic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
Introduction. Rhythm control is Indicated in patients suffering from intractable idiopathic atrial fibrillation (AF) but remains difficult to establish. The Cox Maze III procedure Is a well-known surgical option in treating these AF patients. However, little is known about the long-term cardiac performance and quality of life in patients undergoing this procedure. In this study, we investigated the long-term treatment efficacy, cardiac performance as well as quality of life in patients with symptomatic Idiopathic AF undergoing Cox Maze III surgery. Methods. Patients were included with a history of symptomatic paroxysmal or persistent AF (1) refractory for at least 2 dass I or III anti-arrhythmic drugs and (2) without structural heart disease or bradyarrhythmias. All patients underwent Cox Maze III surgery. Complete success was defined as freedom of AF without anti-arrhythmic drugs beyond 3 months after surgery. Left ventricular and atrial function using echocardiography, exercise testing and quality of life using the SF36 questionnaire were assessed during and at the end of fdlow up. Results. A total of 29 patients were induded (mean age 48*6 years, 27 males). Major complications included reoperations for postoperative bleeding (n-3), pericardieal effusion (n-3) and mediastinitis (n-1). After a mean follow up of 4.8*2.4 years, 79% of patients had complete success, and 7% were free of AF with anti-arrhythmic drugs. At the end of follow up, fractional shortening was signiflcantiy improved (from 31*10% to 39*8%, p-0.002), left atrial function was comparable and exercise capadty was within normal ranges. Quality of life in successfully treated patients was similar to that of healthy controls.
Conclusion. Cox Maze III surgery Is an effective therapy for patients with drugrefractory idiopathic AF and is associated with a favorable cardiac performance and quality of life.
pulmonary
The influence of oxygen concentration and Inflation preseure during lschema on lung lschemia reperfusion Injury
H.J. Reesink*, P. Symerskyl, J.T. Marcus', I.I. Tuievskil, A. Vonk Noordegraaf', 3. . Kloek' P. Bresser* Depts. of Pulmonology*, Cardiothoradc Surgery' and Cardiology Academic Medical Center, University of Amsterdam. Dept. of Physiology' and Pulmonologyi Free University Medical Center Amsterdam, the Netherlands.
N.P. van der Kaali', J. Kluin', R.A. Lachmann2, M.A. den Bakker3, J.J. Haitsma2, B.N. Lrambrecht4, R.W.F. de Bruin%, B. Lachmann2, A.J.J.C. Bogers' Department of 'Cardlo-Thoradc Surgery, 2Anestheslology, 3Pathology, 'Pulmonary Diseases, 5Surgery, Erasmus MC Rotterdam, and Cardio-Thoradc Surgery UMC Utrecht.
Reverse right ventricular remodeling endarterectomy assesead by MRI
after
Introduction. Pulmonary hypertension causes right ventricular (RV) remodeling, I.e. RV dIlatatIon, hypertrophy and left ventricular (LV) septum deviation. We studied the effect of pulmonary endarterectomy (PEA) on restoration of RV remodeling in chronic thromboembolic pulmonary hypertension (CTEPH). Methods. In 17 CTEPH patients, before and after PEA, and 12 healthy controls, ventricular end diastolic and systolic volumes (EDV/ESV, ml.m'2), mass (g.m2) and septum deviation (1/radius, cm') were determined by magnetic resonance imaging (MRI, 1.5 T, Sonata, Siemens, Germany) using MASS software (MEDIS, the Netherlands). Results. Before PEA, RV ESV, mass and septum deviation dlffered significantly between patients and healthy controls. LV mass was similar. Upon PEA, cardiac MRI parameters (Table 1) and pulmonary hemodynamics improved signlficantly. The decrease (A) in RV mass correlated with A total pulmonary resistance
(r=0.64, p
