The Pulmonary Hypertension and Pulmonary Vascular Disease Programs at Cedars-Sinai are focusing efforts around two important areas—right ventricular failure and tricuspid regurgitations—that will allow innovative approaches for diagnosis and treatment to improve patient outcomes.
Right Ventricular Failure
Right ventricular heart failure carries a high mortality. Therefore, the right ventricular can no longer be the forgotten ventricle.
The Smidt Heart Institute focuses on diagnosing and treating the right ventricle, whether it is related to right ventricular infarction, right ventricle dysplasia, pulmonary embolism, pulmonary hypertension, cardiomyopathy, or other cause of shock and right ventricle failure.
The right ventricular Failure and Shock teams is a multidisciplinary team of cardiologists (imaging, interventional, mechanical circulatory support—MCS—and transplant cardiologists), cardiothoracic surgeons, pulmonary hypertension specialists, pulmonologist (and PERT team if needed), intensivists, perfusionists, acute care nurses and pharmacists. The team get together urgently and as needed to decide on the best diagnostic and therapeutic course for a particular patient. Whether it is to use catheter directed lytic therapy for a massive pulmonary embolism, perform an emergent percutaneous intervention to open a coronary artery, placing an Impella, Tandem right ventricularAD or Extracorporeal membrane oxygenation (ECMO), or deciding on a durable right ventricular assist device, or even deciding on cardiac transplantation.
The team benefits from state of the art imaging techniques, including echocardiograms, CT scans, MRIs, as well as hybrid cath labs where coronary and structural interventions and even urgent cardiac surgeries can be performed.
Tricuspid regurgitation can result from right and left heart diseases associated with cardiomyopathies and annular dilatation, atrial fibrillation and atrial remodeling, the presence of devices such as pace makers and defibrillators, as a result of injuries during heart biopsies, from pulmonary hypertension, carcinoid heart disease and a multitude of other causes.
Isolated tricuspid valve surgery is associated with the highest mortality among all valve procedures. The structural heart disease program at the Smidt Heart Institute, led by Rajendra Makkar, MD, is working on perfecting the imaging of the tricuspid valve by obtaining echo, CT and cMRI data and for selection of ideal candidates for the percutaneous transcatheter repair of the tricuspid valve and its regurgitation, an unmet need in a large number of patients.
Multiple clinical trials are now ongoing at the Smidt Heart Institute including the use of the Forma Repair System (Edwards Lifesciences), The Triclip (Abbott Vascular), Pascal (Edwards Pascal transcatheter mitral valve repair system used for TV repair) and multiple other devices are being tested at Cedars-Sinai.
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The Pulmonary Hypertension team at Cedars-Sinai provides expert care and innovation to bring you optimal results. If you have questions, need a second opinion or require special care, contact the Cedars-Sinai Pulmonary Hypertension Program.