BIOMECHANICAL APPROACH TO THE CLINICAL TREATMENT OF PULMONARY ARTERIAL HYPERTENSION

Negative clinical trend of severe pulmonary arterial hypertension (PAH) is due to right ventricular chamber dilatation and consequent dysfunction. On a biomechanical basis the clinical evolution is associated to a progressive mismatching of the artero-ventricular junction and a possible mechanical intervention may be foreseen. This paper demonstrates how the progressive right ventricular dysfunction, in terms of biochemical–mechanical efficiency, is related to the stress–strain curve of the pulmonary artery, simulated by superimposing different elastance tubes in a cardiovascular mock. Applying the experimental signals to an "ideal" normal and dilated ventricle, it was demonstrated that the very high pulmonary elastance at high pressure is the prime cause of a sharp efficiency drop, in comparison with an aortic similar condition. This evidence supports the proposal of mechanical interventions to reduce pulmonary arterial elastance to improve the artero-ventricular matching, increase the reduced ventricular efficiency and change the negative trend of the illness.