Purpose
Chronic thromboembolic pulmonary hypertension (CTEPH) results from incomplete resolution of the vascular obstruction caused by pulmonary thromboemboli.
If left untreated,
over time,
a gradual hemodynamic and symptomatic decline can be observed in these patients.
As a consequence,
prognosis in CTEPH is poor and proportional to the degree of pulmonary hypertension [1].
Pulmonary endarterectomy (PEA) represents the therapy of choice for patients with surgically accessible disease.
PEA may be performed with a low mortality risk and results in clinical improvement and improved prognosis [2-4].
Radiologic assessment,...
Methods and materials
Between February 2006 and September 2015,
one hundred and forty-five patients (M:F=64:81,
mean age 60) affected by CTEPH underwent hemodynamic and CTPA evaluation at the Department of Cardio-Thoracic Surgery of our University Hospital.
All patients had undergone a cardiovascular examination with clinical,
functional and hemodynamic assessment (New York Heart Association class determination,
echocardiography,
Right Heart Catheterization) and a radiological evaluation through CTPA.
Finally,
cardio-surgical examination had been performed to verify eligibility criteria for PEA.
CTEPH diagnosis was based on values of Mean Pulmonary Artery Pressure...
Results
145 patients were selected for the study.
In physical examination before surgery,
few patients were asymptomatic,
while all others had a variety of symptoms: worsening exertional dyspnoea,
chronic non-productive cough,
atypical chest pain,
tachycardia,
syncope,
and cor pulmonale.
All patients had hemodynamic evidence of PH (mPAP values > 25 mmHg),
which was also confirmed by radiological evaluation through the presence of typical CT signs.
CTPA revealed the presence of unilateral disease only in 10 patients,
while 135 patients had bilateral disease.
106 patients showed a...
Conclusion
The results of our study further confirm the fundamental role of CTPA in the evaluation of pulmonary vascular and parenchymal alterations in patients with chronic pulmonary embolism and highlight the usefulness of this technique both in the radiological evaluation of this patients also before and after PEA and in assessing the outcome of the surgical procedure.
Our results also open a new horizon in the use of CTPA for a possible prediction of hemodynamic changes in this kind of patients also after PEA,
either associated...
References
1. Herre J Reesink,
J Tim Marcus,
PhD et al (2007) Reverse right ventricular remodeling after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: Utility of magnetic resonance imaging to demonstrate restoration of the right ventricle.
J Thorac Cardiovasc Surg 133:58-64.
2.
Berman M,
Gopalan D,
Sharples L, Screaton N et al (2014) Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment.
Pulmonary Circulation 4:36-44.
3. Marshall PS,
Kerr KM et al (2013) Chronic Thromboembolic Pulmonary...