Risk stratification in patients with residual pulmonary hypertension after pulmonary endarterectomy

2021 ◽  
Author(s):  
Stefano Ghio ◽  
Catherine Klersy ◽  
Angelo Corsico ◽  
Sofia Lucia Gamba ◽  
Cristian Monterosso ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Risk Stratification ◽  
Pulmonary Endarterectomy ◽  
Residual Pulmonary Hypertension

scholarly journals Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy

Kardiologiia ◽  
2018 ◽  
Vol 17 (4) ◽  
pp. 15-21 ◽  
Author(s):  
A. M. CHernyavskiy ◽  
◽  
A. G. Edemskiy ◽  
N. V. Novikova ◽  
A. B. Romanov ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Endarterectomy ◽  
Residual Pulmonary Hypertension

scholarly journals Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis

2018 ◽  
Vol 156 (3) ◽  
pp. 1275-1287 ◽  
Author(s):  
Wan Chin Hsieh ◽  
Pavel Jansa ◽  
Wei Chun Huang ◽  
Matus Nižnanský ◽  
Mohamend Omara ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Meta Analysis ◽  
Pulmonary Endarterectomy ◽  
Residual Pulmonary Hypertension

scholarly journals The extent of enlarged bronchial arteries is not correlated with the development of reperfusion pulmonary edema after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402096867
Author(s):  
Yumiko Ikubo ◽  
Takayuki J. Sanada ◽  
Nobuhiro Tanabe ◽  
Akira Naito ◽  
Hiroki Shoji ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Edema ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Endarterectomy ◽  
Bronchial Arteries ◽  
Thromboembolic Pulmonary Hypertension ◽  
Residual Pulmonary Hypertension

This study investigated whether dilated bronchial arteries are associated with reperfusion pulmonary edema in patients with chronic thromboembolic pulmonary hypertension. Results showed that the extent of enlarged bronchial arteries was not associated with the development of reperfusion pulmonary edema, whereas the residual pulmonary hypertension had a significant association.

scholarly journals CAMPHOR score: patient-reported outcomes are improved by pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

2020 ◽  
Vol 56 (4) ◽  
pp. 1902096
Author(s):  
Michael Newnham ◽  
Katherine Bunclark ◽  
Nisha Abraham ◽  
Samantha Ali ◽  
Liliana Amaral-Almeida ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Patient Reported Outcome ◽  
Pulmonary Endarterectomy ◽  
Minimally Clinically Important Difference ◽  
Recommended Treatment ◽  
Patient Reported ◽  
Thromboembolic Pulmonary Hypertension ◽  
Clinically Significant ◽  
Residual Pulmonary Hypertension

BackgroundPulmonary endarterectomy (PEA) is the recommended treatment for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) score is an internationally validated patient-reported outcome (PRO) measure for CTEPH. It assesses three domains: activity, quality of life (QoL) and symptoms. We assessed PROs in patients with CTEPH undergoing PEA.MethodsThis retrospective observational study of consecutive CTEPH patients undergoing PEA at the UK national PEA centre between 2006 and 2017 assessed change in CAMPHOR score from baseline (pre-PEA) until up to 5 years post-PEA. CAMPHOR scores were compared between 1) those with and without clinically significant residual pulmonary hypertension and 2) those undergoing PEA and propensity-matched CTEPH patients who were not operated on. The minimally clinically important difference (MCID) was calculated using an anchor-based method.ResultsOut of 1324 CTEPH patients who underwent PEA, 1053 (80%) had a CAMPHOR score recorded pre-PEA, 934 (71%) had a score recorded within a year of PEA and 784 (60%) had both. There were significant improvements between pre- and post-PEA in all three CAMPHOR domains (median±interquartile range activity −5±7, QoL −4±8, symptoms −7±8; all p<0.0001). Improvements in CAMPHOR score were greater and more sustained in those without clinically significant residual pulmonary hypertension. CTEPH patients undergoing PEA had better CAMPHOR scores than those not operated on. The MCID in CAMPHOR score was −3±5 for activity, −4±7 for QoL and −6±7 for symptoms.ConclusionsPROs are markedly improved by PEA in patients with CTEPH, more so in those without clinically significant residual pulmonary hypertension.

scholarly journals Cardiopulmonary exercise test could predict residual pulmonary hypertension after pulmonary endarterectomy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.L Coronel ◽  
A Flox Camacho ◽  
T Segura De La Cal ◽  
C Perez Olivares Delgado ◽  
M.J Cristo Ropero ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Test ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Cardiopulmonary Exercise Test ◽  
Functional Class ◽  
Functional Improvement ◽  
Invasive Technique ◽  
Pulmonary Endarterectomy ◽  
Cardiopulmonary Exercise ◽  
Residual Pulmonary Hypertension

Abstract Introduction Pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic lesions at pulmonary arteries and arteriolar remodeling in distal regions. There is an increase in pulmonary vascular resistance that will lead to heart failure and early death without treatment. Currently, pulmonary endarterectomy (PE) is the potentially curative treatment for this condition. Cardiopulmonary exercise test (CPET) allows to quantify functional improvement after PE. Objective: To analyze changes in CPET and hemodynamic parameters after surgery in a cohort of patients with CTEPH. Methods 502 patients with CTEPH have been evaluated until December 2018, PE was performed in 255 (51%). In 49 patients, CPET was available before and 6 months after surgery. Residual pulmonary hypertension (RPH) was defined as mean pulmonary arterial pressure ≥30 mmHg evaluated by right cardiac catheterization at 3–6 months after PE. Results 54% were men, mean age 48±13 years. Two thirds of patients were in functional class II/III at time of diagnosis and with severe hemodynamic and functional profile. Hemodynamics and CPET parameters improved after surgery. However, in patients with RPH they did not improve significantly. Results are shown in table. Conclusions PE restores functional capacity in CTEPH, represented by significant improvement in CPET parameters. CPET is emerging as a non-invasive technique suitable of detecting RPH. More studies are needed to confirm this hypothesis. Funding Acknowledgement Type of funding source: None

scholarly journals Impact of pulmonary endarterectomy on pulmonary arterial wave propagation and reservoir function

2019 ◽  
Vol 317 (3) ◽  
pp. H505-H516 ◽  
Author(s):  
Junjing Su ◽  
Alun D. Hughes ◽  
Ulf Simonsen ◽  
Jens Erik Nielsen-Kudsk ◽  
Kim H. Parker ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Stiffness ◽  
Pulmonary Artery ◽  
Wave Reflection ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Endarterectomy ◽  
Reflection Index ◽  
Large Wave ◽  
Pulmonary Arterial ◽  
Residual Pulmonary Hypertension

High wave speed and large wave reflection in the pulmonary artery have previously been reported in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We assessed the impact of pulmonary endarterectomy (PEA) on pulmonary arterial wave propagation and reservoir function in patients with CTEPH. Right heart catheterization was performed using a combined pressure and Doppler flow sensor-tipped guidewire to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery in eight patients with CTEPH before and 3 mo after PEA. Wave intensity and reservoir-excess pressure analyses were then performed. Following PEA, mean pulmonary arterial pressure (PAPm; ∼49 vs. ∼32 mmHg), pulmonary vascular resistance (PVR; ∼11.1 vs. ∼5.1 Wood units), and wave speed (∼16.5 vs. ∼8.1 m/s), i.e., local arterial stiffness, markedly decreased. The changes in the intensity of the reflected arterial wave and wave reflection index (pre: ∼28%; post: ∼22%) were small, and patients post-PEA with and without residual pulmonary hypertension (i.e., PAPm ≥ 25 mmHg) had similar wave reflection index (∼20 vs. ∼23%). The reservoir and excess pressure decreased post-PEA, and the changes were associated with improved right ventricular afterload, function, and size. In conclusion, although PVR and arterial stiffness decreased substantially following PEA, large wave reflection persisted, even in patients without residual pulmonary hypertension, indicating lack of improvement in vascular impedance mismatch. This may continue to affect the optimal ventriculoarterial interaction, and further studies are warranted to determine whether this contributes to persistent symptoms in some patients. NEW & NOTEWORTHY We performed wave intensity analysis in the pulmonary artery in patients with chronic thromboembolic pulmonary hypertension before and 3 mo after pulmonary endarterectomy. Despite substantial reduction in pulmonary arterial pressures, vascular resistance, and arterial stiffness, large pulmonary arterial wave reflection persisted 3 mo postsurgery, even in patients without residual pulmonary hypertension, suggestive of lack of improvement in vascular impedance mismatch.

Sign in / Sign up

Export Citation Format

Share Document