Long‐term changes of resting and exercise right ventricular systolic performance in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy – A two‐dimensional and three‐dimensional echocardiographic study

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and life-threatening condition with poor prognosis in patients with antiphospholipid syndrome (APS). Pulmonary thromboendarterectomy (PTE) is the optimal surgical option for CTEPH. Objectives This retrospective cohort study aimed to evaluate the efficacy and risk of PTE in patients with APS-associated CTEPH. Methods Consecutive patients with APS-associated CTEPH diagnosed between January 2012 and September 2017 at Peking Union Medical College Hospital were retrospectively evaluated. Demographics, clinical manifestations, antiphospholipid antibody (aPL) profiles, and pulmonary arterial hypertension–targeted medications were collected. Deterioration of cardiac function and death were chosen as the endpoints, in order to assess the effect of PTE on short-term and long-term prognoses (evaluated by the change of cardiac function after treatment and cardiac deterioration or death in the follow-up, respectively). Results A total of 20 patients with APS-associated CTEPH were enrolled, and eight patients underwent PTE. Chi-square test ( p = 0.01) and Kaplan–Meier curves (log rank test, p = 0.04) showed that there were statistically significant differences in both short-term and long-term prognoses between patients with and without PTE. Conclusion These results provide strong evidence that PTE is a curative resolution in patients with APS-associated CTEPH. Following a full specialized and multidisciplinary risk-benefit evaluation to limit the risk of thrombosis or bleeding and to manage possible thrombocytopenia, PTE is at least a temporal curative resolution for CTEPH complicated with APS.

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Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-6.2.83 ◽

2007 ◽

Vol 6 (2) ◽

pp. 83-91

Author(s):

Michael M. Madani ◽

Stuart W. Jamieson

Keyword(s):

Pulmonary Hypertension ◽

Medical Management ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Thromboembolic Disease ◽

Definitive Treatment ◽

Pulmonary Vasculature ◽

Pulmonary Thromboendarterectomy ◽

Thromboembolic Pulmonary Hypertension ◽

Long Term Prognosis

Pulmonary hypertension as the result of chronic pulmonary thromboembolic disease is a serious condition with poor long-term prognosis. The condition is one of the more common cardiovascular diseases affecting Americans, yet it is severely underdiagnosed. Pulmonary thromboendarterectomy is the definitive treatment for chronic pulmonary hyper-tension as the result of thromboembolic disease; however. it is an uncommon procedure, primarily because of lack of recognition on the part of the clinicians. Patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) may present with a variety of debilitating cardiopulmonary symptoms. However, once diagnosed, there is no curative role for medical management, and surgery remains the only option. Palliation therapy with medical management in order to delay surgery carries the risk of prolonging the disease and irreversibly damaging unaffected pulmonary vasculature.

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Quantitative Assessment of Right Ventricular Volumes in Severe Chronic Thromboembolic Pulmonary Hypertension using Transthoracic Three-dimensional Echocardiography: Changes due to Pulmonary Thromboendarterectomy

European Journal of Echocardiography ◽

10.1053/euje.2001.0129 ◽

2002 ◽

Vol 3 (1) ◽

pp. 67-72 ◽

Cited By ~ 35

Author(s):

T Menzel

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Quantitative Assessment ◽

Three Dimensional ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Thromboendarterectomy ◽

Ventricular Volumes ◽

Thromboembolic Pulmonary Hypertension ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography

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Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500108 ◽

1997 ◽

Vol 5 (1) ◽

pp. 35-38

Author(s):

Gao Chang Qing ◽

Rodolfo Barragan Garcia

Keyword(s):

Pulmonary Hypertension ◽

Median Sternotomy ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Thromboendarterectomy ◽

Pulmonary Hemodynamic ◽

Major Vessel ◽

Thromboembolic Pulmonary Hypertension ◽

Hemodynamic Improvement

We describe our experience of treating chronic major vessel thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy. Thromboendarterectomy was performed in 15 patients through a median sternotomy incision using extracorporeal circulation and deep hypothermia. Postoperatively mean pulmonary artery pressure, mean pulmonary vascular resistance, and cardiac index were significantly improved (p < 0.001). Four patients died during surgery, mainly from perfusion edema (operative mortality 27%). The 11 surviving patients received long-term anticoagulant therapy and no incidence of thromboembolism has occurred during the follow-up period. All have shown sustained pulmonary hemodynamic improvement; however, there were 2 late deaths from cardiac failure. We conclude that thromboendarterectomy is an effective treatment for chronic major vessel thromboembolic pulmonary hypertension.

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Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-12.4.186 ◽

2014 ◽

Vol 12 (4) ◽

pp. 186-192 ◽

Cited By ~ 1

Author(s):

David Poch ◽

Victor Pretorius

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Pulmonary Arteries ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Artery Wedge Pressure ◽

Pulmonary Endarterectomy ◽

Pulmonary Thromboendarterectomy ◽

Thromboembolic Pulmonary Hypertension ◽

Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

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