Long-term results after thromboendarterectomy for chronic pulmonary embolism

Objective: In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. Methods: Twenty-two patients (12 female, 10 male, me...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 1999-05, Vol.15 (5), p.579-584
Main Authors: Kramm, T., Mayer, E., Dahm, M., Guth, S., Menzel, T., Pitton, M., Oelert, H.
Format: Article
Language:English
Subjects:
Adult
Aged
Chronic Disease
Chronic pulmonary embolism
Endarterectomy - methods
Endarterectomy - mortality
Evaluation Studies as Topic
Female
Follow-Up Studies
Hemodynamics
Humans
Male
Middle Aged
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - mortality
Pulmonary Embolism - physiopathology
Pulmonary Embolism - surgery
Pulmonary thromboendarterectomy
Radiography
Respiratory Function Tests
Survival Rate
Treatment Outcome
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Summary:Objective: In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. Methods: Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n=1/12/9) were re-evaluated 48–72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed. Results: All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NYHA class II and one patient was in class III. PVR and mean pulmonary artery pressure (mPAP) were significantly reduced (preoperative PVR 800±274 dynes/s per cm−5, follow-up PVR 180±28.3 dynes/s per cm−5; P≪0.001; preoperative mPAP 48.5±7.4 mmHg, follow-up mPAP 27.5±4.9 mmHg; P≪0.001). There was also a significant increase in arterial blood oxygen tension (preoperative PaO2 59±10 mmHg; follow-up PaO2 84±12 mmHg; P≪0.001). Chest roentgenograms and echocardiographic examinations revealed significantly decreased right heart dimensions and a recovery of right heart function. Conclusion: In patients with severe chronic thromboembolic pulmonary hypertension, persistent symptomatic and hemodynamic improvements can be achieved by PTE.
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(99)00076-7