Chronic thromboembolic pulmonary hypertension

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that results from obstruction of the major pulmonary arteries by incompletely resolved or organized pulmonary emboli that have become incorporated into the pulmonary artery wall, eventually causing an increase in pulmonary vascular resistance. From 0.1 to 4.0% of patients recovering from acute pulmonary embolism develop CTEPH. Without intervention, CTEPH is a progressive and lethal disease for which there is no effective medical therapy. Pulmonary endarterectomy (PEA) is the treatment of choice. Careful pre- and postoperative management is essential for a successful outcome after PEA. Lung transplantation is indicated only in few cases when PEA is not feasible. In 1994, we started a program (in Pavia, Italy) in which members of a multidisciplinary team work closely with the aim of increasing experience in the challenging problems these patients present in the evaluative, surgical, and postoperative phases of their care. To date, 134 PEAs have been performed. Preoperatively, New York Heart Association (NYHA) class distribution was three class II, 56 class III, and 75 class IV patients, respectively; mean pulmonary artery pressure and pulmonary vascular resistance values were 47 ± 13 mm Hg and 1149 ± 535 dyn/s/cm-5, respectively. The overall operative mortality has been 9.7% (4.5% in 2004). Survival at 3-month, 1-year, and 3-year follow-up was 89.5 ± 2.6%, 87.8 ± 2.9%, and 83.3 ± 3.5%, respectively; this last rate was unchanged up to 10 years. After PEA, mean pulmonary artery pressure and pulmonary vascular resistance values were 25 it 9 mm Hg and 322 ± 229 dyn/s/cm-5, respectively, and these results were stable over time. At the 3-year follow-up, 94% of patients were in NYHA class I or II and were being treated with oral anticoagulants only.

Original languageEnglish
Pages (from-to)848-855
Number of pages8
JournalSeminars in Thrombosis and Hemostasis
Volume32
Issue number8
DOIs
Publication statusPublished - Nov 2006

Fingerprint

Endarterectomy
Pulmonary Hypertension
Pulmonary Artery
Lung
Vascular Resistance
Pressure
Lung Transplantation
Rare Diseases
Embolism
Pulmonary Embolism
Anticoagulants
Italy
Survival
Mortality
Therapeutics

Keywords

  • Anticoagulants
  • Chronic pulmonary hypertension
  • Lung transplantation
  • Pulmonary endarterectomy
  • Thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Chronic thromboembolic pulmonary hypertension. / Piovella, Franco; D'Armini, Andrea M.; Barone, Marisa; Tapson, Victor F.

In: Seminars in Thrombosis and Hemostasis, Vol. 32, No. 8, 11.2006, p. 848-855.

Research output: Contribution to journalArticle

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abstract = "Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that results from obstruction of the major pulmonary arteries by incompletely resolved or organized pulmonary emboli that have become incorporated into the pulmonary artery wall, eventually causing an increase in pulmonary vascular resistance. From 0.1 to 4.0{\%} of patients recovering from acute pulmonary embolism develop CTEPH. Without intervention, CTEPH is a progressive and lethal disease for which there is no effective medical therapy. Pulmonary endarterectomy (PEA) is the treatment of choice. Careful pre- and postoperative management is essential for a successful outcome after PEA. Lung transplantation is indicated only in few cases when PEA is not feasible. In 1994, we started a program (in Pavia, Italy) in which members of a multidisciplinary team work closely with the aim of increasing experience in the challenging problems these patients present in the evaluative, surgical, and postoperative phases of their care. To date, 134 PEAs have been performed. Preoperatively, New York Heart Association (NYHA) class distribution was three class II, 56 class III, and 75 class IV patients, respectively; mean pulmonary artery pressure and pulmonary vascular resistance values were 47 ± 13 mm Hg and 1149 ± 535 dyn/s/cm-5, respectively. The overall operative mortality has been 9.7{\%} (4.5{\%} in 2004). Survival at 3-month, 1-year, and 3-year follow-up was 89.5 ± 2.6{\%}, 87.8 ± 2.9{\%}, and 83.3 ± 3.5{\%}, respectively; this last rate was unchanged up to 10 years. After PEA, mean pulmonary artery pressure and pulmonary vascular resistance values were 25 it 9 mm Hg and 322 ± 229 dyn/s/cm-5, respectively, and these results were stable over time. At the 3-year follow-up, 94{\%} of patients were in NYHA class I or II and were being treated with oral anticoagulants only.",
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