Lege Artis Medicinae

[Chronic thromboembolic pulmonary hypertension: diagnosis and treatment]

LENGYEL Mária1, TEMESVÁRI András1, RUSZTY László2, RAIMUND Erbel3, STEIN Iversen3

JANUARY 27, 1993

Lege Artis Medicinae - 1993;3(01)

[More than half of the cases of primary pulmonary hypertension belongs to the thromboembolic form which can successfully be treated by pulmonary thromboendarterectomy. The aim of the study was to demonstrate the selection of surgical candidates and the results of first operations. 22 patients were studied in the last 2 years in whom pulmonary systolic pressure was over 50 mm Hgby Doppler-echocardiography, and no cause could be identified and in whom transesophageal echocardiography was performed. Per fusion lung scan was carried out in 14, venous Doppler in 10 and pulmonary angiography in 7 cases. Out of 22 patients with suspected PPH an atrial septal defect (ASD) was found in 4 cases, chronic thromboembolic pulmonary hypertension (CTH-PH) in 10 patients and major vessel disease suitable for surgery was established in 6 of them. Acute pulmonary embolism was documented in the history of 2 and deep vein thrombosis in 6 out of the 10 cases. Patent foramen ovale was revealed in 5 of the 10 patients 2 of which led to fatal paradoxic embolism. ASD was closed in 3 cases. Two patients had successful pulmonary thromboendarterectomy followed by complete hemodynamic recovery. CTh-PH should be considered in any patient with effort dyspnea or signs of right ventricular overload for which no cardiac cause can be found, as successful surgical treatment may be possible. A diagnostic algorithm is proposed for the selection of surgical candidates. ]

AFFILIATIONS

  1. Országos Kardiológiai Intézet Budapest
  2. Jahn Ferenc Kórház, Kardiológia Budapest
  3. Johannes Gutenberg Egyetem, II. Belklinika és Szívsebészeti Klinika Mainz

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