Improved Outcomes in Medically and Surgically Treated Chronic Thromboembolic Pulmonary Hypertension

Abstract

The prognosis in nonsurgical disease has improved. We have confirmed the previously described good outcome in surgically treated disease. However, we have also demonstrated that the long-term prognosis for patients who have persistent pulmonary hypertension at 3 months after surgery is good. The observed improvements in outcome during the modern treatment era reinforce the importance of identifying patients with this increasingly treatable condition.

Contrast‐enhanced multidetector‐row computed tomography vs. Time‐resolved magnetic resonance angiography vs. contrast‐enhanced perfusion MRI: Assessment of treatment response by patients with inoperable chronic thromboembolic pulmonary hypertension

“…As for the MRIs, a 3D slab was employed, but this one 110 mm thick with 20 partitions, also with the use of an overcontiguous slice technique in the coronal plane with left-to-right phase encoding, resulting in an effective partition thickness of 5 mm and 10-step real-phase encoding in the slice direction. Voxel sizes of time-resolved CE-MRA in all patients ranged from 2.3 mm 3 to 3.0 mm 3 .…”

“…With this protocol, high and uniform contrast enhancement was consistently achieved for the entire thorax of all patients. Voxel sizes of CE-MDCT in all patients ranged from 0.34 mm 3 to 0.70 mm 3 .…”

“…For each scan, 20 images were obtained at end-inspiration of a single breath-hold. Voxel sizes of dynamic CE-perfusion MRI in all patients were ranged from 30.9 mm 3 to 85.8 mm 3 .…”

“…Further increases in pulmonary artery pressure may occur and is thought to be related to the development of precapillary arteriopathy with pathological abnormalities, which is similar to idiopathic pulmonary arterial hypertension. In addition, patient outcomes have been improved by means of medical and surgical treatments in CTEPH patients (3). Diagnosis of CTEPH is based on the findings of radiological investigations performed during the assessment of patients with hypertension.…”

Lung perfusion: MRI vs. SPECT for screening in suspected chronic thromboembolic pulmonary hypertension

“…It is important that the diagnosis of CTEPH is made, as pulmonary endarterectomy is associated with increased survival and a favorable functional outcome in CTEPH 1. The 2013 World Symposium on Pulmonary Hypertension recommended single photon emission computed tomography (SPECT) ventilation/perfusion (V/Q) scintigraphy as the preferred screening test for CTEPH,8 but this entails injection of 100 MBq of 99mTc‐labeled macroaggregated human albumin, resulting in exposure to ionizing radiation with an effective dose of 0.017 mSv/MBq 9…”