Pulmonary endarterectomy for chronic thromboembolic disease

Yıldızeli, Şehnaz Olgun; Kepez, Alper; Taş, Serpil; Yanartaş, Mehmed; Durusoy, Ali; Erkılınç, Atakan; Mutlu, Bülent; Kaymaz, Ci̇hangi̇r; Sunar, Hasan; Yıldızeli, Bedrettin

doi:10.14744/anatoljcardiol.2018.37929

Cited by 22 publications

(30 citation statements)

References 25 publications

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“…Another instance where pre-capillary PH can be diagnosed at an earlier stage is chronic thromboembolism, as in this setting exercise limitation can occur in the absence of overt PH at rest due to the increase in dead-space ventilation resulting in a decreased ventilatory efficiency. Recently, two cohorts of 42 and 23 patients, respectively, have been reported with extensive persistent thromboembolic occlusions but without PH [18, 19]. At diagnosis, mPAP was 15–24 mmHg and PVR was 2–3 WU.…”

Section: Haemodynamic Definitionsmentioning

confidence: 99%

Haemodynamic definitions and updated clinical classification of pulmonary hypertension

et al. 2019

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Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this mean value would suggest mPAP >20 mmHg as above the upper limit of normal (above the 97.5th percentile). This definition is no longer arbitrary, but based on a scientific approach. However, this abnormal elevation of mPAP is not sufficient to define pulmonary vascular disease as it can be due to an increase in cardiac output or pulmonary arterial wedge pressure. Thus, this 6th WSPH Task Force proposes to include pulmonary vascular resistance ≥3 Wood Units in the definition of all forms of pre-capillary PH associated with mPAP >20 mmHg. Prospective trials are required to determine whether this PH population might benefit from specific management.Regarding clinical classification, the main Task Force changes were the inclusion in group 1 of a subgroup “pulmonary arterial hypertension (PAH) long-term responders to calcium channel blockers”, due to the specific prognostic and management of these patients, and a subgroup “PAH with overt features of venous/capillaries (pulmonary veno-occlusive disease/pulmonary capillary haemangiomatosis) involvement”, due to evidence suggesting a continuum between arterial, capillary and vein involvement in PAH.

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Section: Haemodynamic Definitionsmentioning

confidence: 99%

Haemodynamic definitions and updated clinical classification of pulmonary hypertension

et al. 2019

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“…10,[17][18][19] The prompt recognition of CTEPH and instigating early treatment is a critical factor in its management since it remains a potentially 'curable' condition by way of a pulmonary endarterectomy, which can dramatically improve symptoms of dyspnoea. 20,21 This is underscored by the fact that if CTEPH remains undiagnosed or untreated, the 5-year survival is approximately 30% and is associated with a marked increase in morbidity and a detrimental effect on quality of life. 22…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification of Acute Pulmonary Embolism and Determining the Effect on Chronic Cardiopulmonary Complications: The REACH Study

Stevens

Fang

Clements

et al. 2020

TH Open

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Introduction Patients with acute pulmonary embolism (PE) are at risk of developing chronic complications including the post-PE syndrome with reduced cardiopulmonary function and chronic thromboembolism pulmonary hypertension (CTEPH). Risk stratification at PE diagnosis is an important tool in predicting early mortality; however, its use in predicting chronic complications has not been evaluated. Objective This study investigates the effect of initial risk stratification of intermediate risk and standard risk PE on the rate of development of chronic complications including right ventricular (RV) dysfunction, residual perfusion defects, and CTEPH. Methods Cases of acute PE (n = 1,524) were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification discharge diagnosis coding for PE. Evidence of RV dysfunction and systolic blood pressure < 90 mm Hg were used to risk stratify into high, intermediate and standard risk PE. Results There were 508 patients included in the analysis. Intermediate risk PE was associated with higher rates of persistent RV dysfunction as well as residual perfusion defects on repeat imaging. The overall rate of CTEPH was low (0.6%) and there was no difference between the intermediate risk and standard risk PE groups. Conclusion These findings demonstrate that acute intermediate risk PE is associated with higher rates of RV dysfunction on follow-up imaging than standard risk PE. However, the rate of CTEPH was similar between the two groups and overall the CTEPH rate was low among all patients with intermediate and standard risk PE.

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“…5 However, several issues, whether the reducing the definitive cut-off value of PH to 20 mmHg significantly increases the ''new'' prevalence of the patients with pre-C PH or may lead to misdiagnosis, unnecessary RHC procedures, earlier initiation of aggressive PAH-targeted therapies in borderline pre-C PH subsets, and surgical endarterectomy in chronic thromboembolic disease remain to be determined. [14][15][16] In this single-center retrospective study, we aimed to evaluate the characteristics of patients with normal mPAP, borderline elevation in mPAP and overt PH, and to assess the impact of the revised PH definitive mPAP threshold >20 mmHg on diagnosis rates of additional PH, pre-C PH, and combined pre-and post-capillary (co-pre-post-C) PH as compared to those with prior cut-off value of mPAP !25 mmHg.…”

Section: Introductionmentioning

confidence: 99%

“…However, several issues, whether the reducing the definitive cut-off value of PH to 20 mmHg significantly increases the “new” prevalence of the patients with pre-C PH or may lead to misdiagnosis, unnecessary RHC procedures, earlier initiation of aggressive PAH-targeted therapies in borderline pre-C PH subsets, and surgical endarterectomy in chronic thromboembolic disease remain to be determined. 14 – 16 …”

Section: Introductionmentioning

confidence: 99%

Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension

et al. 2020

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Pulmonary endarterectomy for chronic thromboembolic disease

Cited by 22 publications

References 25 publications

Haemodynamic definitions and updated clinical classification of pulmonary hypertension

Haemodynamic definitions and updated clinical classification of pulmonary hypertension

Risk Stratification of Acute Pulmonary Embolism and Determining the Effect on Chronic Cardiopulmonary Complications: The REACH Study

Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension

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