Recognizing pulmonary hypertension following pulmonary thromboendarterectomy: A practical guide for clinicians

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension (PH) arising from pulmonary vascular obstruction at varying levels within the pulmonary vascular bed, due to chronic pulmonary emboli. The cornerstone of treatment for CTEPH is pulmonary thromboendarterectomy (PTE), a specialized surgery to remove the chronic vascular obstruction. At experienced centers, PTE leads to marked hemodynamic improvement and, in many cases, normalization of cardiopulmonary hemodynamics. However, increasing evidence supports the fact that a significant percentage of patients will have persistent PH after PTE. No consensus exists on the optimal approach to post-PTE patient assessment, and often the most experienced CTEPH centers have little experience in the direct follow-up care of the CTEPH patient post PTE.In this article, we will discuss a practical approach to patient assessment after PTE to help guide clinicians on how to recognize significant PH following PTE. In doing so, we identify the true phenotype of persistent PH post PTE so that appropriate patients can be further helped with the evolving therapies for the management of CTEPH.

Exercise Testing in Patients with Pulmonary Hypertension

“…Here, the use of CPET can be highly valuable, for it can provide greater insight into the significance of each individual patient's physiologic response to exercise. Exercise testing can therefore be utilized to differentiate those post-PTE patients who will derive benefit from pulmonary vasodilator therapy or BPA, depending on the reason for the residual PH [22].…”

Diagnostic Evaluation of Chronic Thromboembolic Pulmonary Hypertension

“…18 Importantly, ongoing RV structure and function abnormalities post-PTE are highly suggestive of residual or recurrent PH and should be monitored carefully after PTE. 19…”

Nursing role in the care of patients undergoing pulmonary thromboendarterectomy. An integrative review

“…Pulmonary thromboendarterectomy, consisting of surgical disobliteration of the pulmonary arteries, is the treatment of choice and only potentially curative option for chronic thromboembolic pulmonary hypertension, classified as Group 4 pulmonary hypertension. 1 It is a rare condition, with an incidence of close to 4%. It is estimated that 1 to 5% of patients who survive an acute pulmonary thromboembolism may develop chronic thromboembolic pulmonary hypertension.…”