Treatment experience of patients with chronic thromboembolic pulmonary hypertension combined with severe right heart dysfunction: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Jiade , DU Juan , JIANG Xin , WU Yan , SHI Li , LUO Qing , GAO Ge , LOU Song , JI Bingyang , YANG Jing , WU Liming , LIU Mingzheng , LIU Zhihong , JING Zhicheng , SONG Yunhu ,  LIU Sheng

Adult Cardiac Surgery Center, Pulmonary Vascular Disease Center, Extracorporeal Circulation Center, Anesthesia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P.R.China;

Corresponding author：

LIU Sheng, Email: liusheng1999@msn.com

Keywords：

Chronic thromboembolic pulmonary hypertension; pulmonary endarterectomy; severe right heart failure; treatment result

DOI：

10.7507/1007-4848.201608026

Video：

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Objective To discuss the safety and validity of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) patients with severe right heart failure (RHF). Methods PEA procedures were performed on 36 patients in Fu Wai Hospital from January 2015 to April 2016. There were 28 males and 8 females, with a mean age of 46.56±11.85 years. According to the New York Heart Association (NYHA) cardiac function classification, 36 patients were divided into preoperative severe RHF group (grade Ⅲ-Ⅳ,n=28) and preoperative without severe RHF group (grade Ⅱ,n=8). Hemodynamic parameters before and after PEA were recorded and 3-18 months' follow-up was done. Results All the patients having PEA surgeries had an obvious decrease of mean pulmonary arterial pressure (from 49.53±13.14 mm Hg to 23.58±10.79 mm Hg) and pulmonary vascular resistance (from 788.46±354.60 dyn·s/cm⁵ to 352.89±363.49 dyn·s/cm⁵, bothP<0.001). There was no in-hospital mortality among all the patients. Persistent pulmonary hypertension occurred in 2 patients, perfused lung in 2 patients, pericardial effusion in 2 patients. No mortality was found during the follow-up period. All patients improved to NYHA grade Ⅰ-Ⅱ (WHO grade Ⅰ-Ⅱ), and only 2 patients remained in the NYHA grade Ⅲ (P<0.01). Conclusion The CTEPH patients having PEA surgeries had an obvious improvement in both their hemodynamics results and postoperative heart function, which in return could improve their quality of life.

Citation： ZHU Jiade, DU Juan, JIANG Xin, WU Yan, SHI Li, LUO Qing, GAO Ge, LOU Song, JI Bingyang, YANG Jing, WU Liming, LIU Mingzheng, LIU Zhihong, JING Zhicheng, SONG Yunhu, LIU Sheng. Treatment experience of patients with chronic thromboembolic pulmonary hypertension combined with severe right heart dysfunction: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 269-274. doi: 10.7507/1007-4848.201608026 Copy

1.	Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J, 2009, 34(6): 1219-1263.
2.	De Perrot M, Fadel E, McRae K, et al. Evaluation of persistent pulmonary hypertension after acute pulmonary embolism. Chest, 2007, 132(3): 780-785.
3.	Riddle M, Widimsky J, Prerovsky I, et al. Long term follow-up of patients with pulmonary thromboembolism: late prognosis and evolution of hemodynamic and respiratory data. Chest, 1982, 81(2): 151-158.
4.	Menzel T, Wagner S, Kramm T, et al. Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy. Chest, 2000, 118(4): 897-903.
5.	Liu M, Ma Z, Guo X, et al. Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction. Eur J Radiol, 2011, 80(3): e462-e469.
6.	Escribano-Subías P, Del Pozo R, Román-Broto A, et al. Management and outcomes in chronic thromboembolic pulmonary hypertension: From expert centers to a nationwide perspective. Int J Cardiol, 2016, 203: 938-944.
7.	de Perrot M, Thenganatt J, McRae K, et al. Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant, 2015, 34(3): 369-375.
8.	Bresser P, Pepke-Zaba J, Jais X, et al. Medical therapies for chronic thromboembolic pulmonary hypertension. An evolving treatment paradigm. Proc Am Thorac Soc, 2006, 3(7): 594-600.
9.	Jensen K, Kerr K, Fedullo P, et al. Pulmonary hypertensive medical therapy in chronic thromboembolic pulmonary hypertension before pulmonary thromboendarterectomy. Circulation, 2009, 120(13): 1248-1254.
10.	Kim N. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc, 2006, 3(7): 584-588.
11.	Darteville P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Resp J, 2004, 23(4): 637-648.
12.	D’Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med, 1991, 115(5): 343-349.
13.	Olschewski H, Simonneau G, Galiè N, et al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med, 2002, 347(5): 322-329.
14.	Mehta S, Helmersen D, Provencher S, et al. Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: A clinical practice guideline. Can Respir J, 2010, 17(6): 301-334.
15.	宁宁, 王岚, 张宏达, 等. 基于吸入伊洛前列素的联合治疗策略挽救合并严重右心衰竭肺动脉高压的探索. 中华心血管病杂志, 2015, 43(9): 765-768.
16.	Mariëlle C, van de Veerdonk, Taco Kind, et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol, 2011, 58(24): 2511-2519.
17.	Mydin M, Berman M, Klein A, et al. Extracorporeal membrane oxygenation as a bridge to pulmonary endarterectomy. Ann Thorac Surg, 2011, 92(5): e101-e103.
18.	Kitamura T, Morota T, Takamoto S. Emergent pulmonary thromboen-darterectomy with percutaneous cardiopulmonary support system for chronic thromboembolic pulmonary hypertension. Eur J Cardiothorac Surg, 2003, 24(4): 656-658.
19.	Voswinckel R, Hoeper MM, Kramm T, et al. Right heart failure in chronic pulmonary hypertension and acute pulmonary embolism. Internist (Berl), 2012, 53(5): 545-556.

1. Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J, 2009, 34(6): 1219-1263.
2. De Perrot M, Fadel E, McRae K, et al. Evaluation of persistent pulmonary hypertension after acute pulmonary embolism. Chest, 2007, 132(3): 780-785.
3. Riddle M, Widimsky J, Prerovsky I, et al. Long term follow-up of patients with pulmonary thromboembolism: late prognosis and evolution of hemodynamic and respiratory data. Chest, 1982, 81(2): 151-158.
4. Menzel T, Wagner S, Kramm T, et al. Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy. Chest, 2000, 118(4): 897-903.
5. Liu M, Ma Z, Guo X, et al. Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction. Eur J Radiol, 2011, 80(3): e462-e469.
6. Escribano-Subías P, Del Pozo R, Román-Broto A, et al. Management and outcomes in chronic thromboembolic pulmonary hypertension: From expert centers to a nationwide perspective. Int J Cardiol, 2016, 203: 938-944.
7. de Perrot M, Thenganatt J, McRae K, et al. Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant, 2015, 34(3): 369-375.
8. Bresser P, Pepke-Zaba J, Jais X, et al. Medical therapies for chronic thromboembolic pulmonary hypertension. An evolving treatment paradigm. Proc Am Thorac Soc, 2006, 3(7): 594-600.
9. Jensen K, Kerr K, Fedullo P, et al. Pulmonary hypertensive medical therapy in chronic thromboembolic pulmonary hypertension before pulmonary thromboendarterectomy. Circulation, 2009, 120(13): 1248-1254.
10. Kim N. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc, 2006, 3(7): 584-588.
11. Darteville P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Resp J, 2004, 23(4): 637-648.
12. D’Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med, 1991, 115(5): 343-349.
13. Olschewski H, Simonneau G, Galiè N, et al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med, 2002, 347(5): 322-329.
14. Mehta S, Helmersen D, Provencher S, et al. Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: A clinical practice guideline. Can Respir J, 2010, 17(6): 301-334.
15. 宁宁, 王岚, 张宏达, 等. 基于吸入伊洛前列素的联合治疗策略挽救合并严重右心衰竭肺动脉高压的探索. 中华心血管病杂志, 2015, 43(9): 765-768.
16. Mariëlle C, van de Veerdonk, Taco Kind, et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol, 2011, 58(24): 2511-2519.
17. Mydin M, Berman M, Klein A, et al. Extracorporeal membrane oxygenation as a bridge to pulmonary endarterectomy. Ann Thorac Surg, 2011, 92(5): e101-e103.
18. Kitamura T, Morota T, Takamoto S. Emergent pulmonary thromboen-darterectomy with percutaneous cardiopulmonary support system for chronic thromboembolic pulmonary hypertension. Eur J Cardiothorac Surg, 2003, 24(4): 656-658.
19. Voswinckel R, Hoeper MM, Kramm T, et al. Right heart failure in chronic pulmonary hypertension and acute pulmonary embolism. Internist (Berl), 2012, 53(5): 545-556.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment experience of patients with chronic thromboembolic pulmonary hypertension combined with severe right heart dysfunction: A case control study

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