Long-term results after thromboendarterectomy for chronic pulmonary embolism.
OBJECTIVE
In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated.


METHODS
Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n = 1/12/9) were re-evaluated 48-72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed.


RESULTS
All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NYHA class II and one patient was in class III. PVR and mean pulmonary artery pressure (mPAP) were significantly reduced (preoperative PVR 800+/-274 dynes/s per cm(-5), follow-up PVR 180+/-28.3 dynes/s per cm(-5); P < 0.001; preoperative mPAP 48.5+/-7.4 mmHg, follow-up mPAP 27.5+/-4.9 mmHg; P < 0.001). There was also a significant increase in arterial blood oxygen tension (preoperative PaO2 59+/-10 mmHg; follow-up PaO2 84+/-12 mmHg; P < 0.001). Chest roentgenograms and echocardiographic examinations revealed significantly decreased right heart dimensions and a recovery of right heart function.


CONCLUSIONS
In patients with severe chronic thromboembolic pulmonary hypertension, persistent symptomatic and hemodynamic improvements can be achieved by PTE.
Kramm
T
T
Department of Cardiothoracic- and Vascular Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. kramm@mail.uni-mainz.de
Mayer
E
E
Dahm
M
M
Guth
S
S
Menzel
T
T
Pitton
M
M
Oelert
H
H
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004691:Endarterectomy / Q000379:methods* / Q000401:mortality; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012129:Respiratory Function Tests; D015996:Survival Rate; D016896:Treatment Outcome