Chronic thromboembolic pulmonary arterial hypertension: correlation of postoperative results of thromboendarterectomy with preoperative helical contrast-enhanced computed tomography.
BACKGROUND
Pulmonary thromboendarterectomy is the treatment of choice for patients with chronic thromboembolic pulmonary arterial hypertension (CTEPH). Some patients do poorly after this procedure and may be better candidates for heart-lung transplant. The purpose of this study was to correlate preoperative findings on helical contrast-enhanced computed tomography (CT) with surgical outcome.


METHODS
Thirty-seven patients (mean age 52.9, range 22-71) who underwent pulmonary thromboendarterectomy and had preoperative helical contrast-enhanced CT followed by High Resolution CT (HRCT) scans were included in the study. The CTs were evaluated for the presence of central and segmental disease and for the presence of mosaic perfusion pattern.


RESULTS
The presence of central disease, as well as the presence of segmental disease, correlated negatively with the postoperative mean pulmonary arterial pressure [r(c) = -0.401, P = 0.015, r(s) = -0.38, P = 0.024)] and the pulmonary vascular resistance [(r(c) = -0.37, P = 0.027, r(s) = -0.39, P = 0.019]. No correlation was found between the clinical variables and the presence of mosaic perfusion pattern.


CONCLUSIONS
Patients with CTEPH and evidence of chronic PE in the central or segmental pulmonary arteries have a better clinical outcome after pulmonary thromboendarterectomy than patients without these findings. The presence of mosaic perfusion pattern is not helpful in predicting postoperative outcome.
Oikonomou
Anastasia
A
Department of Radiology, The Ottawa Hospital, Ontario, Canada. aoikonom@med.duth.gr
Dennie
Carole J
CJ
Müller
Nestor L
NL
Seely
Jean M
JM
Matzinger
Fred R
FR
Rubens
Fraser D
FD
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012044:Regression Analysis; D012189:Retrospective Studies; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome