CT scan findings in chronic thromboembolic pulmonary hypertension: predictors of hemodynamic improvement after pulmonary thromboendarterectomy.
OBJECTIVE
The aim was to correlate CT scan findings with hemodynamic measurements in patients who had undergone pulmonary thromboendarterectomy (PTE) and to evaluate whether CT scan findings can help to predict surgical outcome.


METHODS
Sixty patients who underwent PTE and preoperative helical CT scanning were included. Preoperative and postoperative hemodynamics were correlated with preoperative CT imaging features.


RESULTS
The diameter of the main pulmonary artery (PA) and the ratio of the PA and the diameter of the ascending aorta correlated with preoperative mean pulmonary artery pressure (PAP) [r = 0.42; p < 0.001; and r = 0.48; p < 0.0001, respectively]. There was a significant correlation of subpleural densities with preoperative pulmonary vascular resistance (PVR) [r = 0.44; p < 0.001] and of the number of abnormal perfused lobes with preoperative PAP (r = 0.66; p < 0.0001) and PVR (r = 0.76; p < 0.0001). Postoperative PVR correlated negatively with the presence and extent of central thrombi (r = -0.36; p = 0.007) and dilated bronchial arteries (p = 0.03) seen on preoperative CT scans. Sixty percent of patients (3 of 5 patients) without visible central thromboembolic material on CT scans had an inadequate hemodynamic improvement in contrast to 4% of patients (2 of 51 patients) with central thrombi (p = 0.003). Preoperative PVR (r = 0.31; p = 0.018) and the extent of abnormal lung perfusion (r = 0.37; p = 0.007) and of subpleural densities (r = 0.32; p = 0.017) were positively correlated with postoperative PVR.


CONCLUSIONS
In patients with thromboembolic pulmonary hypertension, CT scan findings can help to predict hemodynamic improvement after PTE. The absence of central thrombi is a significant risk factor for inadequate hemodynamic improvement.
Heinrich
Marc
M
Department of Diagnostic Radiology, University Hospital of Saarland, Homburg/Saar, Germany.
Uder
Michael
M
Tscholl
Dietmar
D
Grgic
Aleksandar
A
Kramann
Bernhard
B
Schäfers
Hans-Joachim
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001981:Bronchial Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002908:Chronic Disease; D004108:Dilatation, Pathologic; D004691:Endarterectomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000209:etiology; D012307:Risk Factors; D036542:Tomography, Spiral Computed