[Surgical treatment of chronic thromboembolic pulmonary hypertension with pulmonary endarterectomy].
Acute pulmonary embolism is the third most common cardiovascular disease in Italy with approximately 65 000 new cases a year. Appropriate medical therapy does not necessarily prevent evolution of acute pulmonary embolism into chronic thromboembolic pulmonary hypertension (CTEPH), which occurs in 0.1-4.0% of cases. In our country, there are approximately up to 2600 new CTEPH patients a year. CTEPH is a progressive and potentially lethal disease. Medical therapy is palliative and only surgery can modify its natural history. Pulmonary endarterectomy (PEA) is the treatment of choice and lung transplantation should be considered only when PEA is contraindicated. Currently, nearly 4000 PEAs have been performed worldwide. Approximately ten centers are able to carry out this intervention with excellent and permanent results. Solid experience and close multidisciplinary collaboration allow appropriate patient selection, rigorous surgical technique, and adequate postoperative management. All these aspects represent the key to the success in the treatment of CTEPH. After PEA, quality and expected length of life are similar to the age-matched general population and the only therapy required is oral anticoagulation.
D'Armini
Andrea Maria
AM
Cattedra e Divisione di Cardiochirurgia, Università degli Studi di Pavia, IRCCS Policlinico San Matteo, Pavia. darmini@smatteo.pv.it
Zanotti
Giorgio
G
Pozzi
Matteo
M
Nicolardi
Salvatore
S
Tramontin
Corrado
C
Ruggieri
Vito G
VG
Morsolini
Marco
M
Tancredi
Fabrizio
F
Monterosso
Cristian
C
Viganò
Mario
M
D000208:Acute Disease; D002908:Chronic Disease; D004691:Endarterectomy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011651:Pulmonary Artery / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors