[Surgical treatment of pulmonary hypertension].
There are two important options in the surgical treatment of chronic pulmonary hypertension, namely thrombendarterectomy or, if there are no other alternatives, transplantation, which nowadays is almost always double-lung transplantation. Pulmonary thrombendarterectomy is indicated in patients who have a mean pulmonary artery pressure (PAPm) of 40 mm Hg or more, have proximal changes (types I - II) and are in NYHA functional class III - IV. An initial estimate of whether surgical intervention is reasonable can be obtained with spiral computed tomography and pulmonary angiography. Immediate postoperative death rate averages 10 %. In well selected patients operation improves hemodynamics, quality of life and long-term prognosis. Transplantation is indicated in the end-stage. But this therapeutic option is limited by the scarcity of lungs suitable as transplants.
Wahlers
Th
T
Herz-, Thoraxchirurgie, Herzzentrum, Universitätsklinikum Köln, Kerpener Strasse 62, 50924 Köln. thorsten.wahlers@uk-koeln.de
D000792:Angiography / Q000379:methods; D004691:Endarterectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology; D036542:Tomography, Spiral Computed