[Treatment of chronic thromboembolic pulmonary hypertension through pulmonary thromboendarterectomy and the effect of deep hypothermia circulation arrest thereon].
OBJECTIVE
To evaluate the role of the pulmonary thromboendarterectomy (PTE) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and the effect of the deep hypothermia circulation arrest (DHCA) thereon.


METHODS
The clinical data of 40 cases of CTEPH, 25 cases of central type and 15 cases of peripheral type, 29 males and 11 females, aged 46 +/- 12 (20 - 70), underwent PTH, 17 under deep hypothermia circulatory arrest (DHCA, Group A) and 23 not under DHCA (Group B), from February 1995 to October 2006. Follow-up was conducted for 41.8 +/- 36.4 months.


RESULTS
In the peri-operative period, no patient died in Group A and there were 6 deaths in Group B. 9 suffered with residual pulmonary hypertension and 18 with severe pulmonary reflux injury. 72 h after the PTE, the pulmonary artery systolic pressure (PASP) was 58.3 +/- 30.7 mm Hg, significantly lower than that before PTS (91.4 +/- 38.4 mm Hg, P < 0.05), the pulmonary vascular resistance (PVR) was 357 +/- 278.7 dynes x sec(-1) x cm(-5), significantly lower than that before PTE (978 +/- 675.6 dynes x sec(-1) x cm(-5), P < 0.01); the partial pressure of oxygen in the arterial blood (PaO(2)) was 89.9 +/- 7 mm Hg, significantly higher than that before the PTE (54.5 +/- 7.7 mm Hg, P < 0.01),; and the arterial oxygen saturation (SaO(2)) was 96.5 +/- 1.8%, significantly higher than that before the PTE (90 +/- 4.3%, P < 0.05). During the follow-up there were 2 late deaths, and the cardiac function was graded as NYHA class I in 22 patients, as NYHA class II in 9 patients, and as NYHA class III in 1 patient.


CONCLUSIONS
DHCA is a necessary and elementary condition for PTE, and it is a key factor in promoting the effect of PTE to treat the pulmonary reflux injury and residual pulmonary hypertension properly.
Gan
Hui-Li
HL
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. ganhuili@hotmail.com
Zhang
Jian-Qun
JQ
Chen
Hui
H
Mu
Jun-Sheng
JS
Zhou
Qi-Wen
QW
Wang
Sheng-Xun
SX
Zheng
Si-Hong
SH
Zhang
Xiang-Feng
XF
Liu
Shuang
S
D000328:Adult; D000368:Aged; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011655:Pulmonary Embolism / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies