title: [Effects of thromboendarterectomy for post-embolic pulmonary hypertension on physiological dead space on exercise].
abstract: The effect of therapy on the modification of a functional parameter is an elegant method for assessing the causal relationship between functional abnormalities and symptoms. We report an analysis of the effects of thromboendarterectomy for post-embolic pulmonary arterial hypertension on exercise functional parameters. A patient (62 years) had post-embolic pulmonary hypertension documented by pulmonary angiography and right heart catheterization (PAP mean: 48 mmHg). Cardiopulmonary exercise testing demonstrated a decreased aerobic capacity (59% predicted), significant hyperventilation (VE/VO(2) at peak 82) and a dead space to tidal volume ratio (VD/Vt) increased at rest (0.55) and remaining high at peak exercise (0.48). Thromboendarterectomy was performed and led to a dramatic improvement in dyspnoea (NYHA class II to I), a gradual improvement in aerobic capacity, and a significant decrease of VD/Vt (0.26) and hyperventilation (VE/VO(2) at peak: 38) on exercise. This observation illustrates the fact that an increase in the physiological dead space on exercise is associated with significant hyperventilation and consequently dyspnoea of effort.
authors.affiliation: Service de pneumologie et d'immunoallergologie, centre de compétence des maladies pulmonaires rares, hôpital Calmette, CHRU, 1 boulevard Leclercq, Lille cedex, France.
authors.forename: A D
authors.initials: AD
authors.lastname: Botelho
authors.forename: G
authors.initials: G
authors.lastname: Tercé
authors.forename: L
authors.initials: L
authors.lastname: Stervinou-Wemeau
authors.forename: S
authors.initials: S
authors.lastname: Robin
authors.forename: B
authors.initials: B
authors.lastname: Wallaert
mesh_terms: D004417:Dyspnea / Q000209:etiology; D004691:Endarterectomy / Q000379:methods; D005080:Exercise Test; D017079:Exercise Tolerance; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012126:Respiratory Dead Space; D016896:Treatment Outcome; D016138:Walking