title: Chronic Thromboembolic Pulmonary Hypertension: Experience from a Single Center in Mexico.
abstract: BACKGROUND
  Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by precapillary pulmonary hypertension secondary to vaso-occlusive pulmonary vasculopathy and is classified as Pulmonary Hypertension Group 4. The aim of this study is to report the clinical experience of CTEPH in Mexico.
  
  
  METHODS
  Consecutive patients diagnosed with CTEPH were identified from the Registro de Pacientes con Hipertension Pulmonar del Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (REPHPISSSTE) registry between January 2009 and February 2014. Right heart catheterization was not routinely performed prior to August 2010 in the work-up of CTEPH.
  
  
  RESULTS
  We identified 50 patients with CTEPH; their median age was 63 years and 58 % were female. Patients had multiple associated co-morbidities and moderate hemodynamic impairment. All patients were treated with anticoagulation. Despite surgical evaluation for pulmonary endarterectomy (PEA), only one patient underwent PEA given the lack of infrastructure for post-operative care and lack of insurance for this procedure. Most of the patients were treated with sildenafil, bosentan, or both, with increasing use of rivaroxaban and sildenafil in recent years. The overall survival of the cohort was similar to that reported in other international registries, despite the limitations of care imposed by drug availability and surgical feasibility.
  
  
  CONCLUSIONS
  This is the first report on the CTEPH experience in Mexico. It highlights the similarity of patients in the REPHPISSSTE registry to those in international registries as well as the challenges that clinicians face in a resource-limited setting.
authors.affiliation: Pulmonary, Critical Care and Sleep Division, Tufts Medical Center, 800 Washington Street, Box 257, Boston, MA, 02111, USA.|Tufts Clinical and Translational Science Institute, Boston, MA, USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Al-Naamani
authors.affiliation: Hospital Regional "1° Octubre", Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (ISSSTE), Mexico, DF, Mexico.
authors.forename: Gaudalupe
authors.initials: G
authors.lastname: Espitia H
authors.affiliation: Hospital Regional "1° Octubre", Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (ISSSTE), Mexico, DF, Mexico.
authors.forename: Hugo
authors.initials: H
authors.lastname: Velazquez-Moreno
authors.affiliation: Hospital Regional "1° Octubre", Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (ISSSTE), Mexico, DF, Mexico.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Macuil-Chazaro
authors.affiliation: Hospital Regional "1° Octubre", Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (ISSSTE), Mexico, DF, Mexico.
authors.forename: Arturo
authors.initials: A
authors.lastname: Serrano-Lopez
authors.affiliation: Hospital Regional "1° Octubre", Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (ISSSTE), Mexico, DF, Mexico.
authors.forename: Ricardo S
authors.initials: RS
authors.lastname: Vega-Barrientos
authors.affiliation: Pulmonary, Critical Care and Sleep Division, Tufts Medical Center, 800 Washington Street, Box 257, Boston, MA, 02111, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
authors.affiliation: Pulmonary, Critical Care and Sleep Division, Tufts Medical Center, 800 Washington Street, Box 257, Boston, MA, 02111, USA. ipreston@tuftsmedicalcenter.org.
authors.forename: Ioana R
authors.initials: IR
authors.lastname: Preston
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002407:Catheterization, Swan-Ganz; D002908:Chronic Disease; D015897:Comorbidity; D004691:Endarterectomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents
keywords: Chronic thromboembolic pulmonary hypertension; Management; Pulmonary endarterectomy; Survival