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Pulmonary endarterectomy, chronic thromboembolic pulmonary hypertension

Benedetta Vanini, Valentina Grazioli, Antonio Sciortino, Maurizio Pin, Vera N Merli, Anna Celentano, Ilaria Parisi, Catherine Klersy, Lucia Petrucci, Maurizio Salati, Pierluigi Politi, Andrea M D'Armini
BACKGROUND: In this prospective, single-center, observational study, we investigated the association between repeated short periods of circulatory arrest with moderate hypothermia during pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and different neuropsychological dimensions. METHODS: We examined 70 patients with CTEPH, >18 to 80 years of age, who had been treated with PEA. Neuropsychological testing was performed...
February 19, 2018: Journal of Heart and Lung Transplantation
Hideki Miwa, Nobuhiro Tanabe, Takayuki Jujo, Fumiaki Kato, Rie Anazawa, Keiko Yamamoto, Akira Naito, Hajime Kasai, Rintaro Nishimura, Rika Suda, Toshihiko Sugiura, Seiichiro Sakao, Keiichi Ishida, Masahisa Masuda, Koichiro Tatsumi
BACKGROUND: Several new treatments for chronic thromboembolic pulmonary hypertension (CTEPH) have appeared in recent years, which have led to changes in the treatment algorithm. Changes in survival rates and prognostic factors, however, have not been estimated so far.Methods and Results:Two hundred and eighty patients were diagnosed with CTEPH at Chiba University Hospital between June 1986 and June 2016. Survival rate was investigated by date of treatment initiation (group 1, 1986-1998; group 2, 1999-2008; group 3, 2009-2016)...
March 13, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Raffaele Pesavento, Paolo Prandoni
Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon and late complication of pulmonary embolism resulting from misguided remodelling of residual pulmonary thromboembolic material and small-vessel arteriopathy. CTEPH is the only form of pulmonary hypertension (PH) potentially curable by pulmonary endarterectomy (PEA). Unfortunately, several patients have either an unacceptable risk-benefit ratio for undergoing the surgical intervention or develop persistent PH after PEA. Novel medical and endovascular therapies can be considered for them...
March 2, 2018: Thrombosis Research
Takayuki Kawashima, Akihiro Yoshitake, Takashi Kawakami, Hideyuki Shimizu
We performed a two-stage procedure combining balloon pulmonary angioplasty and pulmonary endarterectomy for a high-risk chronic thromboembolic pulmonary hypertension patient with high pulmonary vascular resistance. First, balloon pulmonary angioplasty was performed for distal lesions to improve hemodynamics and decrease the surgical risk. Subsequently, pulmonary endarterectomy was performed for proximal lesions, and the hemodynamics and symptoms improved dramatically. Our strategy was therefore found to be useful for treating a high-risk chronic thromboembolic pulmonary hypertension patient...
February 23, 2018: Annals of Vascular Surgery
Panagiotis Karyofyllis, Varvara Papadopoulou, Vassilis Voudris, Hiromi Matsubara
PURPOSE OF REVIEW: Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of precapillary pulmonary hypertension. Although pulmonary endarterectomy (PEA) is the preferred management strategy, a significant number of CTEPH patients will have an inoperable disease. As drug therapy is not expected to offer relief from the mechanical component of the disease, the novel technique of balloon pulmonary angioplasty (BPA) has provided a new therapeutic option for patients with inoperable CTEPH...
February 24, 2018: Current Treatment Options in Cardiovascular Medicine
Thorsten Kramm, Heinrike Wilkens, Jan Fuge, Hans-Joachim Schäfers, Stefan Guth, Christoph B Wiedenroth, Bettina Weingard, Doerte Huscher, David Pittrow, Serghei Cebotari, Marius M Hoeper, Eckhard Mayer, Karen M Olsson
BACKGROUND: The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) is unknown. Previous studies from the United Kingdom and Spain have reported incidence rates of 1.75 and 0.9 per million, respectively. These figures, however, may underestimate the true incidence of CTEPH. METHODS: We prospectively enrolled patients newly diagnosed with CTEPH within 2016 in Germany. Data were obtained from the three German referral centers and from the German branch of COMPERA, a European pulmonary hypertension registry...
February 15, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Paolo Ruggeri, Federica Lo Bello, Francesco Nucera, Michele Gaeta, Francesco Monaco, Gaetano Caramori, Giuseppe Girbino
We present here the case of a 30-year-old man with a long term history of nephrotic syndrome (NS) who developed an episode of acute left main pulmonary artery thrombosis complicated by a lung abscess. During the hospital admission was also identified a concomitant hyperhomocysteinemia. After an atypical resection of the left upper pulmonary lobe and the starting of long term anticoagulation the patient was discharged but did not attend the planned follow up visits until one year later when he was seen again for severe dyspnea and exercise intolerance...
December 19, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Koji Hoshino, Koichi Takita, Masami Demura, Tomonori Kubo, Yuji Morimoto
No abstract text is available yet for this article.
June 16, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Jason M Ali, John Dunning, Choo Ng, Steven Tsui, John E Cannon, Karen K Sheares, Dolores Taboada, Mark Toshner, Nick Screaton, Joanna Pepke-Zaba, David P Jenkins
OBJECTIVES: Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH). Despite excellent outcomes following PEA, a small proportion of patients have residual proximal disease or present with recurrent chronic thromboembolic PH and may benefit from further surgery. The aim of this study was to analyse outcomes following reoperative PEA at a high-volume national tertiary referral centre for the management of chronic thromboembolic PH...
January 23, 2018: Interactive Cardiovascular and Thoracic Surgery
Mitsumasa Okano, Kazuhiko Nakayama, Naoki Tamada, Yuto Shinkura, Ken-Ichi Yanaka, Hiroyuki Onishi, Hidekazu Tanaka, Toshiro Shinke, Hiroshi Tanaka, Yutaka Okita, Noriaki Emoto, Ken-Ichi Hirata
Antiphospholipid syndrome (APS) is a cause of chronic thromboembolic pulmonary hypertension (CTEPH) and it is associated with an increased risk of postoperative neurological complications. We experienced a case of reversible parkinsonism after pulmonary endarterectomy (PEA) and subsequent multiple cerebral infarctions under standard anticoagulation therapy in a patient with CTEPH associated with APS. Strict management using a combination of antiplatelet and anticoagulation therapy should be considered in patients with a high titer of triple antiphospholipid antibodies in the perioperative period...
January 11, 2018: Internal Medicine
Kayo Sugiyama, Nobusato Koizumi, Hitoshi Ogino
Extrinsic compression of the left main coronary artery (LMCA) can occur in patients with an enlarged pulmonary artery trunk secondary to severe pulmonary hypertension (PH). This phenomenon rarely occurs in PH; moreover, few reports have shown that chronic thromboembolic PH can be a triggering factor for this syndrome. Herein, we describe a patient with extrinsic compression of the LMCA with chronic thromboembolic PH who underwent pulmonary endarterectomy and coronary artery bypass grafting successfully. Intravenous ultrasonography (IVUS) was effective for detecting and assessing the compression...
January 10, 2018: Annals of Thoracic and Cardiovascular Surgery
Woochan Kwon, Jeong Hoon Yang, Taek Kyu Park, Sung A Chang, Dong Seop Jung, Young Seok Cho, Sung Mok Kim, Tae Jung Kim, Hye Yoon Park, Seung Hyuk Choi, Duk Kyung Kim
BACKGROUND: The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. METHODS: Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session...
January 22, 2018: Journal of Korean Medical Science
Tom Verbelen, Alexander Van De Bruaene, Bjorn Cools, Dirk Van Raemdonck, Marion Delcroix, Filip Rega, Bart Meyns
OBJECTIVES: Left ventricular dysfunction after pulmonary endarterectomy is well described. Left ventricular failure has only been described after lung transplantation for pulmonary arterial hypertension (PAH). We sought to identify factors that contribute to this failure and hypothesized that atrial septostomy before transplantation could prevent this complication. METHODS: From our database, all bilateral lung transplants for PAH (n = 24) and all pulmonary endarterectomies, with a minimal reduction of 800 dyn⋅s⋅cm-5 (n = 27), were selected...
January 2, 2018: Interactive Cardiovascular and Thoracic Surgery
Mara B Antonoff
The Pavia group reports their experience with reoperative pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension. They achieved impressive results in terms of hemodynamic parameters and functional status; however, a mortality rate of 40% represents inappropriate patient selection. Recommendations are made for identifying ideal operative candidates.
November 24, 2017: Seminars in Thoracic and Cardiovascular Surgery
Aileen Kharat, Béatrice Duxbury, Anne-Lise Hachull, Stéphane Noble, Hélène Bouvaist, Paola M Soccal, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) is uncommon. Its diagnosis should not be delayed as its prognosis is poor if not treated. In most cases, an acute pulmonary embolism is found in the medical history of the patient. Once suspected, a specific work-up should be performed in a pulmonary hypertension (PH) center. The ventilation/perfusion scan has a central role in this workup but the emergence of non invasive imaging technologies provides morphological and functional information which take part in the therapeutic decision making, such as operability...
November 15, 2017: Revue Médicale Suisse
Yun-Xia Zhang, Ji-Feng Li, Yuan-Hua Yang, Zhen-Guo Zhai, Song Gu, Yan Liu, Ran Miao, Ping-Ping Zhong, Ying Wang, Xiao-Xi Huang, Chen Wang
Pulmonary arterial smooth muscle cell (PASMC) migration plays a key role in vascular remodeling, which occurs during development of chronic thromboembolic pulmonary hypertension (CTEPH). Activation of the renin-angiotensin system (RAS) contributes to vascular remodeling observed in many diseases, including idiopathic pulmonary arterial hypertension. However, the role of RAS imbalance in CTEPH has not been characterized. Here, we hypothesize that RAS imbalance regulates vascular remodeling by promoting PASMC migration in CTEPH...
February 1, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
Aiko Ogawa, Toru Satoh, Tetsuya Fukuda, Koichiro Sugimura, Yoshihiro Fukumoto, Noriaki Emoto, Norikazu Yamada, Atsushi Yao, Motomi Ando, Hitoshi Ogino, Nobuhiro Tanabe, Ichizo Tsujino, Masayuki Hanaoka, Kenji Minatoya, Hiroshi Ito, Hiromi Matsubara
BACKGROUND: Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. METHODS AND RESULTS: A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan...
November 2017: Circulation. Cardiovascular Quality and Outcomes
Long Deng, Jiade Zhu, Jianping Xu, Shaoxian Guo, Sheng Liu, Yunhu Song
OBJECTIVES: Pulmonary artery sarcoma (PAS) is a rare and devastating disease. The diagnosis modality and optimal surgical strategy remain unclear. The aim of this study was to report our surgical experience in this disease. METHODS: Between 2000 and 2017, 13 patients underwent operations for PAS at our institution. Five patients underwent tumour resection alone, whereas the other 8 patients received pulmonary endarterectomy. The medical records were retrospectively reviewed to evaluate the clinical characteristics, operative findings and the postoperative outcomes...
September 27, 2017: Interactive Cardiovascular and Thoracic Surgery
Stefan Guth, Christoph B Wiedenroth, Marc Wollenschläger, Manuel Jonas Richter, Hossein A Ghofrani, Matthias Arlt, Eckhard Mayer
OBJECTIVES: Pulmonary endarterectomy (PEA) is the only curative treatment option for patients with chronic thromboembolic pulmonary hypertension. Massive endobronchial bleeding that precludes weaning from cardiopulmonary bypass is an often-fatal complication of PEA. The aim of this study was to determine whether short-term extracorporeal membrane oxygenation (ECMO) is a safe and feasible procedure in patients with severe endobronchial bleeding. METHODS: From January 2014 to December 2016, 396 patients (mean age 60 ± 18 years, 54...
September 20, 2017: Journal of Thoracic and Cardiovascular Surgery
Michael D Rivers-Bowerman, Rebecca Zener, Arash Jaberi, Marc de Perrot, John Granton, John M Moriarty, Kong T Tan
Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. The prognosis of untreated CTEPH is poor, but advances in medical and surgical treatments over the past few decades have improved patient outcomes. The gold standard and curative treatment for CTEPH is pulmonary endarterectomy; however, some patients are inoperable and others who have undergone pulmonary endarterectomy experience persistent or recurrent pulmonary hypertension despite medical therapy...
September 2017: Techniques in Vascular and Interventional Radiology
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