Vnitr Lek 2019, 65(5):353-358 | DOI: 10.36290/vnl.2019.063

Surgical treatment of chronic thromboembolic pulmonary hypertension

Matúš Nižňanský^1,*, David Ambrož², Tomáš Prskavec¹, Pavel Jansa², Jaroslav Lindner¹

¹ II. chirurgická klinika kardiovaskulární chirurgie 1. LF UK a VFN v Praze

² II. interní klinika - klinika kardiologie a angiologie 1. LF UK a VFN v Praze

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by a mean pulmonary artery pressure that exceeds 25 mm Hg and is caused by intraluminal thrombi organisation, stenosis and occlusions of pulmonary artery and its branches and peripheral vascular remodelation. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. The only center that specializes into the surgical treatment of patients with CTEPH in the Czech Republic is the Complex Cardiovascular Centre at the General Teaching Hospital in Prague. Between years 2004-2017 there were 314 patients operated (including 50 patients from Slovakia, where this treatment is not available). Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon angioplasty or lung transplantation.

Keywords: balloon angioplasty; chronic thromboembolic pulmonary hypertension; pulmonary endarterectomy; riociguat; surgical technique; treatment options

Received: May 10, 2018; Accepted: October 15, 2018; Published: May 1, 2019  Show citation