Rubens F, Wells P, Bencze S, Bourke M
University of Ottawa Heart Institute, Ottawa, Canada.
Can Respir J. 2000 Jan-Feb;7(1):49-57. doi: 10.1155/2000/496809.
There are only limited treatment options for patients with chronic thromboembolic pulmonary hypertension in Canada.
To conduct a case-series study to assess the effectiveness of surgical endarterectomy of the pulmonary artery.
Twenty-one patients with chronic thromboembolic pulmonary hypertension were admitted for surgery between July 1995 and October 1999. Clinical, laboratory and radiological data were collected for all patients who then underwent pulmonary thromboendarterectomy.
Thirteen men and eight women between 22 and 71 years of age underwent surgery. The main presenting complaint was dyspnea on exertion. Pulmonary vascular resistance ranged from 382 to 1694 dynes s cm-5 with a mean of 765+/-372 dynes s cm-5 (normal is less than 180 dynes s cm-5) with a mean cardiac index of 2.2+/-0.9 L/min/m2. Two patients had concomitant tricuspid valve replacement and one patient had coronary bypass grafting. In three cases, the surgery involved a repeat sternotomy. After surgery, there was a significant drop in the pulmonary vascular resistance (208+/-92 dynes s cm-5, P<0.05) and a concomitant rise in the cardiac index to a mean of 3.1+/-0.6 L/min/m2 (P<0.05). There was one death in a patient who also had severe chronic obstructive pulmonary disease. Of the remaining patients, all but two showed significant clinical improvement. Spiral computed tomography postsurgery demonstrated improvement in pulmonary perfusion with either complete clearing or significant improvement in the mosaic perfusion pattern. Right ventricular function and pressure on echocardiogram improved in all but two patients.
Pulmonary thromboendarterectomy provides effective treatment for chronic thromboembolic pulmonary hypertension.
在加拿大，慢性血栓栓塞性肺动脉高压患者的治疗选择有限。
进行一项病例系列研究，以评估肺动脉内膜剥脱术的有效性。
1995年7月至1999年10月期间，21例慢性血栓栓塞性肺动脉高压患者入院接受手术。收集了所有接受肺动脉血栓内膜剥脱术患者的临床、实验室和放射学数据。
13名男性和8名女性，年龄在22岁至71岁之间接受了手术。主要主诉为劳力性呼吸困难。肺血管阻力范围为382至1694达因·秒·厘米⁻⁵，平均为765±372达因·秒·厘米⁻⁵（正常小于180达因·秒·厘米⁻⁵），平均心脏指数为2.2±0.9升/分钟/平方米。2例患者同时进行了三尖瓣置换术，1例患者进行了冠状动脉搭桥术。3例手术涉及再次开胸。术后，肺血管阻力显著下降（208±92达因·秒·厘米⁻⁵，P<0.05），同时心脏指数上升至平均3.1±0.6升/分钟/平方米（P<0.05）。1例患有严重慢性阻塞性肺疾病的患者死亡。其余患者中，除2例外均有显著的临床改善。术后螺旋计算机断层扫描显示肺灌注改善，表现为完全清除或马赛克灌注模式显著改善。除2例外，所有患者超声心动图显示右心室功能和压力均有改善。
肺动脉血栓内膜剥脱术为慢性血栓栓塞性肺动脉高压提供了有效的治疗方法。
