Heijmen R H, van Haarlem S W, Morshuis W J, Jansen E W, Jaarsma W, Snijder R J
St. Antonius Ziekenhuis, afd. Cardiothoracale Chirurgie, Postbus 2500, 3430 EM Nieuwegein.
Ned Tijdschr Geneeskd. 2002 Nov 2;146(44):2087-92.
To evaluate the initial experience with pulmonary thromboendarterectomy for cor pulmonale due to chronic pulmonary embolism.
In the period 1 April 1996 to 31 October 2001, 18 patients with right ventricular failure due to chronic thromboembolic pulmonary hypertension were operated on. Their mean age was 54 (SD: 14) years. Preoperatively, all of the patients were in functional New York Heart Association (NYHA) class III or IV. Pulmonary angiography revealed pulmonary hypertension with an increased pulmonary vascular resistance, as well as typical angiographic signs of unresolved chronic emboli. Pulmonary thromboendarterectomy was performed via median sternotomy, using extracorporeal circulation and intermittent deep hypothermic circulatory arrest. The patients were monitored via the outpatients' department.
From a technical viewpoint, the procedure was performed successfully in all of the patients. Initially the pulmonary thromboendarterectomy was performed unilaterally (n = 7), which did not decrease pulmonary artery pressure significantly. The following 11 patients were treated bilaterally; in them thromboendarterectomy required an average of circulatory arrest totalling 64 (SD: 30) min with 161 (SD: 35) min of myocardial ischemia. After bilateral pulmonary thromboendarterectomy, the pulmonary artery pressure decreased from 45 (SD: 13) to 28 (SD: 9) mmHg (p = 0.001). Reperfusion pulmonary oedema, requiring prolonged ventilation, occurred in 3 patients. There was no operative or later mortality. At a mean follow-up of 28 (SD: 19) months, all but one of the patients were in functional NYHA class I or II. Echocardiography revealed reduced right ventricular dimensions and pulmonary artery pressures. One patient, with mainly distally located obstructions, exhibited no substantial improvement.
The initial experience with pulmonary thromboendarterectomy for patients with cor pulmonale due to chronic pulmonary emboli demonstrated satisfactory mid-term follow-up data.
评估慢性肺栓塞所致肺心病行肺动脉血栓内膜剥脱术的初步经验。
1996年4月1日至2001年10月31日期间，对18例因慢性血栓栓塞性肺动脉高压导致右心室衰竭的患者进行了手术。他们的平均年龄为54（标准差：14）岁。术前，所有患者的纽约心脏协会（NYHA）心功能分级均为Ⅲ级或Ⅳ级。肺血管造影显示肺动脉高压伴肺血管阻力增加，以及未溶解的慢性栓子的典型血管造影征象。通过正中胸骨切开术，采用体外循环和间歇性深低温循环停搏进行肺动脉血栓内膜剥脱术。通过门诊对患者进行监测。
从技术角度来看，所有患者的手术均成功完成。最初，7例患者进行了单侧肺动脉血栓内膜剥脱术，肺动脉压未显著降低。随后的11例患者接受了双侧手术；其中，血栓内膜剥脱术平均需要循环停搏64（标准差：30）分钟，心肌缺血161（标准差：35）分钟。双侧肺动脉血栓内膜剥脱术后，肺动脉压从45（标准差：13）降至28（标准差：9）mmHg（p = 0.001）。3例患者出现需要长时间通气的再灌注肺水肿。无手术或后期死亡病例。平均随访28（标准差：19）个月时，除1例患者外，所有患者的NYHA心功能分级均为Ⅰ级或Ⅱ级。超声心动图显示右心室尺寸和肺动脉压减小。1例主要为远端梗阻的患者无明显改善。
慢性肺栓塞所致肺心病患者行肺动脉血栓内膜剥脱术的初步经验显示中期随访数据令人满意。
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