Zonzin Pietro, Vizza Carmine Dario, Favretto Giuseppe
Divisione di Cardiologia, Ospedale S. Maria della Misericordia, Rovigo.
Ital Heart J Suppl. 2003 Oct;4(10):814-24.
Chronic thromboembolic pulmonary hypertension is due to unresolved or recurrent pulmonary embolism. In the United States the estimated prevalence is 0.1-0.5% among survived patients with pulmonary embolism. The survival rate at 5 years was 30% among patients with a mean pulmonary artery pressure > 40 mmHg at the time of diagnosis and only 10% among those with a value > 50 mmHg. The interval between the onset of disturbances and the diagnosis may be as long as 3 years. Doppler echocardiography permits to establish the diagnosis of pulmonary hypertension. Radionuclide scanning determines whether pulmonary hypertension has a thromboembolic basis. Right heart catheterization and pulmonary angiography are performed in order to establish the extension and the accessibility to surgery of thrombi and to rule out other causes. The surgical treatment is thromboendarterectomy. A dramatic reduction in the pulmonary vascular resistance can be achieved; corresponding improvements in the NYHA class--from class III or IV before surgery to class I-II after surgery--are usually observed. Patients who are not considered candidates for thromboendarterectomy may be considered candidates for lung transplantation.
慢性血栓栓塞性肺动脉高压是由未解决的或复发性肺栓塞所致。在美国，肺栓塞存活患者中估计患病率为0.1% - 0.5%。诊断时平均肺动脉压>40 mmHg的患者5年生存率为30%，而平均肺动脉压>50 mmHg的患者5年生存率仅为10%。从出现症状到诊断的间隔时间可能长达3年。多普勒超声心动图可用于诊断肺动脉高压。放射性核素扫描可确定肺动脉高压是否有血栓栓塞基础。进行右心导管检查和肺血管造影，以确定血栓的范围以及手术可及性，并排除其他病因。手术治疗为血栓内膜剥脱术。可显著降低肺血管阻力；通常可观察到纽约心脏协会（NYHA）心功能分级有相应改善，即从术前的III或IV级改善为术后的I - II级。不适合进行血栓内膜剥脱术的患者可考虑进行肺移植。
