D'Armini Andrea Maria, Zanotti Giorgio, Viganò Mario
Division of Cardiac Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Ital Heart J. 2005 Oct;6(10):861-8.
A percentage ranging from 0.1 to 4.0 of patients recovering from acute pulmonary embolism develop chronic thromboembolic pulmonary hypertension (CTEPH). Without intervention, CTEPH is a progressive and lethal disease for which there is no effective medical therapy. Pulmonary endarterectomy (PEA) is the treatment of choice. Lung transplantation is indicated only in few cases when PEA is not feasible. Since 1994 at the IRCCS San Matteo Hospital - University of Pavia (Italy), 134 PEAs have been performed. Preoperatively, NYHA class distribution was respectively 3-II, 56-III, and 75-IV; mean pulmonary artery pressure and pulmonary vascular resistances were 47 +/- 13 mmHg and 1149 +/- 535 dynesscm(-5) respectively. The overall operative mortality has been 9.7% (4.5% in 2004). Survival at 3-month, 1-year, and 3-year follow-up was 89.5 +/- 2.6, 87.8 +/- 2.9, and 83.3 +/- 3.5% respectively; this last rate was unchanged up to 10 years. After PEA, mean pulmonary artery pressure and pulmonary vascular resistances were 25 +/- 9 mmHg and 322 +/- 229 dynesscm(-5) respectively and these results were stable over time. At the 3-year follow-up, 94% of patients were in NYHA class I or II and the only therapy is anticoagulation.
从急性肺栓塞中康复的患者有0.1%至4.0%会发展为慢性血栓栓塞性肺动脉高压（CTEPH）。若不进行干预，CTEPH是一种进行性致命疾病，尚无有效的药物治疗方法。肺动脉内膜剥脱术（PEA）是首选治疗方法。仅在少数PEA不可行的情况下才考虑肺移植。自1994年以来，意大利帕维亚大学圣马泰奥医院IRCCS已进行了134例PEA手术。术前，纽约心脏协会（NYHA）心功能分级分别为Ⅱ级3例、Ⅲ级56例和Ⅳ级75例；平均肺动脉压和肺血管阻力分别为47±13 mmHg和1149±535达因·秒·厘米⁻⁵。总体手术死亡率为9.7%（2004年为4.5%）。3个月、1年和3年随访时的生存率分别为89.5±2.6%、87.8±2.9%和83.3±3.5%；最后这个比率在长达10年的时间里保持不变。PEA术后，平均肺动脉压和肺血管阻力分别为25±9 mmHg和322±229达因·秒·厘米⁻⁵，且这些结果随时间保持稳定。在3年随访时，94%的患者NYHA心功能分级为Ⅰ级或Ⅱ级，唯一的治疗方法是抗凝治疗。
