Lindner J, Jansa P, Kunstýr J, Bláha J, Grus T, Mlejnský F, Heller S, Skvarilová M, Ambroz D, Tosovský J, Aschermann M, Linhart A, Krivánek J, Vítková I, Stríteský M
II. chirurgická klinika kardiovaskulární chirurgie 1, LF UK a VFN, Praha.
Cas Lek Cesk. 2006;145(4):307-12.
Chronic thromboembolic pulmonary hypertension (CTEPH) in indicated cases can be successfully treated by the endarterectomy of pulmonary arteries (PEA). Symptomatically not treated CTEPH has highly unfavourable prognosis. Five years survival of patients with mean pulmonary pressure over 50 mmHg is only 10%. PEA was not available in the Czech Republic till 2004, when PEA program was initiated it the Cardiocenter of the General teaching hospital in Prague in collaboration with leading clinics in that field (Prof. Mayer, University of Mainz, BRD).
Up-to-date surgical technique, which in various modifications has been used at majority of clinics, was elaborated by Jamieson and Daily at University of California in San Diego. It is based on reverse endarterectomy performed during complete circulatory arrest with brain protection by deep hypothermia. Till September 2005 twelve patients were operated with zero mortality. In one patient a suture of atrial septum defect was necessary to perform along. Average time of the circulatory arrest was 45 minutes; duration of the extracorporal circulation was 334 minutes. Average duration of the operation was 450 minutes. Duration of the mechanical ventilation was in average 45.5 hours. After one month already haemodynamic parameters (mPA, CI, PVR) significantly improved or normalized and the average length in the test of six minutes walking increased by 132 meters.
PEA represents a treatment method for patients with CTEPH and surgically accessible pulmonary artery obstruction. Centralized care of those patients is a rational necessity enabling to get maximum experience with complicated diagnostics and treatment of those patients. Multidisciplinary collaboration is the essential condition for the success of the program.
在特定病例中，慢性血栓栓塞性肺动脉高压（CTEPH）可通过肺动脉内膜剥脱术（PEA）成功治疗。未经症状治疗的CTEPH预后极差。平均肺动脉压超过50 mmHg的患者5年生存率仅为10%。直到2004年，捷克共和国才开展PEA手术，当时布拉格综合教学医院心脏中心与该领域的领先诊所（德国美因茨大学的迈耶教授）合作启动了PEA项目。
加利福尼亚大学圣地亚哥分校的贾米森和戴利详细阐述了目前大多数诊所采用的各种改良的最新手术技术。该技术基于在完全循环停止期间进行的逆向内膜剥脱术，并通过深度低温进行脑保护。截至2005年9月，12例患者接受了手术，无死亡病例。1例患者需要同时进行房间隔缺损缝合。平均循环停止时间为45分钟；体外循环时间为334分钟。平均手术时间为450分钟。机械通气平均持续时间为45.5小时。1个月后，血流动力学参数（平均肺动脉压、心脏指数、肺血管阻力）显著改善或恢复正常，6分钟步行试验中的平均步行距离增加了132米。
PEA是治疗CTEPH和手术可及的肺动脉阻塞患者的一种治疗方法。对这些患者进行集中护理是合理必要的，能够积累复杂诊断和治疗这些患者的最大经验。多学科合作是该项目成功的必要条件。
