Chazova I E, Martynyuk T V
A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, Moscow, Russia.
Ter Arkh. 2016;88(10):63-73. doi: 10.17116/terarkh201688663-73.
The paper gives current approaches to treating chronic thromboembolic pulmonary hypertension (CTEPH) from the document «Federal Guidelines for the Diagnosis and Treatment of CTEPH» approved at the Third Russian Congress on Pulmonary Hypertension on December 11, 2015. The guidelines had been elaborated to optimize the treatment of patients with CTEPH on the basis of an analysis of the data of the present-day registries and multicenter randomized clinical trials, national and international guidelines and consensus documents, and documents published in recent years. CTEPH is a unique form of pulmonary hypertension since it is potentially curable by surgical treatment. The paper presents indications for and contraindications to pulmonary thromboendartectomy; preparation for surgery; operating room facilities; the specific features of postoperative management and possible complications; and long-term RESULTS: In terms of therapy, in addition to non-pharmacological measures, the authors discuss maintenance and specific treatment options for CTEPH, balloon pulmonary angioplasty, and lung/heart-lung transplantation. In conclusion they propose a management algorithm in patients with CTEPH and requirements for its problem to the center of experts.
本文依据2015年12月11日第三届俄罗斯肺动脉高压大会批准的《慢性血栓栓塞性肺动脉高压诊断与治疗联邦指南》,介绍了当前治疗慢性血栓栓塞性肺动脉高压(CTEPH)的方法。该指南是在分析当代注册研究和多中心随机临床试验数据、国家和国际指南及共识文件以及近年来发表的文献基础上制定的,旨在优化CTEPH患者的治疗。CTEPH是一种独特的肺动脉高压形式,因为它有可能通过手术治愈。本文介绍了肺动脉血栓内膜剥脱术的适应证和禁忌证、手术准备、手术室设施、术后管理的特点及可能的并发症,以及长期结果。在治疗方面,除了非药物措施外,作者还讨论了CTEPH的维持治疗和特殊治疗选择、球囊肺动脉成形术以及肺/心肺移植。最后,他们提出了CTEPH患者的管理算法以及对专家中心的要求。