Sugiyama Kayo, Suzuki Shun, Maruno Keita, Fujiyoshi Toshiki, Koizumi Nobusato, Ogino Hitoshi
Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Department of Cardiovascular Surgery, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuju, Tokyo, 160-0023, Japan.
Surg Case Rep. 2019 Apr 11;5(1):59. doi: 10.1186/s40792-019-0616-7.
Anticoagulation control in active inflammatory bowel disease (IBD) is challenging because of hypercoagulation and bleeding complications. The strategy for treating chronic thromboembolic pulmonary hypertension (CTEPH) in IBD remains controversial because only a few studies have reported its successful treatment (Kim and Lang. Eur Respir Rev 21: 27-31, 2012, Bonderman, et al. Circulation 115: 2153-8, 2007). We describe a case of CTEPH with active Crohn's disease successfully treated with pulmonary endarterectomy (PEA).
A 49-year-old man with CTEPH had undergone balloon pulmonary angioplasty four times; however, severe pulmonary hypertension remained. Moreover, he had Crohn's disease, and sufficient anticoagulant therapy could not be performed because of frequent melena. He also had frequent episodes of intestinal ileus resulting in malnutrition. After strict anticoagulant control with warfarin, PEA was performed safely with strict control of the activated coagulation time. After PEA, his pulmonary hypertension improved to a normal range, and he underwent abdominal surgery for the recurrent intestinal ileus.
PEA for CTEPH with active IBD is challenging, but feasible. The strict anticoagulant control is critical for active IBD patients. Safety of taking direct oral anticoagulants is unclear because there are no parameters for monitoring the level of anticoagulation.
由于存在高凝状态和出血并发症，活动性炎症性肠病（IBD）的抗凝控制具有挑战性。IBD 中慢性血栓栓塞性肺动脉高压（CTEPH）的治疗策略仍存在争议，因为仅有少数研究报道了其成功治疗的案例（Kim 和 Lang。《欧洲呼吸杂志综述》21：27 - 31，2012 年；Bonderman 等人。《循环》115：2153 - 2158，2007 年）。我们描述了一例患有活动性克罗恩病的 CTEPH 患者经肺动脉内膜切除术（PEA）成功治疗的病例。
一名患有 CTEPH 的 49 岁男性已接受了 4 次球囊肺动脉成形术；然而，严重的肺动脉高压仍然存在。此外，他患有克罗恩病，由于频繁出现黑便，无法进行充分的抗凝治疗。他还频繁发生肠梗阻，导致营养不良。在用华法林进行严格的抗凝控制后，在严格控制活化凝血时间的情况下安全地进行了 PEA。PEA 术后，他的肺动脉高压改善至正常范围，并且他因复发性肠梗阻接受了腹部手术。
对于患有活动性 IBD 的 CTEPH 患者，进行 PEA 具有挑战性，但可行。严格的抗凝控制对于活动性 IBD 患者至关重要。由于没有监测抗凝水平的参数，直接口服抗凝剂的安全性尚不清楚。
