Ryan K L, Fedullo P F, Davis G B, Vasquez T E, Moser K M
Division of Pulmonary and Critical Care Medicine, University of California Medical Center, San Diego.
Chest. 1988 Jun;93(6):1180-5. doi: 10.1378/chest.93.6.1180.
Major vessel chronic thromboembolic pulmonary hypertension is potentially remediable by thromboendarterectomy. The diagnosis often has been delayed because a lung perfusion scan demonstrated modest defects thought to be incompatible with severe vascular obstruction. To define the relationships between perfusion scan abnormalities, angiographic findings, and hemodynamic data, we analyzed 25 consecutive patients with chronic major vessel thromboembolic pulmonary hypertension who subsequently underwent thromboendarterectomy. We found that the perfusion lung scan consistently caused us to underestimate the severity of pulmonary arterial obstruction as defined by pulmonary angiography. Furthermore, there was no significant correlation between the severity of hemodynamic compromise and the extent of obstruction defined by perfusion scan or angiogram. These findings suggest that, when pulmonary hypertension is known or suspected, the diagnosis of correctable, chronic major vessel obstruction should be pursued by angiography and hemodynamic assessment even though the perfusion scan may demonstrate only two segmental defects.
主要血管慢性血栓栓塞性肺动脉高压可通过血栓内膜剥脱术得到潜在治疗。诊断往往会延迟，因为肺部灌注扫描显示的轻度缺损被认为与严重血管阻塞不相符。为了明确灌注扫描异常、血管造影结果和血流动力学数据之间的关系，我们分析了25例连续的慢性主要血管血栓栓塞性肺动脉高压患者，这些患者随后接受了血栓内膜剥脱术。我们发现，肺部灌注扫描始终使我们低估了由肺动脉造影定义的肺动脉阻塞的严重程度。此外，血流动力学损害的严重程度与灌注扫描或血管造影所定义的阻塞程度之间没有显著相关性。这些发现表明，当已知或怀疑有肺动脉高压时，即使灌注扫描可能仅显示两个节段性缺损，也应通过血管造影和血流动力学评估来寻求可纠正的慢性主要血管阻塞的诊断。
