Forfia Paul, Ferraro Bruce, Vaidya Anjali
Pulmonary Hypertension, Right Heart Failure, and CTEPH Program, Heart and Vascular Institute, Temple University Hospital Temple University Lewis Katz School of Medicine Philadelphia Pennsylvania USA.
Pulm Circ. 2022 Jun 7;12(2):e12073. doi: 10.1002/pul2.12073. eCollection 2022 Apr.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension (PH) arising from pulmonary vascular obstruction at varying levels within the pulmonary vascular bed, due to chronic pulmonary emboli. The cornerstone of treatment for CTEPH is pulmonary thromboendarterectomy (PTE), a specialized surgery to remove the chronic vascular obstruction. At experienced centers, PTE leads to marked hemodynamic improvement and, in many cases, normalization of cardiopulmonary hemodynamics. However, increasing evidence supports the fact that a significant percentage of patients will have persistent PH after PTE. No consensus exists on the optimal approach to post-PTE patient assessment, and often the most experienced CTEPH centers have little experience in the direct follow-up care of the CTEPH patient post PTE. In this article, we will discuss a approach to patient assessment after PTE to help guide clinicians on how to recognize significant PH following PTE. In doing so, we identify the true phenotype of persistent PH post PTE so that appropriate patients can be further helped with the evolving therapies for the management of CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）是一种由于慢性肺栓塞导致肺血管床不同水平出现肺血管阻塞而引起的肺动脉高压（PH）形式。CTEPH治疗的基石是肺动脉血栓内膜剥脱术（PTE），这是一种用于清除慢性血管阻塞的专门手术。在经验丰富的中心，PTE可显著改善血流动力学，在许多情况下，还可使心肺血流动力学恢复正常。然而，越来越多的证据支持这样一个事实，即相当一部分患者在PTE后仍会持续存在PH。对于PTE后患者评估的最佳方法尚无共识，而且通常最有经验的CTEPH中心在PTE后CTEPH患者的直接后续护理方面经验不足。在本文中，我们将讨论一种PTE后患者评估方法，以帮助指导临床医生如何识别PTE后显著的PH。通过这样做，我们确定PTE后持续性PH的真实表型，以便可以通过CTEPH管理的不断发展的疗法进一步帮助合适的患者。
