Putra Swastya Dwi, Prakoso Radityo, Sembiring Aditya Agita, Sakti Damba Dwisepto Aulia, Adiarto Suko, Mangkuanom Arwin Saleh, Kurniawati Yovi
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia.
National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia.
Egypt Heart J. 2023 Aug 12;75(1):70. doi: 10.1186/s43044-023-00397-8.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease that can progress and lead to a deadly outcome. Despite optimal drug therapy, pulmonary hypertension (PH) remains fatal. Untreatable right heart failure (RHF) from CTEPH is eventually a significant cause of death. However, unloading the right heart and increasing systemic output are the treatment goals in these patients.
A 42-year-old female presented to the emergency department with worsening dyspnea experienced for three days before admission. There were also complaints of leg edema, ascites, orthopnea, and palpitation. Physical examination revealed an attenuated second heart sound, abdominal ascites, and bilateral leg edema. She had a history of frequent readmissions due to RHF despite optimal medical therapy and was diagnosed with CTEPH 5 months ago. It was decided that the patient would undergo interatrial septal (IAS) stenting with a vascular stent of 8 mm × 39 mm × 135 cm. The results were good; her symptoms and signs of RHF improved, and she was eventually discharged from the hospital. Four months after the procedure, the patient was able to engage in physical activities without any limitations.
A palliative IAS stent is one of the choices for intractable RHF management in patients with CTEPH. The vascular stent can be used as an alternative in order to make the interatrial connection more stable and last longer.
慢性血栓栓塞性肺动脉高压（CTEPH）是一种严重疾病，可进展并导致致命后果。尽管进行了最佳药物治疗，肺动脉高压（PH）仍然是致命的。CTEPH导致的无法治疗的右心衰竭（RHF）最终是主要死因。然而，减轻右心负荷并增加全身输出是这些患者的治疗目标。
一名42岁女性因入院前三天呼吸困难加重就诊于急诊科。还伴有腿部水肿、腹水、端坐呼吸和心悸等症状。体格检查发现第二心音减弱、腹部腹水和双侧腿部水肿。尽管接受了最佳药物治疗，但她因RHF频繁入院，5个月前被诊断为CTEPH。决定该患者将接受使用8mm×39mm×135cm血管支架的房间隔（IAS）支架置入术。结果良好；她的RHF症状和体征得到改善，最终出院。术后四个月，患者能够无限制地进行体育活动。
姑息性IAS支架是CTEPH患者顽固性RHF治疗的选择之一。血管支架可作为一种替代方法，以使房间连接更稳定且持续时间更长。
