Acar J, Cabrol C, Samama M, Milochevitch R, Pouget P, Fanjoux J, Poisson M, Feldman A
Arch Mal Coeur Vaiss. 1975 Nov;68(11):1165-73.
Six cases of post-embolic chronic cor pulmonale are presented. All six were treated with thrombolytic agents (4 with streptokinase, 2 with urokinase), and in only one case was improvement maintained at the end of one year. Two patients underwent a disobliterative procedure of the pulmonary artery, together with ligation of the inferior vena cava. One of these operations was unsuccessful, and the other had a successful outcome, as confirmed by objective assessment with angiography, scintigraphy and haemodynamic studies. The literature is reviewed at this stage. It was found that the fibrinolytic agents had some chance of working only if the condition was less than a few months old. One major drawback to surgical disobliteration that cannot be foreseen before operation is the presence of thromboses at the arteriolar level in subjects whose main arteries are already blocked proximally. Nervertheless it is possible to obtain good results by surgery, and the operation is worth attempting in young subjects, given the poor prognosis of the untreated condition.
本文报告6例栓塞后慢性肺心病患者。所有6例均接受了溶栓治疗（4例用链激酶，2例用尿激酶），仅1例在1年末病情仍持续改善。2例患者接受了肺动脉再通术，并结扎了下腔静脉。其中1例手术失败，另1例手术成功，血管造影、闪烁扫描和血流动力学研究的客观评估证实了这一点。现阶段对相关文献进行了综述。发现只有在病程小于几个月的情况下，纤溶药物才有起效的可能。手术再通术前无法预见的一个主要缺点是，在主要动脉近端已阻塞的患者中，小动脉水平存在血栓形成。然而，手术有可能取得良好效果，鉴于未经治疗的病情预后较差，手术值得在年轻患者中尝试。
