Chronic thromboembolic pulmonary hypertension in local hospital

Česká verzia

Authors: M. Belicová
Authors place of work: I. interná klinika Jesseniovej Lekárskej fakulty a UN Martin, Slovenská republika, prednosta prof. MUDr. Marian Mokáň, DrSc., FRCP Edin
Published in the journal: Vnitř Lék 2011; 57(2): 140-146
Category: Original Contributions

Summary

Background:
Chronic thromboembolic pulmonary hypertension is a serious consequence of pulmonary embolism associated with considerable morbidity and mortality. It develops in about 0.1–3.8% among patients who survive pulmonary embolism despite adecvate treatment.

Objective:
Retrospectively evaluate incidence, clinical picture and difficulties in diagnostics and treatement of patients, in which the diagnosis was confirmed.

Patients and methods:
In years 1996–2007 there were 33,108 patients hospitalized at 1. Internal Clinic of University hospital in Martin, 267 patients (134 women) had pulmonary embolism, 5 (2 women) of them were diagnosed chronic thromboembolic pulmonary hypertension.

Results:
3 of them overcame acute pulmonary embolism and one of them had deep venous thrombosis at the same time. These patients, during acute pulmonary embolism, were administrated trombolytic treatment. Two patients were hospitalized because of progressive dyspnoe, 1 patient as acute myocardial infarction without ST segment elevation, 1 patient as heart failure and 1 patient because of susceptive recommitement of pulmonary embolism with hemoptysis. ECG of right heart owerload were found in 4 patients, in all 5 patients in transthoracic echocardiographic examination a pulmonary hypertension were present, in 3 patients there were CT angiography negative and all 5 patients were positive in perfuse scintigraphy of lungs. This time, 2 of them are after successful operation, pulmonary endarterectomy and 1 patient (woman) died as right heart failure. Rest of the patients (2) are followed up by cardiologist in stadium NYHA II.

Conclusion:
Time till making definitive diagnosis, in spite of progressive discomfort and approved pulmonary embolism, was relatively long (1–5 years), ECG changes was most of the time diagnosed as ischaemic ones. Negative CT angiography of lungs was another step to long term diagnostics. Exactly right and early diagnosis is conclusive, because pulmonary endarterectomy, if its well indicated, is a treatement method, which makes better quality of life and survivance, as we can see in our 2 patients. On the other hand not indicated operation caused the death in our 1 patient.

Key words:
pulmonary embolism – pulmonary hypertension – pulmonary endarterectomy

Zdroje

1. Pengo V, Lensing AW, Prins MH et al. Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257–2264.

2. Hoeper MM, Mayer E, Simonneau G et al. Chronic thromboembolic pulmonary hypertension. Circulation 2006; 113: 2011–2020.

3. Wolf M, Boyer-Neumann C, Parent F et al. Thrombotic risk factors in pulmonary hypertension. Eur Respir J 2000; 15: 395–399.

4. Feddullo PF, Auger WR, Kerr KM et al. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001; 345: 1465–1472.

5. Lang IM. Chronic thromboembolic pulmonary hypertension – not so rare after all. N Engl J Med 2004; 350: 2236–2238.

6. Galiè N, Hoeper MM, Humbert M et al. ESC Committe for Practice Guidelines. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–2537.

7. Bonderman D, Turecek P, Jakowitsch J et al. High prevalence of elevated clotting factor VIII in chronic thromboembolic pulmonary hypertension. Thromb Haemost 2003; 90: 372–376.

8. Lang I, Kerr K. Risk factors for chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc 2006; 3: 568–570.

9. Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg 2000; 37: 165–252.

10. Pengo V, Prandoni P. From acute pulmonary embolism to chronic thromboembolic pulmonary hypertension. Ital Heart J 2005; 6: 830–833.

11. Barst RJ, McGoon M, Torbicki A et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43 (Suppl 12): 40S–47S.

12. Morris TA, Auger WR, Ysrael MZ et al. Parenchymal scarring is associated with restrictive spirometric defects in patients with chronic thromboembolic pulmonary hypertension. Chest 1996; 110: 399–403.

13. King MA, Ysrael M, Bergin CJ. Chronic thromboembolic pulmonary hypertension: CT findings. AJR Am J Roentgenol 1998; 170: 955–960.

14. Dartevelle P, Fadel E, Mussot S et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2004; 23: 637–648.

15. Lindner J, Jansa P. Chronická tromboembolická plicní hypertenze. Endarterektomie plicních tepen. Praha: Maxdorf 2009.

16. Simková I, Pacák J, Riečanský I et al. Initial experiences with novel therapy for pulmonary hypertension in Slovakia. Bratisl Lek Listy 2006; 107: 239–247.

17. Widimský J. Je farmakologická léčba chronické tromboembolické plicní hypertenze nadějná? Vnitř Lék 2009; 55: 517–522.

18. Jansa P, Ambrož D, Marešová J et al. Dlouhodobé zkušenosti s infuzní léčbou treprostinilem u nemocných s plicní arteriální hypertenzí v České republice. Vnitř Lék 2007; 53: 333–337.

19. Belicová M et al. Vývoj chronickej tromboembolickej pľúcnej hypertenzie po akútnej pľúcnej embolii. Interná Med 2009; 9: 541–545.