Chronic thromboembolic pulmonary hypertension

Experience of a reference center in Argentina

Abstract

Methods: Of a total of 44 patients diagnosed with pulmonary hypertension (HP), 15 patients with chronic thromboembolic pulmonary hypertension were detected (January 2010 to June 2016). Two patients were lost in the follow-up, so the total analyzed were: 13; 12 were considered candidates for endarterectomy and 1 patient was proposed to undergo angioplasty due to high
surgical risk. Results: Regarding surgical patients (12), one died because of massive hemoptysis pending surgery and another refused the procedure. As a conclusion, 10 endarterectomies were performed. At the time of diagnosis, most of the population were in functional class III/IV (77%, 10 pts) and more than half (54%, 7 pts) had clinical signs of right heart failure. Surgical results: length of hospital stay was 13 (IQR 25-75: 8-19) days. As complications, reperfusion edema and right ventricular failure were recorded in 20% (2 pts), one of the patients died 72 hours after surgery (pulmonary vascular resistance (PVR) 1357 dynes.sec.cm-5). Median pre-operatory pulmonary vascular resistance was 572 (IQR 25-75: 375-1149) dynes.sec.cm-5 and the mPAP of 51 (IQR 25-75: 31-61) mmHg. After surgery, a reduction of mPAP was observed: 22 (IQR 25-75: 20-37) mmHg, (p = 0.005) Conclusions: At 12 months, 100% of patients had FC I / II; 2 patients (20%) developed residual pulmonary HTN because of distal vasculopathy, both of them are under treatment with riociguat. The patient undergoing angioplasty had improvement of dyspnea (FC II with reduced pulmonary pressure (mPAP 36 mmHg); she is on riociguat.