[Chronic thromboembolic pulmonary hypertension].

Abstract

CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION. Chronic thromboembolic pulmonary hypertension (CTEPH) typically develops after one or more acute pulmonary embolisms (PE). Screening with echocardiography and ventilation-perfusion lung scan is recommended in cases of persistent dyspnea following PE, especially if risk factors for CTEPH are present. However, CTEPH is most often diagnosed during the evaluation of PH. Diagnostic confirmation requires right heart catheterization, which must demonstrate the presence of PH and imaging examinations (CT pulmonary angiography and/or conventional pulmonary angiography) that must reveal characteristic chronic thromboembolic lesions. In addition to effective anticoagulation, which is recommended for all patients, the choice of treatment depends on the location of pulmonary arterial obstructions, the severity of pulmonary hemodynamics, and the presence or absence of comorbidities. Treatment options include pulmonary endarterectomy, medical therapy, and balloon pulmonary angioplasty.