A management of a patient with chronic thromboembolic pulmonary hypertension prior to surgical resection for lung cancer

IF 0.7 Q4 RESPIRATORY SYSTEM

Respiratory Medicine Case Reports Pub Date : 2025-01-01 DOI:10.1016/j.rmcr.2025.102269

Satoshi Isomatsu , Kenichiro Takeda , Yu Shionoya , Toshihiko Sugiura , Shizu Miyata , Shun Imai , Jun Nagata , Yu Taniguchi , Akira Naito , Rika Suda , Ayako Shigeta , Nobuhiro Tanabe , Takuji Suzuki

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Abstract

The basic treatment for chronic thromboembolic pulmonary hypertension (CTEPH) includes lifelong anticoagulant therapy and pulmonary endarterectomy; moreover, balloon pulmonary angioplasty (BPA) and vasodilators are also known to be effective. Surgery is the standard treatment for localized lung cancer. However, no established treatment guidelines exist for cases of coexisting CTEPH and lung cancer.

The patient was a 55-year-old woman who experienced dyspnea on exertion. She was diagnosed with non-small cell lung cancer, and surgery was scheduled; however, she was also diagnosed with CTEPH during preoperative examinations. She was referred to our hospital, where right heart catheterization revealed a mean pulmonary artery pressure (mPAP) of 39 mmHg. We prioritized the treatment of CTEPH, starting oral riociguat followed by BPA three times. The mPAP decreased to 27 mmHg. Then, right upper lobectomy and lymph node dissection were performed. After surgery, there was no significant worsening of right heart failure, and no recurrence of the lung cancer.

This case report presents a method for managing both CTEPH and primary lung cancer. The essence was the intensification of CTEPH treatment in anticipation of lobectomy.

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一例慢性血栓栓塞性肺动脉高压患者在肺癌手术切除前的处理

慢性血栓栓塞性肺动脉高压（CTEPH）的基本治疗包括终身抗凝治疗和肺动脉内膜切除术；此外，球囊肺动脉成形术（BPA）和血管扩张剂也被认为是有效的。手术是局部肺癌的标准治疗方法。然而，对于同时存在CTEPH和肺癌的病例，没有既定的治疗指南。患者为55岁女性，用力时呼吸困难。她被诊断为非小细胞肺癌，并计划进行手术；然而，在术前检查中，她也被诊断为CTEPH。她被转介到我们医院，右心导管检查显示平均肺动脉压（mPAP）为39mmhg。我们优先考虑CTEPH的治疗，开始口服riociguat，然后三次使用BPA。mPAP降至27 mmHg。然后行右上肺叶切除术及淋巴结清扫术。术后右心衰无明显恶化，肺癌无复发。本病例报告提出了一种治疗CTEPH和原发性肺癌的方法。其实质是在肺叶切除术前加强CTEPH治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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