导管导向治疗慢性血栓栓塞性肺动脉高压的疗效

Jenny Z. Yang MD , Nick H. Kim MD , Seth Kligerman MD , Timothy M. Fernandes MD, MPH , Demosthenes G. Papamatheakis MD , David S. Poch MD , Mona Alotaibi MD , Victor G. Pretorius MD , Michael M. Madani MD , Kim M. Kerr MD
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引用次数: 0

摘要

背景导管导向治疗急性肺栓塞(PE)越来越受欢迎。尽管CDT对急性PE有潜在的益处,但对慢性血栓栓塞性疾病无效。在此,我们介绍了随后确诊为慢性血栓栓塞性肺动脉高压(CTEPH)或肺动脉肉瘤的患者的经验,这些患者在转诊进行手术干预之前最初接受了CDT。研究问题CDT在CTEPH或肺动脉肿瘤患者中的使用频率如何,相关结果如何?研究设计和方法对2020年1月1日至2021年12月31日在加州大学圣地亚哥分校进行的所有肺血栓内膜切除术进行回顾性审查。52名患者在转诊前接受CDT治疗(15%)。在尝试CDT之前,呼吸困难的持续时间为3天至10年,超声心动图测量的平均右心室收缩压为75±23毫米汞柱。CDT后,平均右心室收缩压为77±23毫米汞柱。3名患者报告症状完全恢复,23名患者报告有所改善,26名患者报告没有症状变化。CDT时的影像学检查可用于32名患者的检查;23名患者显示CTEPH的放射学证据,3名患者显示可疑肉瘤的证据。与CDT相关的并发症发生在7名患者(13%)中,其中1人死亡。解释CTEPH的放射学体征在CDT时经常被忽视。大多数患者(94%)在CDT后症状几乎没有改善,13%出现并发症。在假定的急性PE中考虑CDT时,评估CTEPH的临床和放射学体征是很重要的,以最大限度地减少不必要的风险,并转诊患者进行CTEPH评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes Associated With Catheter-Directed Therapies in Chronic Thromboembolic Pulmonary Hypertension

Background

Catheter-directed therapies (CDTs) for acute pulmonary embolism (PE) are becoming increasingly popular. Although potentially beneficial in acute PE, CDT is ineffective for chronic thromboembolic disease. Herein we present our experience of patients with subsequently confirmed chronic thromboembolic pulmonary hypertension (CTEPH) or pulmonary artery sarcoma who initially received CDT before referral for surgical intervention.

Research Question

How often is CDT being used in patients with CTEPH or pulmonary artery tumor, and what are the associated outcomes?

Study Design and Methods

Retrospective review of all pulmonary thromboendarterectomy surgeries performed at the University of California, San Diego, from January 1, 2020, through December 31, 2021.

Results

Three hundred fifty-four pulmonary thromboendarterectomy surgeries were performed during the study period. Fifty-two patients received CDT before referral (15%). Before CDT attempt, duration of dyspnea ranged from 3 days to 10 years and mean right ventricular systolic pressure measured by echocardiography was 75 ± 23 mm Hg. After CDT, mean right ventricular systolic pressure was 77 ± 23 mm Hg. Three patients reported full recovery of symptoms, 23 patients reported some improvement, and 26 patients reported no change in symptoms. Imaging at time of CDT was available for review for 32 patients; 23 patients showed radiologic evidence of CTEPH and three patients showed evidence suspicious of sarcoma. Complications associated with CDT occurred in seven patients (13%) and included one death.

Interpretation

Radiologic signs of CTEPH frequently were overlooked at the time of CDT. Most patients (94%) achieved minimal or no improvement in symptoms after CDT, and 13% experienced complications. It is important to assess for clinical and radiologic signs of CTEPH when considering CDT in presumed acute PE to minimize unnecessary risk and instead refer patients for CTEPH evaluation.

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