Effects of Pulmonary Thromboendarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension / 결핵및호흡기질환

ABSTRACT

BACKGROUND: Bilateral pulmonary thromboendarterectomy(PTE) is recognized as the definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We investigated the symptomatic, hemodynamic and prognostic effects of PTE in comparison with medical treatment. METHODs: Twenty-four patients diagnosed with CTEPH from 1995 to 2003 at the Asan Medical Center were divided into two groups patients treated with PTE(PTE group, n=12) and those not treated with PTE(Med group, n=12). The serial changes in dyspnea, the tricuspid regurgitation maximal velocity (TRVmax) and survival of the PTE and Med groups were compared retrospectively. RESULTS: In PTE group, during a follow-up period of 1 year, the New York Heart Association(NYHA) functional class significantly improved, while there was no significant improvement in the Med group. PTE significantly lowered the TRVmax from 4.23+/-0.54 m/sec to 3.22+/-0.70 m/sec over a follow up period of 2 years. (p=0.028) However, the TRVmax in the medically treated group did not show any significant improvement, changing from 3.98+/-0.68 m/sec to 4.27+/-0.95 m/sec during 1 year. The 5-year survival of the PTE group was 77.9% compared with 64.3% in the medically treated group. CONCLUSION: PTE provides substantial long-term improvement in dyspnea and the echocardiographic changes compared with medically treated patients.