Outcome of pulmonary thromboendarterectomy in chronic thromboembolic disease with normal hemodynamic: is it time to change the definition of CTEPH

Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition that results from insufficient resolution of thromboemboli in the pulmonary arteries. Some of symptomatic patients with chronic thromboembolic disease have normal hemodynamic at rest. The aim of this study is to assess the outcome of PEA in symptomatic patients with chronic thromboembolic disease (CTED) in the absence of PH as currently defined (mean PAP> 25 mmHg).Methods: Here we report 4 symptomatic chronic thromboembolic patients with normal hemodynamic at rest (mean.PAP<=25) who underwent PEA between September 2015 and September 2017. Mean pulmonary artery pressure (PAP) and mean pulmonary vascular resistance before surgery were 21.6+-2.3 mmHg and 209.2+-75 dynes · sec1 · cm5+- 511 (191 to 316) respectively. The main outcome measures were Functional New York Heart Association [NYHA] class, 6‑Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity and mortality. There were significant improvement in function class (p2.6+-0.54 vs. 1+-0.2, p=0.00), mean PAP (21.6+-4.2 mmHg vs. post 19+-1.3 mmHg, p=0.000), 6MWD (380.4+-59.7 m vs. post 419+-42 m, p= 0.000 ), and pulmonary vascular resistance (209.2+-75 dynes • sec 1 • cm 5 vs 92+-14 dynes • sec 1 • cm 5, p= 0.012 ).Conclusions: In these 4 CTED patients performing PEA could improve function class and hemodynamic. Considering improvement hemodynamic in this group of patients after PEA ,definition of CTEPH may need to be revised

Keywords:

pulmonary hypertension , Thromboendarterectomy , chronic thromboembolism