Abstract
This study aimed to evaluate the feasibility of a noninvasive operability assessment of chronic thromboembolic pulmonary hypertension (CTEPH) based on multidetector computed tomographic angiography (MCTA). Up to 176 patients were evaluated from January 2016 to April 2018. Throughout the first phase, the initial surgical decision was made based on MCTA with further analysis of pulmonary angiography (PA) in order to evaluate in which cases the initial decision was not modified by PA. During the second phase, PA was limited to patients judged inoperable based on MCTA or those whose assessment was not possible. Patients deemed operable (50%) based on MCTA along the first phase had been adequately classified, as PA did not modify the initial decision in all but one patient. Comparable results were obtained throughout the implementation phase. Regarding operated patients, the decision of operability was based solely on MCTA in 94% of those with level I disease, in 75% with level II, and 54% with level III. This approach enabled shorter periods of time to complete surgical assessment and the avoidance of PA-related morbidity. Baseline parameters, postoperative measures, and survival rates at 1 year after surgery were comparable in both phases. Noninvasive operability assessment is feasible in a subset of CTEPH patients and optimizes surgical candidacy evaluation.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) represents the third most common cause of pulmonary hypertension (PH) [1] and the only one that is potentially curable [2]
The thrombi, concordance between surgically accessible vascular obstruction and pulmonary vascular resistance, and evaluation of underlying comorbidities prohibiting diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) requires the demonstration of pulmonary hypertension on right heart Thecatheterization, advanced imaging recommended the operability assessment of CTEPH include along techniques with mismatched perfusion for defects on ventilation/perfusion (V/Q)
Among the whole patient series, 16 patients were excluded from further analysis: 9 of them because of thromboembolic disease with no PH, and the remaining 7 patients because of final diagnosis of PH secondary to alternative causes different from CTEPH, in which the misdiagnosis of CTEPH
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) represents the third most common cause of pulmonary hypertension (PH) [1] and the only one that is potentially curable [2]. Diagnostics 2020, 10, 855 along with mismatched perfusion defects on ventilation/perfusion (V/Q) scintigraphy and signs of CTEPH in advanced imaging techniques [3]. Once the diagnosis is confirmed, the pivotal step consists of assessing the suitability for pulmonary endarterectomy (PEA), which offers the best chance of improved long-term outcomes [4,5]. Diagnosis of CTEPH requires the demonstration of pulmonary hypertension on right heart Thecatheterization, advanced imaging recommended the operability assessment of CTEPH include along techniques with mismatched perfusion for defects on ventilation/perfusion (V/Q). Scintigraphy and signs tomographic of CTEPH in advanced imaging techniques [3].magnetic resonance (MR) imaging, multidetector computed angiography (MCTA), Once the diagnosis is confirmed, the pivotal step consists of assessing the suitability for and conventional pulmonary angiography (PA) [3]. The operability assessment of patients with CTEPH is complex and accounts for surgical accessibility of Diagnostics 2020, 10, x FOR PEER REVIEW the thrombi, concordance between surgically accessible vascular obstruction and pulmonary vascular resistance, and evaluation of underlying comorbidities prohibiting PEA [3,4].
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