A 35-year old man with dyspnea on exertion, history of acute pulmonary embolism and ischaemic stroke
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Abstract
We present a case of a 35-year old man with a history of an acute pulmonary embolism and ischaemic stroke, who after several weeks of adequate antithrombotic treatment experienced functional deterioration with severe dyspnea and haemoptysis. Detailed evaluation reveled chronic thromboembolic pulmonary hypertension, deep vein thrombosis of his right thigh and patent foramen ovale. No laboratory signs of a hypercoagulable conditions were found. After through assessment the patient was referred
for pulmonary endarterectomy and patent foramen ovale closure. Both procedures were performed successfully with the significant improvement in patient’s clinical status. Patient remained clinically stable with no signs of right ventricle dysfunction in the follow-up. This article provides details regarding etiopathogenesis, clinical features and diagnostic evaluation of chronic thromboembolic pulmonary hypertension related to an acute pulmonary embolism. It covers the latest guidelines for screening
and therapy as well as information regarding innovations in health care, and social care. JRCD 2012; 1: 24–29
Key words: Pulmonary embolism; Chronic thromboembolic pulmonary hypertension; Pulmonary endarterectomy
References
Galiè N, Hoeper MM, Humbert M, et al Guidelines for the diagnosis and treatment of pulmonary hypertension. The task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Respir J 2009; 54: 2493–2537.
Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276–2315.
Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2004; 23: 637–648.
Auger WR, Kerr KM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension. Cardiol Clin 2004; 22: 453–466.
Hoeper MM, Barbera JA, Channick RN, et al. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol 2009; 54 (1 Suppl): 85–96.
Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation 2006; 113: 2011–2020.
Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54 (1 Suppl): 43–54.
Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension: from acute to chronic pulmonary embolism. Proc Am Thorac Soc 2006; 3: 564–567.
Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257–2264.
Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest 20 0 6; 130 : 172–175.
Lang IM. Chronic thromboembolic pulmonary hypertensionnot so rare after all. N Engl J Med 2004; 350: 2236–2238.
Galiè N, Kim N. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac 2006; 3:571–576
Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993; 103: 685–692.
Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 1982; 81: 151–158.
Lewczuk J, Piszko P, Jagas J, et al. Prognostic factors in medically treated patients with chronic pulmonary embolism. Chest 2001; 119: 818–823.
Bonderman D, Wilkens H, Wakounig S, et al. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir J 2009; 33: 325–331.
Lang I, Kerr K. Risk factors for chronic thromboembolic pulmonary hypertension 1. Proc Am Thorac Soc 2006; 3: 568–570.
Reesink HJ, Tulevski II, Marcus JT, et al. Brain natriuretic peptide as noninvasive marker of the severity of right ventricular dysfunction in chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 2007; 84: 537–543.
Fijalkowska A, Kurzyna M, Torbicki A, et al. Serum N -terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest 20 0 6; 129: 1313 –1321.
Torbicki A, Kurzyna M, Kuca P, et al. Detectable serum cardiac troponin T as a marker of poor prognosis among patients with chronic precapillary pulmonary hypertension. Circulation 2003; 108: 844–848
Jamieson SW, Kapelanski DP, Sakakibara N, et al. Pulmonary endarter-ectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003; 76: 1457–1462.
Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg 2000; 37: 165–252.
Thistlethwaite PA, Kaneko K, Madani MM, Jamieson SW. Technique and outcomes of pulmonary endarterectomy surgery. Ann Thorac Cardiovasc Surg 2008; 14: 274–282.
Doyle RL, McCrory D, Channick RN, et al. Surgical treatments/interventions for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004;126(1 Suppl): 63–71.
Adams A, Fedullo PF. Postoperative management of the patient undergoing pulmonary endarterectomy. Semin Thorac Cardiovasc Surg 2006; 18: 250–256.
Kearon C, Kahn SR, Agnelli G, et al. , American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133 (6 Suppl): 454–545.
Saouti N, Morshuis WJ, Heijmen RH, Snijder RJ. Long – term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience. Eur J Cardiothorac Surg. 2009; 35: 947–952.
Kim NH: Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc 2006; 3: 584–588.
Saouti N, de MF, Westerhof N, et al. Predictors of mortality in inoperable chronic thromboembolic pulmonary hypertension 3. Respir Med 2009; 103: 1013–1019.
Jais X, D’Armini AM, Jansa P, et al. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008; 52: 2127–2134.
Olschewski H, Simonneau G, Galie N, et al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med 2002; 347: 322–329.
Suntharalingam J, Treacy CM, Doughty NJ, et al. Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension. Chest 2008; 134: 229–236.
Seyfarth HJ, Halank M, Wilkens H, et al. Standard PAH therapy improves long term survival in CTEPH patients. Clin Res Cardiol. 2010;
DOI: http://dx.doi.org/10.20418%2Fjrcd.vol1no1.26
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