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Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary emboli...

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Autores principales: Yang, Jenny, Madani, Michael M., Mahmud, Ehtisham, Kim, Nick H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American College of Chest Physicians 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410247/
https://www.ncbi.nlm.nih.gov/pubmed/36990148
http://dx.doi.org/10.1016/j.chest.2023.03.029
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author Yang, Jenny
Madani, Michael M.
Mahmud, Ehtisham
Kim, Nick H.
author_facet Yang, Jenny
Madani, Michael M.
Mahmud, Ehtisham
Kim, Nick H.
author_sort Yang, Jenny
collection PubMed
description Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary embolism. CTEPH also may present without prior VTE history, which can contribute to its underrecognition. The true incidence of CTEPH is unclear, but is estimated to be approximately 3% after acute pulmonary embolism. [Formula: see text] scintigraphy is the best screening test for CTEPH, with CT scan imaging and other advanced imaging methods now playing a larger role in disease detection and confirmation. Perfusion defects on [Formula: see text] scintigraphy in the setting of pulmonary hypertension are suggestive of CTEPH, but pulmonary angiography and right heart catheterization are required for confirmation and treatment planning. CTEPH potentially is curative with pulmonary thromboendarterectomy surgery, with mortality rates of approximately 2% at expert centers. Advances in operative techniques are allowing more distal endarterectomies to be performed successfully with favorable outcomes. However, more than one-third of patients may be considered inoperable. Although these patients previously had minimal therapeutic options, effective treatments now are available with pharmacotherapy and balloon pulmonary angioplasty. Diagnosis of CTEPH should be considered in all patients with suspicion of pulmonary hypertension. Treatments for CTEPH have advanced with improvements in outcomes for both operable and inoperable patients. Therapy should be tailored based on multidisciplinary team evaluation to ensure optimal treatment response.
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spelling pubmed-104102472023-08-10 Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension Yang, Jenny Madani, Michael M. Mahmud, Ehtisham Kim, Nick H. Chest Pulmonary Vascular: CHEST Reviews Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary embolism. CTEPH also may present without prior VTE history, which can contribute to its underrecognition. The true incidence of CTEPH is unclear, but is estimated to be approximately 3% after acute pulmonary embolism. [Formula: see text] scintigraphy is the best screening test for CTEPH, with CT scan imaging and other advanced imaging methods now playing a larger role in disease detection and confirmation. Perfusion defects on [Formula: see text] scintigraphy in the setting of pulmonary hypertension are suggestive of CTEPH, but pulmonary angiography and right heart catheterization are required for confirmation and treatment planning. CTEPH potentially is curative with pulmonary thromboendarterectomy surgery, with mortality rates of approximately 2% at expert centers. Advances in operative techniques are allowing more distal endarterectomies to be performed successfully with favorable outcomes. However, more than one-third of patients may be considered inoperable. Although these patients previously had minimal therapeutic options, effective treatments now are available with pharmacotherapy and balloon pulmonary angioplasty. Diagnosis of CTEPH should be considered in all patients with suspicion of pulmonary hypertension. Treatments for CTEPH have advanced with improvements in outcomes for both operable and inoperable patients. Therapy should be tailored based on multidisciplinary team evaluation to ensure optimal treatment response. American College of Chest Physicians 2023-08 2023-03-28 /pmc/articles/PMC10410247/ /pubmed/36990148 http://dx.doi.org/10.1016/j.chest.2023.03.029 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Pulmonary Vascular: CHEST Reviews
Yang, Jenny
Madani, Michael M.
Mahmud, Ehtisham
Kim, Nick H.
Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title_full Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title_fullStr Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title_full_unstemmed Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title_short Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
title_sort evaluation and management of chronic thromboembolic pulmonary hypertension
topic Pulmonary Vascular: CHEST Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410247/
https://www.ncbi.nlm.nih.gov/pubmed/36990148
http://dx.doi.org/10.1016/j.chest.2023.03.029
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