IntroductionChronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by pulmonary endarterectomy (PEA). Despite this a significant proportion of patients offered PEA decline surgery.ObjectiveTo compare long term survival and prognostic indicators in patients with technically operable CTEPH who underwent PEA and those who declined surgery.MethodsData were collected for consecutive, treatment-naïve patients diagnosed with CTEPH between 2001 and 2014 identified from the ASPIRE-pulmonary-hypertension-registry.ResultsOf 588 patients with CTEPH, 368 patients were offered surgery. Seventy six percent (n=281) underwent PEA, 20% (n=72) declined surgery and 4% (n=15) were planned to undergo surgery. Five year survival was superior in patients undergoing PEA at 83% compared to patients who declined surgery at 56% (p=0.001, log-rank test). In patients who were offered surgery, mixed venous oxygen saturation (SvO2) (p=0.003), gas transfer (DLco) (p=0.042), history of coronary artery disease (p=0.031) and patient choice (declining surgery) (p<0.001) were independent predictors of mortality. For patients who declined surgery a median threshold of DLco 62%, right atrial pressure 11 mmHg, and SvO262% the positive and negative predictive values for 3 year survival were 31% and 100%, 32% and 95% and 30% and 97%, respectively.Abstract P183 Figure 1ConclusionIn a cohort of consecutive patients with CTEPH the long-term survival of patients undergoing PEA is excellent and superior to patients declining surgery and strongly favours surgical intervention in eligible patients. More work is required to understand factors influencing decision making in CTEPH and to ensure that patients are counselled and supported to make informed decisions.

BACKGROUNDAdenoid hypertrophy is one of the main causes of upper airway obstruction and Obstructive Sleep Apnoea (OSA) in children. Studies have shown that administration of mometasone furoate aqueous nasal spray significantly improved oxygen saturation in children with sleep-disordered breathing.The aim of this study is to evaluate the effect of mometasone furoate aqueous nasal spray on oxygen saturation measured through nocturnal pulse oximetry and quality of life in children with sleep-disordered breathing due to adenoid hypertrophy. MATERIALS AND METHODSEighty children suspected of having sleep-disordered breathing due to adenoid hypertrophy, whose parents were not willing for surgery (Adenoidectomy) were enrolled in a non-controlled clinical trial. Quality of life questionnaire was distributed pre-and post-interventional and the symptoms were scored depending on its frequency of occurrence. Pre-and post-intervention x-ray nasopharynx taken. Pre-and post-intervention nocturnal oxygen saturation monitoring was done and Oxygen Desaturation Index (ODI) as well as desaturation events were recorded. Data was analysed using paired student t-test and Wilcoxon's Signed Rank Tests. RESULTSOut of the 80 study population, 43 were males (53.8 %) and 37 were females (46.2%). Age distribution of the population ranged from 3 to 10 years with a mean age of 6.2 years. The study showed a strong positive correlation between grade of adenoid size and ODI (r -0.790; p < 0.001). All the pulse oximetric parameters improved significantly after drug administration (p < 0.001). There was a significant improvement in the quality of life of these children after the treatment. CONCLUSIONThe study revealed mometasone furoate aqueous nasal spray therapy leads to significant reduction in adenoid size and gives symptomatic relief for children with sleep disordered breathing. It can be recommended as the prime medical treatment modality for children with sleep disordered breathing, as it substantially reduced the morbidity and health care utilisation by these children.

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