Pulmonary Vascular Lesions Occurring in Patients With Chronic Major Vessel Thromboembolic Pulmonary Hypertension

Moser, Kenneth Μ.; Bloor, Colin M.

doi:10.1378/chest.103.3.685

Cited by 549 publications

(393 citation statements)

References 19 publications

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“…The reduced Vc in PPH as well as in CTEPH may result from the obstruction and obliteration of arterioles caused by medial hypertrophy and intimal fibrosis [7,15] or by the resulting plexogenic lesions which can be considered as nonfunctional parallel capillaries. An inverse relation was found between mean RAP and Vc, indicating decreasing Vc with increasing pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Plexogenic arteriopathy is characterized by an increase in both the size and number of smooth muscle cells of the arterial vascular tree, resulting in medial hypertrophy and expansion of the muscular layer to the originally medialess arterioles, leading to so-called muscularization of these arterioles, and, finally, intimal fibrosis, resulting in obliteration of the vascular lumen [4]. The plexogenic form occurs in 28±80% of cases of PPH [5,6], and is also found in patients with chronic thromboembolic pulmonary hypertension (CT-EPH) [7]. Generally, PPH has a poor prognosis with a median survival of 3±4 yrs from the time of diagnosis [8,9].…”

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confidence: 99%

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Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension

Steenhuis¹,

Groen²,

Koeter³

et al. 2000

Eur Respir J

100

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The transfer factor of the lung for carbon monoxide (TL,CO) is decreased in patients with pulmonary hypertension. The pulmonary membrane diffusion capacity (Dm) and pulmonary capillary blood volume (Vc), were studied to establish: 1) the relative contribution of the components of the transfer factor to the decrease in TL,CO; 2) whether differences exist between primary pulmonary hypertension (PPH) and chronic thromboembolic pulmonary hypertension (CTEPH); and 3) the relationship between these parameters and haemodynamic parameters.Dm and Vc were determined in 19 patients with PPH and in eight patients with CTEPH. The patients had been referred for consideration for lung transplantation. Haemodynamic parameters were assessed by heart catheterization.In the PPH group, Vc was reduced in 12 of 19 patients (mean SD Vc 72 14% of the predicted value) and Dm in 17 of 19 patients (60 22% pred). In the CTEPH group, Vc was reduced in six of eight patients and Dm in seven of eight patients. The mean TL,CO Dm and Vc values were similar to those in the PPH group.The reduction in pulmonary membrane diffusion capacity was significantly greater than that in pulmonary capillary blood volume. No differences in pulmonary and cardiovascular functional values were found between the groups. Right atrial pressure showed a significant negative correlation with pulmonary capillary blood volume and an increased pulmonary vascular resistance was associated with a decrease in pulmonary membrane diffusion capacity. These results suggest pronounced functional impairment of the alveolocapillary membrane in these patients. Eur Respir J 2000; 16: 276±281.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension

Steenhuis¹,

Groen²,

Koeter³

et al. 2000

Eur Respir J

100

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“…Introduzida há vários anos, a retirada cirúrgica dos êmbolos não apresentou, inicialmente, resultados consistentes 3, 25 . Com relação ao ato opera- [15][16][17][18][19] , do mesmo centro em San Diego, Califórnia, tiveram um importante papel no desenvolvimento e sistematização desta operação. Dentre todas as técnicas empregadas, a que utiliza, atualmente, esternotomia, CEC e parada circulatória total (PCT) é a que tem apresentado melhores resultados, com morbimortalidade progressivamente menor 12. O objetivo deste trabalho é a avaliação de um grupo de pts portadores desta afecção, operados para ressecção dos trombos , visando analisar a técnica operatória em função dos resultados imediatos, bem como a evolução tardia.…”

Section: Introductionunclassified

Tratamento cirúrgico da embolia pulmonar crônica: análise da experiência inicial

Jatene¹,

Pêgo‐Fernandes²,

Poveda³

et al. 1995

Rev Bras Cir Cardiovasc

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RESUMO : Após a tromboembolia pulmonar aguda, na maioria dos casos , ocorre lise com recanalização dos ramos pulmonares. Entretanto, em pequeno , mas indeterminado número de pacientes (pts) com embolia pulmonar (EP) crónica , a incompleta resolução do material embólico pode resultar em grave hipertensão pulmonar. A tromboendarterectomia pulmonar (TP) é uma opção, especialmente quando a obstrução é proximal e os pts apresentam falência ao tratamento clínico . Dentre as técnicas cirú rgicas já empregadas, a que utiliza, atualmente, a esternotomia com circulação extracorpórea (CEC) e parada circulatória total (PCT) é a que tem apresentado melhores resultados. Até janeiro/95 foram operados 15 pts portadores de EP recurrente . A arteriografia pulmonar mostrou comprometimento bilateral em 66,7% dos casos. Esternotomia foi realizada em 73,3% dos pts. Nestes pts, a técnica utilizada foi a TP por tração retrógrada dos trombos. Circulação extracorpórea foi utilizada em todos os pts , com tempo médio de 124,8 min, sendo em 66,7% dos casos realizada PCT, com tempo médio de 34,2 min o Os valores pressóricos médios na artéria pulmonar eram 91/32/55 mmHg no pré e apresentaram queda para 52/15/27 mmHg no pós-operatório. Houve 1 (6,7%) óbito hospitalar por coagulopatia e 1 tardio devido a problemas não relacionados à operação. Dos 13 pts vivos, 1 (7,7%) apresentou reobstrução e 12 (92,3%) encontram-se assintomáticos sob anticoagulação oral , tendo retornado às atividades habituais, em um período de seguimento de até 165 meses (média 47m) . Em conclusão, a TP realizada por esternotomia e, quando necessário, com auxílio de PCT é procedimento viável e seguro para resolução de EP crónica, levando à remissão da sintomatologia destes pts e à manutenção do resultado a longo prazo.

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“…Rather, moderate to severe PH in the absence of central pulmonary emboli may be a result of thrombotic material, plate- lets, serotonin, and other growth factors, triggering vasoconstriction and a smooth muscle proliferative response leading to a small vessel arteriopathy. [12][13][14][15][16] …”

Section: Discussionmentioning

confidence: 99%

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

Meier

Rubenfire

2006

Clin Cardiol

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Summary:Severe thromboembolic pulmonary hypertension is an infrequent but potentially fatal complication of effort thrombosis (Paget-Schroetter syndrome) of the upper extremity. It has been sporadically reported in the literature, but in most cases has affected young, otherwise healthy athletes. Because this syndrome has been rarely described, it is likely underdiagnosed, and optimal evaluation and treatment has not been established. We describe three young athletic persons who developed thrombosis of the subclavian vein after repetitive motion of the upper extremity, and in whom life-threatening pulmonary hypertension resulted from acute and chronic pulmonary emboli. We then review the mechanism, clinical presentation, diagnosis, and available therapeutic modalities.

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Pulmonary Vascular Lesions Occurring in Patients With Chronic Major Vessel Thromboembolic Pulmonary Hypertension

Cited by 549 publications

References 19 publications

Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension

Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension

Tratamento cirúrgico da embolia pulmonar crônica: análise da experiência inicial

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

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