Study objectives: This study sought to evaluate
the pathophysiology of left and right heart failure in patients with
chronic thromboembolic pulmonary hypertension (CTEPH) who were
hospitalized to undergo pulmonary thromboendarterectomy (PTE).
Design: Thirty-nine patients (16 women and 23 men;
mean ± SD age, 55 ± 12 years) with severe CTEPH were examined
before and 13 ± 8 days after PTE by way of transthoracic
echocardiography and right heart catheterization.
Measurements and results: Examination results
confirmed in all cases that before surgery the right ventricles were
enlarged and systolic function was impaired. Moderate to severe
tricuspid valve regurgitation was observed. Left ventricular
eccentricity indexes reflected a leftward displacement of the
interventricular septum. End-diastolic left ventricular size and
systolic function had decreased, and the left ventricular filling
pattern showed impaired diastolic function. After surgery, mean
pulmonary artery pressure was significantly lower (48 ± 10 mm Hg vs
25 ± 7 mm Hg; p < 0.05). The calculated end-diastolic and
end-systolic right ventricular areas had decreased: 30 ± 7
cm2 vs 21 ± 5 cm2 (p < 0.05) and
24 ± 6 cm2 vs 14 ± 4 cm2 (p < 0.05),
respectively. Right ventricular fractional area change had increased
(20 ± 7% vs 33 ± 8%; p < 0.05). Most of the patients
exhibited a marked decrease in the severity of tricuspid regurgitation.
Septal motion, left ventricular systolic function, and diastolic
filling pattern returned to normal values (early to late diastolic left
ventricular inflow ratio, 0.70 ± 0.33 vs 1.35 ± 0.51;
p < 0.05). The mean cardiac index also improved (2.7 ± 0.6
L/min/m2 vs 3.7 ± 0.8 L/min/m2).
Conclusions: In CTEPH, functions are impaired in the
right as well as the left ventricles of the heart. Improved lung
perfusion and the reduction of right ventricular pressure overload are
direct results of PTE, which in turn bring a profound reduction of
right ventricular size and a recovery of systolic function.
Normalization of interventricular septal motion as well as improved
venous return to the left atrium lead to a normalization of left
ventricular diastolic and systolic function, and the cardiac index