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Abstract: Poster Presentations |

IMPACT OF PULMONARY ENDARTERECTOMY ON PULMONARY ARTERIAL COMPLIANCE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION FREE TO VIEW

Marc De Perrot, MD*; Karen McRae, MD; Yaron Shargall, MD; John Thenganatt, MD; John T. Granton, MD
Author and Funding Information

Toronto General Hospital, Toronto, ON, Canada


Chest


Chest. 2009;136(4_MeetingAbstracts):62S. doi:10.1378/chest.136.4_MeetingAbstracts.62S-b
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Abstract

PURPOSE:  Chronic thromboembolic pulmonary hypertension (CTEPH) is predominantly a disease of the elastic pulmonary arteries. However, the impact of CTEPH and the results of pulmonary endarterectomy (PEA) on the pulmonary arterial compliance (Cp) have not been analyzed systematically.

METHODS:  We assessed Cp in 41 consecutive patients (23 females, age 57 ± 13 years) evaluated for CTEPH in our institution. CTEPH was confirmed by pulmonary angiogram in all patients. A total of 27 patients underwent PEA (68%). Cp was defined by stroke volume over pulse pressure (SV/PP), and SV was calculated by cardiac output (CO) divided by heart rate. Normal Cp is between 5 and 10 mL/kg at rest. PH was defined by mPAP > 25 mmHg at rest.

RESULTS:  Cp ranged between 0.5 and 3.8 (median 1.1) mL/mmHg. There was an inverse relationship between Cp and pulmonary vascular resistance (p < 0.0001). Cp was abnormal in 5 patients with CTEPH (1.9 to 3.4, median 2.2 mL/mmHg) despite the absence of PH at rest, 2 of these patients underwent PEA with normalization of Cp. Among 27 patients undergoing PEA, 1 died postoperatively for an in-hospital operative mortality of 3.7%. Cp improved from 1.4 ± 0.9 before surgery to 2.4 ± 1.3 mL/mmHg immediately after PEA and to 3.2 ± 1.6 mL/mmHg on the second postoperative day (p < 0.0001). After a median follow-up of 18 months (range 1–45 months), NYHA class improved from 3.2 ± 0.6 to 1.4 ± 0.5, and all but one patient have remained in NYHA class I (62%) or II (38%) during follow-up without pulmonary vasodilatative agents. All patients with postoperative Cp > 4 mL/mmHg were in NYHA class I. The 6` walk distance improved from 344 ± 144m preoperatively to 456 ± 97m after PEA (p = 0.02). There was a significant correlation between the change in Cp and improvement in 6’walk distance between the pre- and post-operative measurements (p = 0.006).

CONCLUSION:  Cp can be abnormal in patients with CTEPH despite the absence of PH at rest and major improvement in Cp is observed after PEA.

CLINICAL IMPLICATIONS:  Cp appears to be an important, early marker to assess patients with CTEPH.

DISCLOSURE:  Marc De Perrot, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

12:45 PM - 2:00 PM


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