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Original Research |

Subpleural Perfusion as a Predictor for a Poor Surgical Outcome in Chronic Thromboembolic Pulmonary HypertensionSubpleural Perfusion in Chronic Pulmonary Embolism

Nobuhiro Tanabe, MD, PhD, FCCP; Toshihiko Sugiura, MD; Takayuki Jujo, MD; Seiichiro Sakao, MD, PhD; Yasunori Kasahara, MD, PhD, FCCP; Hideyuki Kato, RT; Masahisa Masuda, MD, PhD; Koichiro Tatsumi, MD, PhD, FCCP
Author and Funding Information

From the Department of Respirology (Drs Tanabe, Sugiura, Jujo, Sakao, Kasahara, and Tatsumi), Graduate School of Medicine, Chiba University; Department of Radiology (Mr Kato), Chiba University Hospital; and Department of Cardiovascular Surgery (Dr Masuda), National Hospital Organization, Chiba Medical Center, Chiba, Japan.

Correspondence to: Nobuhiro Tanabe, MD, PhD, FCCP, Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba 260-8670, Japan; e-mail: ntanabe@faculty.chiba-u.jp


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: The present study was supported in part by a grant to the Respiratory Failure Research Group from the Ministry of Health, Labor and Welfare of Japan [No. 23162501 to Dr Tatsumi] and a research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan [No. 22590849 to Dr Tanabe].


© 2012 American College of Chest Physicians


Chest. 2012;141(4):929-934. doi:10.1378/chest.11-0769
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Background:  Small vessel disease is a major determinant of poor outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH). Out-of-proportion pulmonary vascular resistance (PVR) may indicate the presence of small vessel disease, but it is a very subjective evaluation. We investigated poor subpleural perfusion as a marker for small vessel disease and assessed its association with disease severity and surgical outcome of CTEPH.

Methods:  We assessed the subpleural perfused area in the capillary phase of pulmonary angiography in 104 consecutive patients, including 45 who underwent surgery, and then divided the patients into either the well-perfused group (the subpleural space in at least one segment was well perfused [n = 75]) or the poorly perfused group (subpleural spaces were either unperfused or minimally perfused in all segments [n = 29]). We compared the pulmonary hemodynamics, degree of distal thrombi, and surgical outcome between these two groups.

Results:  The poorly perfused group had significantly higher PVR (937 ± 350 dyne/s/cm5 vs 754 ± 373 dyne/s/cm5, P = .02) and more distal thrombi, resulting in fewer surgically treated patients (27.6% vs 49.3%, P = .04) compared with the well-perfused group. This group showed a higher surgical mortality (62.5% vs 2.7%) and higher postoperative PVR (656 ± 668 dyne/s/cm5 vs 319 ± 223 dyne/s/cm5, P = .04). Even in a multivariate analysis, poor subpleural perfusion was associated with surgical mortality.

Conclusions:  Poor subpleural perfusion in the capillary phase of pulmonary angiography might be related to small vessel disease and a poor surgical outcome of CTEPH.

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