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      Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease.

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          Abstract

          Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 versus 17±3 mmHg; p=0.008) and during maximal exercise (39±8 versus 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min-1 (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.

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          Author and article information

          Journal
          Eur. Respir. J.
          The European respiratory journal
          European Respiratory Society (ERS)
          1399-3003
          0903-1936
          September 2018
          : 52
          : 3
          Affiliations
          [1 ] Dept of Thoracic Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
          [2 ] These two authors contributed equally to this work.
          [3 ] Dept of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
          [4 ] German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany.
          [5 ] Dept of Pulmonology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
          [6 ] Thorax Clinic, University Hospital Heidelberg, Heidelberg, Germany.
          [7 ] Dept of Anaesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
          [8 ] Dept of Internal Medicine I, Division of Cardiology and Angiology, Justus Liebig University of Giessen, Giessen, Germany.
          Article
          13993003.00458-2018
          10.1183/13993003.00458-2018
          30139773
          423bacf9-d2a8-446c-9baa-72ebdb5c77a2
          History

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