Chest
Clinical InvestigationsPulmonary Vascular Lesions Occurring in Patients With Chronic Major Vessel Thromboembolic Pulmonary Hypertension
Section snippets
Biopsies
Patients who agreed to lung biopsy had this procedure performed at the time of thromboendarterectomy. The site was chosen on the basis of the absence of pleural adhesions as determined by preoperative chest x-ray films, chest computed tomography scans, and inspection at the time of surgery. The status of flow to the biopsy site, as assessed by preoperative perfusion scan and angiogram, was recorded. In no instance was biopsy associated with postoperative complications. Tissue samples were
Biopsy Patients
Clinical Features: The mean age of patients on whom biopsies were performed was 46 years (range: 20 to 70 years). Thirteen were male and two, female. The duration of symptoms prior to surgery averaged 3.5 ± 4.0 (SD) years. Preoperative hemodynamic data disclosed (Table 3) that the mean pulmonary artery pressure was 48 ± 12 (SD) mm Hg; and the calculated pulmonary vascular resistance was 913 ± 395 (SD) dynes•s•cm–5. Postoperatively, in the 14 patients in whom valid postoperative hemodynamic
DISCUSSION
Chronic major vessel thromboembolic pulmonary hypertension is a more common condition than previously recognized.1, 2 Correct diagnosis of CTEPH has assumed greater importance because it has become potentially remediable by surgical thromboendarterectomy.1, 2, 3 However, long diagnostic delays have been characteristic, averaging more than three years; and, often, the patients have been considered to have primary pulmonary hypertension. Indeed, lung biopsies, performed elsewhere, led to apparent
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Supported in part by NHLBI-UCSD SCOR (HL-23584), NIH training grant HL07022, and NIH GCRC grant (MOI-RR00827).
Manuscript received May 18; revision accepted July 31.