Chest
Volume 103, Issue 3, March 1993, Pages 685-692
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Clinical Investigations
Pulmonary Vascular Lesions Occurring in Patients With Chronic Major Vessel Thromboembolic Pulmonary Hypertension

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The status of small pulmonary arteries may influence diagnosis, surgical selection and postoperative outcome of patients with chronic major vessel thromboembolic pulmonary hypertension (CTEPH). Therefore, in patients with the established diagnosis of CTEPH, lung tissue was obtained by biopsy (15 patients) or at autopsy (16 patients) to assess the histopathologic composition of small pulmonary arteries. Pathologic examination disclosed the full range of pulmonary hypertensive lesions in the small arteries, including plexogenic lesions. The type and extent of hypertensive lesions did not relate to preoperative hemodynamic values, to patient age, or to symptom duration. The findings indicate that primary pulmonary hypertension cannot be differentiated from potentially correctable CTEPH on the basis of histopathologic findings in small pulmonary arteries. Furthermore, none of the histologic findings preclude a positive hemodynamic and clinical result from pulmonary thromboendarterectomy. However, development of these hypertensive changes may explain the deterioration which these patients experience preoperatively over time.

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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  • Cited by (0)

    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.

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