呼吸器・呼吸器内科

Prognosis Evaluation of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Abstract

Aissa S, Mezghani S, Benzarti W, Ben Jazia R, Ben Salem H, Gargouri I, Hayouni A, Garrouche A, Benzarti M and Abdelghani A

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the leading causes of severe pulmonary hypertension (PH) curable by pulmonary endarterectomy (PEA) necessarily made in the reference centers.

We report the case of a 30-year-old woman with a history of antiphospholipid syndrome diagnosed after a thromboembolic event responsible of her first pregnancy abortion. Two years after this event, she presented a massive and bilateral pulmonary embolism after the delivery of his second pregnancy. She was hospitalized in the intensive care unit and she received thrombolytic treatment relayed by vitamin K antagonists. One year later, she developed progressive dyspnoea (class III NYHA) and hemoptysis.

Ultrasonic cardiography showed severe pulmonary hypertension (Systolic arterial pulmonary pressure at 120 mmHg) and at the right cardiac catheterization (mean arterial pulmonary pressure at 90 mmHg). Computed tomography pulmonary angiogram and ventilation-perfusion lung scan concluded on CTEPH. Blood gases showed a moderate hypoxemia (58 mmHg); conventional treatment was prescribed (oxygen, vitamine K antagonists and diuretics). The patient was referred to the reference surgical center in Paris and a pulmonary endarterectomy was done. After the surgery, the patient reports an improvement of the class of dsypnea and of the sub-maximal aerobic capacity. The systolic pulmonary pressure decreased at 50 mmHg in the ultrasonic cardiography. The patient actually has a better quality of life and rapidly resumed work.