Vnitr Lek 2011, 57(2):140-146

Chronic thromboembolic pulmonary hypertension in local hospital

M. Belicová

I. interná klinika Jesseniovej Lekárskej fakulty a UN Martin, Slovenská republika, prednosta prof. MUDr. Marian Mokáň, DrSc., FRCP Edin

Background:
Chronic thromboembolic pulmonary hypertension is a serious consequence of pulmonary embolism associated with considerable morbidity and mortality. It develops in about 0.1-3.8% among patients who survive pulmonary embolism despite adecvate treatment.

Objective:
Retrospectively evaluate incidence, clinical picture and difficulties in diagnostics and treatement of patients, in which the diagnosis was confirmed.

Patients and methods:
In years 1996-2007 there were 33,108 patients hospitalized at 1. Internal Clinic of University hospital in Martin, 267 patients (134 women) had pulmonary embolism, 5 (2 women) of them were diagnosed chronic thromboembolic pulmonary hypertension.

Results:
3 of them overcame acute pulmonary embolism and one of them had deep venous thrombosis at the same time. These patients, during acute pulmonary embolism, were administrated trombolytic treatment. Two patients were hospitalized because of progressive dyspnoe, 1 patient as acute myocardial infarction without ST segment elevation, 1 patient as heart failure and 1 patient because of susceptive recommitement of pulmonary embolism with hemoptysis. ECG of right heart owerload were found in 4 patients, in all 5 patients in transthoracic echocardiographic examination a pulmonary hypertension were present, in 3 patients there were CT angiography negative and all 5 patients were positive in perfuse scintigraphy of lungs. This time, 2 of them are after successful operation, pulmonary endarterectomy and 1 patient (woman) died as right heart failure. Rest of the patients (2) are followed up by cardiologist in stadium NYHA II.

Conclusion:
Time till making definitive diagnosis, in spite of progressive discomfort and approved pulmonary embolism, was relatively long (1-5 years), ECG changes was most of the time diagnosed as ischaemic ones. Negative CT angiography of lungs was another step to long term diagnostics. Exactly right and early diagnosis is conclusive, because pulmonary endarterectomy, if its well indicated, is a treatement method, which makes better quality of life and survivance, as we can see in our 2 patients. On the other hand not indicated operation caused the death in our 1 patient.

Keywords: pulmonary embolism; pulmonary hypertension; pulmonary endarterectomy

Received: August 16, 2010; Accepted: November 1, 2010; Published: February 1, 2011  Show citation