Oh, Se Jin
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
,
Bok, Jin San
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
,
Hwang, Ho Young
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
,
Kim, Kyung-Hwan
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
,
Kim, Ki Bong
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
,
Ahn, Hyuk
(Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Background: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as...
Background: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients. Results: In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery ($76{\pm}26$ mmHg vs. $41{\pm}17$ mmHg, p=0.001; $55%{\pm}8%$ vs. $48%{\pm}3%$, p=0.003). Tricuspid regurgitation was reduced from $2.1{\pm}1.1$ to $0.7{\pm}0.6$ (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period. Conclusion: Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality.
Background: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients. Results: In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery ($76{\pm}26$ mmHg vs. $41{\pm}17$ mmHg, p=0.001; $55%{\pm}8%$ vs. $48%{\pm}3%$, p=0.003). Tricuspid regurgitation was reduced from $2.1{\pm}1.1$ to $0.7{\pm}0.6$ (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period. Conclusion: Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality.
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문제 정의
In Korea, there is a lack of clinical studies on the early and long term clinical outcomes, including symptoms and changes of various hemodynamic indices as well as surgical considerations of pulmonary thromboendarterectomy for severe, complicated thromboembolic pulmonary hypertension. In this study, we present our 12-year clinical experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension.
제안 방법
However, echocardiography cannot be used for a definite diagnosis and differentiation between acute and chronic pulmonary embolism [11]. A lung perfusion scan is useful to differentiate chronic thromboembolic pulmonary hypertension from other causes of pulmonary hypertension, by using it for identifying the ventilation-perfusion mismatched segmental defect caused by thromboembolic obstruction. In addition, right heart catheterization has been used to assess the cardiac function and the severity of pulmonary hypertension by measuring the pulmonary artery pressure and resistance.
Continuous variables were expressed as the mean±standard deviation, median and ranges, or proportions. Changes in the hemodynamic variables including mean TR grade and mean pulmonary artery systolic pressure after surgery were analyzed using the repeated measured analysis of variance with Greenhouse Geisser correction. Postoperative changes in the other continuous variables were compared using paired t-test.
2℃. Four patients underwent a concomitant procedure including the Cox Maze IV procedure for paroxysmal atrial fibrillation, ligation of coronary arteriovenous fistula, tricuspid annuloplasty with valve repair, or patent foramen ovale (PFO) closure. Only 1 patient underwent tricuspid valve surgery for more than a moderate degree of TR.
대상 데이터
Between January 1999 and March 2011, 16 patients who underwent pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension were identified in Seoul National University Hospital, and the medical records of these patients were reviewed. The clinical symptoms included dyspnea, nonspecific chest pain, syncope, and exercise intolerance. Chest radiography was routinely performed to find several radiographic abnormalities including cardiomegaly with right heart dilatation, peripheral lung opacities, and dilation of the central pulmonary arteries, and to measure the cardiothoracic ratio.
The patients’ mean age was 44±14 years (range, 23 to 74 years), and there were 6 female patients (37.5%).
데이터처리
Changes in the hemodynamic variables including mean TR grade and mean pulmonary artery systolic pressure after surgery were analyzed using the repeated measured analysis of variance with Greenhouse Geisser correction. Postoperative changes in the other continuous variables were compared using paired t-test. The survival rates were estimated using the Kaplan-Meier method.
이론/모형
Postoperative changes in the other continuous variables were compared using paired t-test. The survival rates were estimated using the Kaplan-Meier method. All of the statistical tests were two-tailed, and all p-values less than 0.
성능/효과
In the current study, a total of 4 patients underwent a concomitant cardiac operation including Cox Maze IV procedure, ligation of coronary arteriovenous fistula, PFO closure, or tricuspid ring annuloplasty with valve repair. All of the procedures were performed during the cooling or rewarming period without the additional operation time for concomitant surgery, and they showed good surgical outcomes.
The survival rates were estimated using the Kaplan-Meier method. All of the statistical tests were two-tailed, and all p-values less than 0.05 were considered statistically significant.
Moreover, the NYHA functional class and systemic arterial oxygenation on ABGA were also greatly improved after surgery, from the perspective of the respiratory purpose. Although the quantitative measurement of right ventricular function, such as ejection fraction or ventricular volume index, was not estimated, the size of the right heart chambers were reduced on echocardiography, and the cardiothoracic ration on chest radiography was significantly decreased, postoperatively.
The mean survival of all the patients was 47.6±46.2 months (range, 0.2 to 141 months), and the 1-, 5-, and 10-year survival rates were 87.1%, 76.2%, and 76.2%, respectively (Fig. 3).
참고문헌 (20)
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