Flores medical - multisonic - Inhalation mit Ultraschall

Thrombo-endarterectomy

PULMONARY HYPERTENSION AFTER PULMONARY THROMBO-ENDARTERECTOMY (PEA)

If left untreated, and depending on mean pulmonary arterial pressure, chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a similarly poor prognosis as idiopathic PAH. PEA is a potentially curative treatment for patients with proximal occlusions and pulmonary artery strictures, and the involved risk is acceptable. Only a few medical centers worldwide perform this operation using controlled hypothermia for pulmonary artery disobliteration as far as the subsegmental plane. In the immediate postoperative period, pulmonary hypertension may still be present even after a successful endarterectomy. Possible complications include haemoptysis, reperfusion oedema associated with hypoxaemia, and right-heart failure. Postoperative persistent pulmonary hypertension and reperfusion oedema are specific risk factors for early postoperative mortality (39). Systemically applied vasodilatators may cause systemic hypotension associated with inadequate perfusion of the hypertrophic right-ventricular myocardium. A selective decrease in pulmonary pressure therefore plays a decisive role. Results of a pilot study (n = 12) show that inhaled epoprostenol and/or iloprost cause selective pulmonary vasodilatation after PEA, while iloprost decreased pulmonary pressure significantly more than epoprostenol.

Study results further confirmed that inhaled iloprost leads to significant improvements in haemodynamics in the early postoperative period after PEA. Findings also included that the magnitude of haemodynamic response was greater than for inhaled NO. No patient showed signs of a clinically relevant reperfusion oedema.

A randomized double-blind study with 22 CTEPH patients demonstrated a significant and persistent reduction in pulmonary artery pressure and resistance compared with placebo. Selective reduction of right-ventricular afterload by inhaled iloprost could help improve postoperative outcome in PEA surgery.