Proceedings of the American Thoracic Society Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


The Proceedings of the American Thoracic Society 3:571-576 (2006)
© 2006 The American Thoracic Society
doi: 10.1513/pats.200605-113LR

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Galiè, N.
Right arrow Articles by Kim, N. H. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Galiè, N.
Right arrow Articles by Kim, N. H. S.

Pulmonary Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension

Nazzareno Galiè and Nick H. S. Kim

Institute of Cardiology, University of Bologna, Bologna, Italy; and Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California

Correspondence and requests for reprints should be addressed to Nazzareno Galiè, M.D., Ospedale S. Orsola, Istituto di Malattie dell'Apparato Cardiovascolare, Università di Bologna, Via Massarenti, 9, 40138 Bologna, Italy. E-mail: nazzareno.galie{at}unibo.it

ABSTRACT

Distal, small-vessel vasculopathy is generally considered a major contributor to the progression of pulmonary hypertension (PH) as chronic thromboembolic pulmonary hypertension (CTEPH) develops over time and is a major determinant of postoperative outcome after pulmonary endarterectomy (PEA). The pathogenesis and natural history of microvascular disease in CTEPH remain uncharacterized. Mechanisms for significant distal disease may involve the following processes: (1) predominant obstructions of "small" subsegmental elastic pulmonary arteries, (2) classical pulmonary arteriopathy of small muscular arteries and arterioles distal to nonobstructed vessels, (3) pulmonary arteriopathy of small muscular arteries and arterioles distal to totally or partially obstructed vessels. Patients in whom obstructed vessels are mainly subsegmental are considered poor surgical candidates. Distal pulmonary vasculopathy in both the occluded and nonoccluded pulmonary vascular bed is characterized by lesions considered typical for idiopathic pulmonary arterial hypertension, including plexiform lesions. The pathogenesis and time course of these vascular lesions remain unclear, but may involve endothelial and/or platelet production and release of mediators and/or altered pulmonary blood flow. The reciprocal contribution of large-vessel (operable) and small-vessel lesions in CTEPH is crucial for the indication and results of PEA. A combination of investigations is used to identify the extent of small-vessel disease, including right-heart catheterization, perfusion lung scan, multidetector spiral computed tomography, pulmonary angiography, and pulmonary arterial occlusion wave-form analysis. Preliminary evidence suggests that medical therapy may provide hemodynamic and clinical benefits for patients in whom PEA cannot be applied, in those who have persistent postoperative PH, or in selected patients with advanced preoperative hemodynamic changes.

Key Words: hypertension • pulmonary • pulmonary embolism.




This article has been cited by other articles:


Home page
Eur Heart JHome page
Authors/Task Force Members, N. Galie, M. M. Hoeper, M. Humbert, A. Torbicki, J.-L. Vachiery, J. A. Barbera, M. Beghetti, P. Corris, S. Gaine, et al.
Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)
Eur. Heart J., October 2, 2009; 30(20): 2493 - 2537.
[Full Text] [PDF]


Home page
CirculationHome page
K. W. Jensen, K. M. Kerr, P. F. Fedullo, N. H. Kim, V. J. Test, O. Ben-Yehuda, and W. R. Auger
Pulmonary Hypertensive Medical Therapy in Chronic Thromboembolic Pulmonary Hypertension Before Pulmonary Thromboendarterectomy
Circulation, September 29, 2009; 120(13): 1248 - 1254.
[Abstract] [Full Text] [PDF]


Home page
ERRHome page
I. M. Lang
Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options
Eur. Respir. Rev., March 1, 2009; 18(111): 24 - 28.
[Abstract] [Full Text] [PDF]


Home page
RadioGraphicsHome page
E. Castaner, X. Gallardo, E. Ballesteros, M. Andreu, Y. Pallardo, J. M. Mata, and L. Riera
CT Diagnosis of Chronic Pulmonary Thromboembolism1
RadioGraphics, January 1, 2009; 29(1): 31 - 50.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
S. Rich and M. Rabinovitch
Diagnosis and Treatment of Secondary (Non-Category 1) Pulmonary Hypertension
Circulation, November 18, 2008; 118(21): 2190 - 2199.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
M. Berman, S. Tsui, A. Vuylsteke, A. Snell, S. Colah, R. Latimer, R. Hall, J. E. Arrowsmith, J. Kneeshaw, A. A. Klein, et al.
Successful Extracorporeal Membrane Oxygenation Support After Pulmonary Thromboendarterectomy
Ann. Thorac. Surg., October 1, 2008; 86(4): 1261 - 1267.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota
Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 454S - 545S.
[Abstract] [Full Text] [PDF]


Home page
Proc Am Thorac SocHome page
V. F. Tapson and M. Humbert
Incidence and Prevalence of Chronic Thromboembolic Pulmonary Hypertension: From Acute to Chronic Pulmonary Embolism
Proceedings of the ATS, September 1, 2006; 3(7): 564 - 567.
[Abstract] [Full Text] [PDF]


Home page
Proc Am Thorac SocHome page
P. Bresser, J. Pepke-Zaba, X. Jais, M. Humbert, and M. M. Hoeper
Medical Therapies for Chronic Thromboembolic Pulmonary Hypertension: An Evolving Treatment Paradigm
Proceedings of the ATS, September 1, 2006; 3(7): 594 - 600.
[Abstract] [Full Text] [PDF]


Home page
Proc Am Thorac SocHome page
L. J. Rubin, M. M. Hoeper, W. Klepetko, N. Galie, I. M. Lang, and G. Simonneau
Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses
Proceedings of the ATS, September 1, 2006; 3(7): 601 - 607.
[Abstract] [Full Text] [PDF]


Home page
Proc Am Thorac SocHome page
A. Peacock, G. Simonneau, and L. Rubin
Controversies, Uncertainties and Future Research on the Treatment of Chronic Thromboembolic Pulmonary Hypertension
Proceedings of the ATS, September 1, 2006; 3(7): 608 - 614.
[Abstract] [Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American Thoracic Society.