HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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

Assessment of Operability in Chronic Thromboembolic Pulmonary Hypertension

Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California

Correspondence and requests for reprints should be addressed to Nick H. S. Kim, M.D., Division of Pulmonary and Critical Care Medicine, University of California, San Diego, 9330 Campus Point Drive, MC 7381, La Jolla, CA 92037-7381. E-mail: h33kim{at}ucsd.edu

ABSTRACT

Pulmonary endarterectomy surgery (PEA) offers the possibility of a cure for patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). Despite growing experience worldwide, the approach and criteria for patient selection remain variable and center- or expert-dependent. A significant proportion of patients with CTEPH may be turned down for PEA for a number of reasons, most frequently over concerns of distal or inaccessible disease. Although traditional preoperative testing and currently available tools are adequate in identifying the presence of proximal disease in CTEPH, they provide only limited information on the status of the microvasculature. Because persistent pulmonary hypertension is the most important determinant of post-PEA outcome, the preoperative identification of patients with CTEPH with concomitant small-vessel disease and/or microvascular disease is crucial. Pulmonary vascular resistance (PVR) is a useful parameter for assessing potential concomitant small-vessel disease. By assessing the relative contribution of small vessels to the PVR, the pulmonary artery occlusion technique represents a promising tool for determining the risk of surgery in patients with high PVR. More information is required regarding the potential value or risk of preoperative medical therapies. Although traditional surgical classification of CTEPH takes place intraoperatively, there is a need for a preoperative classification system and consensus on operability. A preliminary preoperative classification system has been proposed.

Key Words: operability • preoperative classification system • pulmonary endarterectomy

This article has been cited by other articles:

				H. J. Reesink, S. Surie, J. J. Kloek, H. L. Tan, R. Tepaske, P. F. Fedullo, and P. Bresser Bosentan as a bridge to pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension J. Thorac. Cardiovasc. Surg., January 1, 2010; 139(1): 85 - 91. [Abstract] [Full Text] [PDF]

				G. Simonneau, I. M. Robbins, M. Beghetti, R. N. Channick, M. Delcroix, C. P. Denton, C. G. Elliott, S. P. Gaine, M. T. Gladwin, Z.-C. Jing, et al. Updated clinical classification of pulmonary hypertension. J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S43 - S54. [Abstract] [Full Text] [PDF]

				A. M. Keogh, E. Mayer, R. L. Benza, P. Corris, P. G. Dartevelle, A. E. Frost, N. H. Kim, I. M. Lang, J. Pepke-Zaba, and J. Sandoval Interventional and surgical modalities of treatment in pulmonary hypertension. J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S67 - S77. [Abstract] [Full Text] [PDF]

				V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, R. S. Rosenson, et al. ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in Collaboration With the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1573 - 1619. [Full Text] [PDF]

				Writing Committee Members, V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, et al. ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: Developed in Collaboration With the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association Circulation, April 28, 2009; 119(16): 2250 - 2294. [Full Text] [PDF]

				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]

				N. Skoro-Sajer, N. Hack, R. Sadushi-Kolici, D. Bonderman, J. Jakowitsch, W. Klepetko, M. A. R. Hoda, M. P. Kneussl, P. Fedullo, and I. M. Lang Pulmonary Vascular Reactivity and Prognosis in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot Study Circulation, January 20, 2009; 119(2): 298 - 305. [Abstract] [Full Text] [PDF]

				X. Jais, A. M. D'Armini, P. Jansa, A. Torbicki, M. Delcroix, H. A. Ghofrani, M. M. Hoeper, I. M. Lang, E. Mayer, J. Pepke-Zaba, et al. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2127 - 2134. [Abstract] [Full Text] [PDF]

				N. Skoro-Sajer, F. Mittermayer, A. Panzenboeck, D. Bonderman, R. Sadushi, R. Hitsch, J. Jakowitsch, W. Klepetko, M. P. Kneussl, M. Wolzt, et al. Asymmetric Dimethylarginine Is Increased in Chronic Thromboembolic Pulmonary Hypertension Am. J. Respir. Crit. Care Med., December 1, 2007; 176(11): 1154 - 1160. [Abstract] [Full Text] [PDF]

				N. Tunariu, S. J.R. Gibbs, Z. Win, W. Gin-Sing, A. Graham, P. Gishen, and A. AL-Nahhas Ventilation-Perfusion Scintigraphy Is More Sensitive than Multidetector CTPA in Detecting Chronic Thromboembolic Pulmonary Disease as a Treatable Cause of Pulmonary Hypertension J. Nucl. Med., May 1, 2007; 48(5): 680 - 684. [Abstract] [Full Text] [PDF]

				N. Galie and N. H. S. Kim Pulmonary Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 571 - 576. [Abstract] [Full Text] [PDF]

				E. Mayer and W. Klepetko Techniques and Outcomes of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 589 - 593. [Abstract] [Full Text] [PDF]

				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]

				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]

				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]