Published Online
on December 29, 2003

A more recent version of this article appeared on January 6, 2004

This Article Full Text (PDF) All Versions of this Article: 109/1/18    most recent 01.CIR.0000111841.28126.D4v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kim, N. H.S. Articles by Rubin, L. J. Search for Related Content PubMed PubMed Citation Articles by Kim, N. H.S. Articles by Rubin, L. J. Related Collections Pulmonary circulation and disease

Submitted on August 26, 2003
Revised on October 20, 2003
Accepted on November 19, 2003

Preoperative Partitioning of Pulmonary Vascular Resistance Correlates With Early Outcome After Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Nick H.S. Kim MD, Pierre Fesler MD, Richard N. Channick MD, Kirk U. Knowlton MD, Ori Ben-Yehuda MD, Stephen H. Lee MD, Robert Naeije MD, and Lewis J. Rubin MD^*

From the University of California, San Diego (N.H.S.K., R.N.C., K.U.K., O.B.-Y., S.H.L., L.J.R.), and the Free University of Brussels, Belgium (P.F., R.N.).

^* To whom correspondence should be addressed. E-mail: ljrubin{at}ucsd.edu.

Background--Pulmonary thromboendarterectomy (PTE) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH), but persistent pulmonary hypertension after PTE, as a result of either inaccessible distal thrombotic material or coexistent intrinsic small-vessel disease, remains a major determinant of poor outcome. Conventional preoperative evaluation is unreliable in identifying patients at risk for persistent pulmonary hypertension or predicting postoperative hemodynamic outcome. We postulated that pulmonary arterial occlusion pressure waveform analysis, a technique that has been used for partitioning pulmonary vascular resistance, might identify CTEPH patients with significant distal, small-vessel disease.

Methods and Results--Twenty-six patients underwent preoperative right heart catheterization before PTE. Pulmonary artery occlusion waveform recordings were performed in triplicate. Postoperative hemodynamics after PTE were compared with preoperative partitioning of pulmonary vascular resistance derived from the occlusion data. Preoperative assessment of upstream resistance (Rup) correlated with both postoperative total pulmonary resistance index (R²=0.79, P<0.001) and postoperative mean pulmonary artery pressure (R²=0.75, P<0.001). All 4 postoperative deaths occurred in patients with a preoperative Rup <60%.

Conclusions--Pulmonary arterial occlusion pressure waveform analysis may identify CTEPH patients at risk for persistent pulmonary hypertension and poor outcome after PTE. Patients with CTEPH and Rup value <60% appear to be at highest risk.

Key words: pulmonary heart disease • hypertension, pulmonary • endarterectomy • occlusion

This article has been cited by other articles:

				K. Ishida, M. Masuda, H. Tanaka, M. Imamaki, M. Katsumata, T. Maruyama, and M. Miyazaki Mid-term results of surgery for chronic thromboembolic pulmonary hypertension Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 626 - 629. [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]

				H. M. Müller, P. H. Rehak, M. Puchinger, D. Wagner, W. Marte, and K.-H. Tscheliessnigg Measurement of cardiac output and pulmonary transit time for assessment of pulmonary vascular resistance in domestic piglets Exp Physiol, June 1, 2009; 94(6): 659 - 664. [Abstract] [Full Text] [PDF]

				National Pulmonary Hypertension Centres of the UK Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland Heart, March 1, 2008; 94(Suppl_1): i1 - i41. [Full Text] [PDF]

				National Pulmonary Hypertension Centres of the UK Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland Thorax, March 1, 2008; 63(Suppl_2): ii1 - ii41. [Full Text] [PDF]

				K. McNeil and J. Dunning Chronic thromboembolic pulmonary hypertension (CTEPH) Heart, September 1, 2007; 93(9): 1152 - 1158. [Full Text] [PDF]

				B. D. Chiodini, M. G. Franzosi, S. Barlera, S. Signorini, C. M. Lewis, A. D'Orazio, P. Mocarelli, E. Nicolis, R. Marchioli, G. Tognoni, et al. Apolipoprotein E polymorphisms influence effect of pravastatin on survival after myocardial infarction in a Mediterranean population: the GISSI-Prevenzione study Eur. Heart J., August 2, 2007; 28(16): 1977 - 1983. [Abstract] [Full Text] [PDF]

				D. Bonderman, N. Skoro-Sajer, J. Jakowitsch, C. Adlbrecht, D. Dunkler, S. Taghavi, W. Klepetko, M. Kneussl, and I. M. Lang Predictors of Outcome in Chronic Thromboembolic Pulmonary Hypertension Circulation, April 24, 2007; 115(16): 2153 - 2158. [Abstract] [Full Text] [PDF]

				M. Hardziyenka, H. J. Reesink, B. J. Bouma, H.A.C.M. R. de Bruin-Bon, M. E. Campian, M. W.T. Tanck, R. B.A. van den Brink, J. J. Kloek, H. L. Tan, and P. Bresser A novel echocardiographic predictor of in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension Eur. Heart J., April 1, 2007; 28(7): 842 - 849. [Abstract] [Full Text] [PDF]

				R. Naeije and S. Huez Reflections on wave reflections in chronic thromboembolic pulmonary hypertension Eur. Heart J., April 1, 2007; 28(7): 785 - 787. [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]

				N. H. S. Kim Assessment of Operability in Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 584 - 588. [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]

				I. Lang, M. Gomez-Sanchez, M. Kneussl, R. Naeije, P. Escribano, N. Skoro-Sajer, and J.-L. Vachiery Efficacy of Long-term Subcutaneous Treprostinil Sodium Therapy in Pulmonary Hypertension Chest, June 1, 2006; 129(6): 1636 - 1643. [Abstract] [Full Text] [PDF]

				J. Fortuny, S. de Sanjose, N. Becker, M. Maynadie, P. L. Cocco, A. Staines, L. Foretova, M. Vornanen, P. Brennan, A. Nieters, et al. Statin Use and Risk of Lymphoid Neoplasms: Results from the European Case-Control Study EPILYMPH. Cancer Epidemiol. Biomarkers Prev., May 1, 2006; 15(5): 921 - 925. [Abstract] [Full Text] [PDF]

				M. M. Hoeper, E. Mayer, G. Simonneau, and L. J. Rubin Chronic Thromboembolic Pulmonary Hypertension Circulation, April 25, 2006; 113(16): 2011 - 2020. [Full Text] [PDF]

				P. A. Thistlethwaite, A. Kemp, L. Du, M. M. Madani, and S. W. Jamieson Outcomes of pulmonary endarterectomy for treatment of extreme thromboembolic pulmonary hypertension J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 307 - 313. [Abstract] [Full Text] [PDF]