Published Online
on December 29, 2003

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

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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

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