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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2493v1 132/3/780    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted 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 Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by de Perrot, M. Articles by Granton, J. T Search for Related Content PubMed PubMed Citation Articles by de Perrot, M. Articles by Granton, J. T

Evaluation of persistent pulmonary hypertension after acute pulmonary emboli

Toronto General Hospital, University of Toronto, Canada

marc.deperrot{at}uhn.on.ca

Abstract

BackgroundBetter knowledge of the evolution of persistent pulmonary hypertension after acute pulmonary emboli PE is required to optimize the indication and timing of pulmonary endarterectomy PEA.

MethodsWe reviewed our experience with 17 consecutive patients demonstrated to have persistent pulmonary hypertension after acute massive n=1, submassive n=7 or recurrent PE n=9.

ResultsAfter a median of 18 weeks of anticoagulation range 12 to 30 weeks since the last PE, 10 patients showed residual pulmonary artery systolic pressure PAsP greater than 50 mmHg. These patients demonstrated significant progression in PAsP over the ensuing 6 to 12 months from 73±14 to 101±26 mmHg p=0.005 and 8 were found to be suitable candidates for PEA. In contrast, among 7 patients with residual PAsP between 35-40 mmHg n=3 and 41-50 mmHg n=4, 6 had evidence of residual perfusion defects on the V/Q scan and CT. The PAsP did not change significantly over the ensuing 6 to 12 months, except in 2 patients who developed new episodes of acute PE.

ConclusionsTwo groups of patients can be identified based on the degree of residual pulmonary hypertension after acute PE. Patients with residual PAsP greater than 50 mmHg should be evaluated for PEA since their pulmonary artery pressures will significantly progress over the ensuing 6 to 12 months despite the absence of recurrent PE. In contrast, patients with PAsP between 35 and 50 mmHg are at risk of developing severe pulmonary hypertension if new PE occurs and should therefore be closely monitored.

Key Words: Acute pulmonary emboli • pulmonary thromboendarterectomy • PTE • chronic thromboembolic pulmonary hypertension • CTEPH