Evaluation outcome of patients with chronic thromboembolic disease by exercise right heart catheterization before and after pulmonary thromboendarterectomy

Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition that results from insufficient resolution of thromboemboli in the pulmonary arteries. Some of symptomatic patients with chronic thromboembolic disease have normal hemodynamic at rest. The aim of this study is to assess the outcome of pulmonary thromboendaterectomy (PEA) in symptomatic patients with chronic thromboembolic disease (CTED) in the absence of PH as currently defined (mean PAP>25 mmHg). Methods: Here we report 4 symptomatic chronic thromboembolic patients with normal hemodynamic at rest (mean.PAP<=25) who underwent PEA between September 2015 and September 2017. The main outcome measures were Functional New York Heart Association [NYHA] class, 6 Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity and mortality. There were significant improvement in function class (p2.6+-0.54 vs. 1+-0.2, p=0.00), mean PAP (23.3+-0.5 mmHg vs. post 18.6+-1.5 mmHg, p=0.02), 6MWD (378.2+-68.7m vs. post 432.9+-44.5m, p= 0.01 ), and pulmonary vascular resistance (215.33+-91dynes • sec 1 • cm 5 vs 101+-32dynes • sec 1 • cm 5, p= 0.1 ). Six month after surgery after exercise under right heart catheterization (RHC) mean PAP decreased significantly (37+-7.7 mmHg vs. post 28+-3.2 mmHg, p=0.06). Conclusions: In these 4 CTED patients performing PEA could improve function class and hemodynamic. Considering improvement hemodynamic in this group of patients after PEA, definition of CTEPH may need to be revised