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[Thromboembolic pulmonary hypertension].

P Presbitero¹, E Aiello, E Aruta

¹Divisione di Cardiologia, Ospedale Giovanni Bosco, Torino.

Cardiologia (Rome, Italy)

|December 1, 1991

Summary

Pulmonary hypertension from recurrent blood clots is dangerous. Diagnosis takes 5 years, with dyspnea common. Medical treatment has a 39% mortality rate, and long-term outcomes for surgery are unknown.

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Area of Science:

Cardiology
Pulmonology
Hematology

Background:

Pulmonary hypertension due to recurrent thromboembolism is a rare, life-threatening condition.
Delayed diagnosis, averaging 5 years, is common, with dyspnea as the primary symptom.

Purpose of the Study:

To evaluate clinical features and outcomes of patients with pulmonary hypertension from recurrent thromboembolism.
To compare findings with existing literature and assess treatment efficacy.

Main Methods:

Retrospective analysis of 18 patients (1973-1991).
Clinical data collection, lung perfusion scintigraphy, and pulmonary angiography.
Assessment of predisposing factors, coagulation status, and treatment outcomes.

Main Results:

Mean pulmonary arterial pressure was 50 mmHg; 8 patients had low output.
Lung perfusion scintigraphy was 98% diagnostic; angiography confirmed diagnosis but thrombus evaluation was difficult.
Medical treatment showed 39% mortality at 4-5 years follow-up.
Recurrent embolism caused progression in 30-40% of cases.
Coagulation abnormalities (lupus anticoagulant, protein C, S, antithrombin III deficiencies) were found in some patients.

Conclusions:

Pulmonary hypertension from recurrent thromboembolism has a high mortality with medical management.
Long-term outcomes of surgical interventions like thromboendarterectomy require further investigation.
The role of caval filters in managing this condition remains uncertain.

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