Chronic thromboembolic pulmonary hypertension - still evolving.

Area of Science:

• Cardiology
• Pulmonology
• Vascular Surgery

Background:

• Chronic thromboembolic pulmonary hypertension (CTEPH) is a significant cause of severe pulmonary hypertension (PH), characterized by organized thrombi and vascular remodeling.
• The condition leads to increased pulmonary vascular resistance, right heart failure, and potential mortality if untreated.
• CTEPH remains underdiagnosed, with its true prevalence yet to be determined.

Purpose of the Study:

• To review the latest advancements in the diagnosis and treatment of CTEPH.
• To discuss the evolving role of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and targeted medical therapies.
• To highlight the importance of multidisciplinary assessment in managing CTEPH patients.

Main Methods:

• Review of recent developments in imaging modalities for CTEPH.
• Analysis of surgical (PEA) and interventional (BPA) techniques.
• Evaluation of the efficacy and safety of targeted medical therapies.

Main Results:

• Pulmonary endarterectomy (PEA) remains the primary curative treatment for eligible CTEPH patients.
• Balloon pulmonary angioplasty (BPA) shows promise in improving hemodynamics and symptoms for inoperable CTEPH patients.
• Targeted medical therapies have demonstrated significant benefits in technically inoperable CTEPH patients.

Conclusions:

• Treatment for CTEPH is rapidly evolving, with new techniques expanding patient eligibility.
• A multidisciplinary approach involving PEA, BPA, and medical management is crucial for optimal outcomes.
• Hybrid treatment strategies combining multiple modalities may become increasingly important for CTEPH management.