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Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
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Pulmonary endarterectomy.

Chirantan Mangukia1, Parth Rali2, Parag Desai2

  • 1Division of Cardiovascular Surgery, Temple University Hospital, 3401 N. Broad Street, 3rd Floor, Parkinson Pavilion, Philadelphia, PA 19140 USA.

Indian Journal of Thoracic and Cardiovascular Surgery
|November 15, 2021
PubMed
Summary
This summary is machine-generated.

Chronic thromboembolic pulmonary hypertension (CTEPH) is often missed, but surgical pulmonary endarterectomy offers a cornerstone treatment. This review details the surgical management of CTEPH, including diagnosis, operative techniques, and outcomes.

Keywords:
Chronic thromboembolic pulmonary hypertensionPulmonary endarterectomyPulmonary thromboendarterectomy

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Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Surgical Innovation

Background:

  • Chronic thromboembolic pulmonary hypertension (CTEPH) is a significant cause of pulmonary hypertension, frequently underdiagnosed.
  • Patients often present with symptoms mimicking right heart failure, delaying diagnosis and treatment.
  • Accurate diagnosis relies on advanced imaging like VQ scans, CT, and pulmonary angiography.

Purpose of the Study:

  • To provide a comprehensive review of the surgical management of CTEPH.
  • To highlight pulmonary endarterectomy as the primary treatment modality.
  • To discuss diagnostic methods, surgical techniques, and patient outcomes.

Main Methods:

  • Review of current literature on CTEPH diagnosis and surgical management.
  • Analysis of data regarding pulmonary endarterectomy, including deep hypothermic circulatory arrest.
  • Examination of adjunctive therapies like balloon pulmonary angioplasty and medical management.

Main Results:

  • Pulmonary endarterectomy is the definitive treatment for CTEPH.
  • In-hospital mortality for the procedure ranges from 1.7% to 14.2%.
  • Key early post-operative concerns include pulmonary hemorrhage, lung injury, and right ventricular failure, with 5-year survival rates between 76-89%.

Conclusions:

  • Surgical management, particularly pulmonary endarterectomy, is crucial for improving outcomes in CTEPH patients.
  • Long-term success is contingent on managing residual pulmonary hypertension.
  • Adjunctive therapies play a supporting role in comprehensive CTEPH care.