Histopathological Examination by Lung Biopsy for the Evaluation of Operability and Postoperative Prognosis in Patients With Chronic Thromboembolic Pulmonary Hypertension

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  • Yamaki Shigeo
    Japanese Research Institute of Pulmonary Vasculature
  • Ando Motomi
    Department of Cardiovascular Surgery, Fujita Health University
  • Fukumoto Yoshihiro
    Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
  • Higuchi Yoshiro
    Department of Cardiovascular Surgery, Fujita Health University
  • Kaneko Kan
    Department of Cardiovascular Surgery, Fujita Health University
  • Maeda Kay
    Japanese Research Institute of Pulmonary Vasculature Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
  • Shimokawa Hiroaki
    Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine

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Background: To evaluate the prognosis after pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), a lung biopsy was performed in 34 patients with central CTEPH and in 7 patients with peripheral CTEPH during PTE. Methods and Results: Postoperative prognosis was classified from A to E based on the postoperative hemodynamic parameters and clinical condition, and was compared with the index of occlusion (IOCTEPH), which indicates the degree of occlusion in the small pulmonary arteries. Criteria of (A–E) were established only for central CTEPH. Category (A) corresponded to an IOCTEPH from 1.0 to 1.4, (B) from 1.5 to 1.7, (C) from 1.8 to 2.0, and (D) from 2.1 to 2.4. One patient with an index of 3.0 was rated as (E). This patient had collateral vessels around the obstructed small pulmonary arteries and died postoperatively. In all 12 patients who underwent PTE after the criteria were established, postoperative hemodynamic parameters and clinical conditions were consistent with the IOCTEPH. One patient with a high degree of medial atrophy in their small pulmonary arteries died after PTE. Conclusions: These results indicate that a lung biopsy during PTE is useful for prognostication in patients with CTEPH.  (Circ J 2014; 78: 476–482)<br>

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  • Circulation Journal

    Circulation Journal 78 (2), 476-482, 2014

    一般社団法人 日本循環器学会

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