PMID- 12448964
OWN - NLM
STAT- MEDLINE
DCOM- 20030213
LR  - 20061115
IS  - 0028-2162 (Print)
IS  - 0028-2162 (Linking)
VI  - 146
IP  - 44
DP  - 2002 Nov 2
TI  - [Pulmonary thromboendarterectomy: an effective surgical treatment for cor 
      pulmonale due to chronic pulmonary emboli].
PG  - 2087-92
AB  - OBJECTIVE: To evaluate the initial experience with pulmonary 
      thromboendarterectomy for cor pulmonale due to chronic pulmonary embolism. 
      METHOD: In the period 1 April 1996 to 31 October 2001, 18 patients with right 
      ventricular failure due to chronic thromboembolic pulmonary hypertension were 
      operated on. Their mean age was 54 (SD: 14) years. Preoperatively, all of the 
      patients were in functional New York Heart Association (NYHA) class III or IV. 
      Pulmonary angiography revealed pulmonary hypertension with an increased pulmonary 
      vascular resistance, as well as typical angiographic signs of unresolved chronic 
      emboli. Pulmonary thromboendarterectomy was performed via median sternotomy, 
      using extracorporeal circulation and intermittent deep hypothermic circulatory 
      arrest. The patients were monitored via the outpatients' department. RESULTS: 
      From a technical viewpoint, the procedure was performed successfully in all of 
      the patients. Initially the pulmonary thromboendarterectomy was performed 
      unilaterally (n = 7), which did not decrease pulmonary artery pressure 
      significantly. The following 11 patients were treated bilaterally; in them 
      thromboendarterectomy required an average of circulatory arrest totalling 64 (SD: 
      30) min with 161 (SD: 35) min of myocardial ischemia. After bilateral pulmonary 
      thromboendarterectomy, the pulmonary artery pressure decreased from 45 (SD: 13) 
      to 28 (SD: 9) mmHg (p = 0.001). Reperfusion pulmonary oedema, requiring prolonged 
      ventilation, occurred in 3 patients. There was no operative or later mortality. 
      At a mean follow-up of 28 (SD: 19) months, all but one of the patients were in 
      functional NYHA class I or II. Echocardiography revealed reduced right 
      ventricular dimensions and pulmonary artery pressures. One patient, with mainly 
      distally located obstructions, exhibited no substantial improvement. CONCLUSION: 
      The initial experience with pulmonary thromboendarterectomy for patients with cor 
      pulmonale due to chronic pulmonary emboli demonstrated satisfactory mid-term 
      follow-up data.
FAU - Heijmen, R H
AU  - Heijmen RH
AD  - St. Antonius Ziekenhuis, afd. Cardiothoracale Chirurgie, Postbus 2500, 3430 EM 
      Nieuwegein. rheijmen@hetnet.nl
FAU - van Haarlem, S W
AU  - van Haarlem SW
FAU - Morshuis, W J
AU  - Morshuis WJ
FAU - Jansen, E W
AU  - Jansen EW
FAU - Jaarsma, W
AU  - Jaarsma W
FAU - Snijder, R J
AU  - Snijder RJ
LA  - dut
PT  - English Abstract
PT  - Journal Article
TT  - Pulmonalistrombo-endarteriectomie: een effectieve chirurgische behandeling voor 
      patienten met cor pulmonale door chronische longembolie.
PL  - Netherlands
TA  - Ned Tijdschr Geneeskd
JT  - Nederlands tijdschrift voor geneeskunde
JID - 0400770
SB  - IM
CIN - Ned Tijdschr Geneeskd. 2003 Feb 8;147(6):269-70; author reply 270. PMID: 12621985
MH  - Chronic Disease
MH  - *Endarterectomy
MH  - Female
MH  - Heart Arrest, Induced
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/complications/*surgery
MH  - Pulmonary Heart Disease/etiology/*surgery
MH  - Treatment Outcome
MH  - Vascular Resistance
MH  - Ventricular Function, Right
EDAT- 2002/11/27 04:00
MHDA- 2003/02/14 04:00
CRDT- 2002/11/27 04:00
PHST- 2002/11/27 04:00 [pubmed]
PHST- 2003/02/14 04:00 [medline]
PHST- 2002/11/27 04:00 [entrez]
PST - ppublish
SO  - Ned Tijdschr Geneeskd. 2002 Nov 2;146(44):2087-92.