LONG-TERM FOLLOW-UP IN PULMONARY EMBOLECTOMY - IS NYHA (DYSPNEA) CLASSIFICATION RELIABLE

In this retrospective investigation we carried out a thorough physical examination, ventilation/perfusion scintigraphy, echocardiography and lung function test in 19 of all 21 long-term survivors consecutively operated on for massive pulmonary embolism between 1968 and 1992. Two patients refused these investigations but were both asymptomatic. The mean follow-up was 8.4 years and 12 (57%) of the patients were in NYHA I and 6 (29%) in NYHA II. The three patients in NYHA III (there were none in class IV) underwent right heart catheterization and pulmonary angiography additionally. Our findings suggest that, generally, the re sults of scintigraphy, echocardiography, lung function tests and physi cal examination correspond to the subjective status expressed as NYHA (dyspnea) class, when evaluated in combination. However, in classes II I and IV other causes of dyspnea apart from residual pulmonary vascula r obstruction can be found. These may also occur in combination. We ob served severe chronic obstructive lung disease, hemidiaphragmatic para lysis, obesity, pulmonary hypertension of unknown origin, atrial septa l defect (ASD) and neurologic residual deficit with depressive state, Thus, in evaluating long-term results of pulmonary embolectomy with re gard to vascular desobliteration, NYHA classification does not seem to be reliable for classes III and IV.