CHRONIC THROMBOEMBOLIC PULMONARY-HYPERTEN SION - THERAPEUTIC INDICATIONS

Chronic thromboembolic pulmonary hypertension is a rare complication o f acute pulmonary embolism. The therapeutic approach to the disease is addressed, based on a series of 81 patients referred to our departmen t between 1984 and 1993. Medical treatment associates long-term antico agulant therapy and, in some cases, inferior vena cava interruption. T wo surgical procedures are available in selected patients: lung transp lantation and pulmonary thrombo-endarterectomy. Lung transplantation h as been performed in 8 patients since 1988 with 6 survivors with a max imal follow-up of 5 years. Twelve patients underwent pulmonary thrombo endarterectomy with in 9 patients a dramatic functional and haemodynam ic improvement. Chronic thromboembolism should be systematically inves tigated as the cause of pulmonary hypertension considering that in sel ected cases, curative surgery is possible.