Perspective - Journal of Pulmonology and Clinical Research (2023) Volume 6, Issue 4
The identification and management of chronic thrombotic pulmonary hypertension
Zalak Sangani *
Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, USA
- *Corresponding Author:
- Zalak Sangani
Department of Internal Medicine
University of Cincinnati Medical Center
Received:26-Jun-2023, Manuscript No. AAJPCR-23-105656; Editor assigned:29-Jun-2023, PreQC No. AAJPCR-23-105656 (PQ); Reviewed:13-July-2023, QC No. AAJPCR-23-105656; Revised:18-July-2023, Manuscript No. AAJPCR-23-105656 (R); Published:25-July-2023, DOI:10.35841/ aajpcr-6.4.151
Citation: Sangani Z. The identification and management of chronic thrombotic pulmonary hypertension. J Pulmonol Clin Res. 2023;6(4):151
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare and potentially life-threatening condition characterized by persistent pulmonary hypertension resulting from unresolved pulmonary emboli. It is a distinct form of pulmonary hypertension that occurs when blood clots fail to dissolve properly, leading to the obstruction of the pulmonary arteries. CTEPH can significantly impact the quality of life and prognosis of affected individuals .
The timely and accurate diagnosis of CTEPH is crucial for implementing appropriate treatment strategies. Diagnostic evaluations encompass a comprehensive assessment of medical history, physical examination, and a range of imaging and functional tests. Ventilation/perfusion lung scanning and computed tomography pulmonary angiography are the primary imaging modalities used to detect chronic thromboembolic obstructions within the pulmonary vasculature. Right heart catheterization is an essential tool for assessing pulmonary hemodynamics and confirming the diagnosis while providing valuable information on disease severity. The treatment of CTEPH requires a multidisciplinary approach, involving various healthcare professionals such as pulmonologists, cardiologists, and cardiothoracic surgeons. The primary therapeutic goal is to alleviate symptoms, improve exercise capacity, and reduce pulmonary hypertension. The gold standard surgical treatment for CTEPH is Pulmonary Endarterectomy (PEA), a complex procedure that involves the removal of thromboembolic material from the pulmonary arteries. PEA is associated with significant improvements in hemodynamics and long-term outcomes for eligible patients. However, not all patients are suitable candidates for PEA due to the location or extent of the obstructions .
In cases where PEA is not feasible or unsuccessful, medical therapy plays a vital role. Riociguat, a soluble guanylate cyclase stimulator, has been approved as the first-line medical therapy for inoperable or persistent/recurrent CTEPH. It has shown efficacy in improving exercise capacity and hemodynamics in clinical trials. Balloon pulmonary angioplasty is an emerging minimally invasive treatment option for patients with non-operable distal CTEPH lesions, offering the potential to improve pulmonary perfusion and alleviate symptoms. Postoperative management and long-term follow-up are crucial for patients who undergo PEA. Anticoagulant therapy is of paramount importance to prevent further thromboembolic events. Supportive measures such as diuretics and supplemental oxygen may be employed to manage symptoms and improve overall well-being .
The diagnosis and treatment of CTEPH require a comprehensive and multidisciplinary approach. Accurate diagnosis through a combination of clinical evaluation, imaging techniques, and hemodynamic assessment is essential. Pulmonary endarterectomy remains the gold standard surgical treatment, while riociguat and balloon pulmonary angioplasty offer viable alternatives. Collaborative efforts between healthcare professionals are crucial to optimize patient management and improve long-term outcomes. Further research is necessary to enhance our understanding of CTEPH and explore novel therapeutic approaches to improve patient outcomes .
The diagnosis and treatment of CTEPH require a comprehensive and collaborative approach. Through accurate diagnosis, utilization of appropriate treatment modalities such as PEA, riociguat, and balloon pulmonary angioplasty, and diligent postoperative care, healthcare providers can make a significant impact on the lives of individuals affected by CTEPH. Continued research and advancements in this field will further enhance our ability to diagnose, treat, and ultimately improve outcomes for patients with CTEPH .
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