1
|
Opitz I, Patella M, Lauk O, Inci I, Bettex D, Horisberger T, Schüpbach R, Keller DI, Frauenfelder T, Kucher N, Granton J, Pfammatter T, de Perrot M, Ulrich S. Acute on Chronic Thromboembolic Pulmonary Hypertension: Case Series and Review of Management. J Clin Med 2022; 11:jcm11144224. [PMID: 35887991 PMCID: PMC9317831 DOI: 10.3390/jcm11144224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct form of precapillary pulmonary hypertension classified as group 4 by the World Symposium on Pulmonary Hypertension (WSPH) and should be excluded during an episode of acute pulmonary embolism (PE). Patients presenting to emergency departments with sudden onset of signs and symptoms of acute PE may already have a pre-existing CTEPH condition decompensated by the new PE episode. Identifying an underlying and undiagnosed CTEPH during acute PE, while challenging, is an important consideration as it will alter the patients’ acute and long-term management. Differential diagnosis and evaluation require an interdisciplinary expert team. Analysis of the clinical condition, the CT angiogram, and the hemodynamic situation are important considerations; patients with CTEPH usually have significantly higher sPAP at the time of index PE, which is unusual and unattainable in the context of acute PE and a naïve right ventricle. The imaging may reveal signs of chronic disease such as right ventricle hypertrophy bronchial collaterals and atypical morphology of the thrombus. There is no standard for the management of acute on chronic CTEPH. Herein, we provide a diagnostic and management algorithm informed by several case descriptions and a review of the literature.
Collapse
Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
- Correspondence: ; Tel.: +41-44-255-88-01
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.P.); (O.L.); (I.I.)
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (T.H.)
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (T.H.)
| | - Reto Schüpbach
- Institute for Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Dagmar I. Keller
- Emergency Department, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (T.F.); (T.P.)
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - John Granton
- Division of Respirology, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (T.F.); (T.P.)
| | - Marc de Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, ON M5G 2C4, Canada;
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland;
| |
Collapse
|