Objective: to show the results of a two-stage (preliminary pulmonary transluminal balloon angioplasty (BAP) and then pulmonary thrombendarterectomy – TEE) surgical correction in patients with chronic thromboembolic pulmonary hypertension of extremely high operational risk.
Material and methods. In the Bakoulev National Medical Research Center for Cardiovascular Surgery from 2017 to 2019, two-stage surgical correction of chronic thromboembolic pulmonary hypertension was performed for 8 patients. The age of patients ranged from 30 to 63 (51.6±7.5 on average) years. All patients had symptoms of severe heart and respiratory failure. Six patients were in NYHA III unctional class (FC) and 2 patients were in NYHA IV functional class. The duration of the disease ranged from 7 to 22 (average 10.8±4.1) months. According to catheterization, the average pulmonary pressure ranged from 35 to 57 (average 47.5±5.3) mm Hg. Ejection fraction of the right ventricle ranged from 31 to 45 (average 38.8±3.6) %. The 6-minute walk test was performed by only 6 patients. The distance ranged from 261 to 389 (average of 329.8±55.5) meters. All patients showed proximal and distal lesions of pulmonary artery.
Results. After BAP PA, an improvement in FC was recorded, an increase in the distance of the 6-minute walk test. Significant mprovement of patients condition and intracardiac hemodynamic parameters was observed after TEE LA. There was no hospital mortality.
Conclusion. A two-stage approach to surgical correction in combination with drug support in the pre- and postoperative period is an effective and relatively safe method of treating the patients with chronic thromboembolic pulmonary hypertension of extremely high operational risk.
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About the authors
- Sergey V. Gorbachevskiy, Dr. Med. Sc., Professor, Head of Department, ORCID
- Karen V. Petrosyan, Dr. Med. Sc., Head of Department, ORCID
- Komoliddin Kh. Rakhmonov, Cand. Med. Sc., Cardiovascular Surgeon, ORCID
- Mariya Yu. Khal'vani, Physician, ORCID
- Inessa Yu. Khachaturova, Cand. Med. Sc., Junior Researcher, Ultrasound Diagnostician
- Amirillo A. Sabitov, Cardiovascular Surgeon, ORCID