HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eckhard Mayer Manfred Dahm Ulrich Hake Stein Iversen Hellmut Oelert Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mayer, E. Articles by Oelert, H. Search for Related Content PubMed PubMed Citation Articles by Mayer, E. Articles by Oelert, H.

Ann Thorac Surg 1996;61:1788-1792
© 1996 The Society of Thoracic Surgeons

---

Original Article: Cardiovascular

Mid-Term Results of Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Departments for Cardiothoracic and Vascular Surgery, Radiology, and II. Medical Clinic, Johannes Gutenberg-University Hospital Mainz, Mainz; and Frankfurt Heart Centre,Frankfurt, Germany

Accepted for publication February 12, 1996.

	Abstract

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Background. In patients with chronic thromboembolic pulmonary hypertension, acute and striking decreases of pulmonary artery pressures and vascular resistance can be achieved by pulmonary thromboendarterectomy. In this study, the long-term effects of pulmonary thromboendarterectomy on hemodynamic indices and right ventricular function were investigated.

Methods. Sixty-five patients (31 women and 34 men; mean age, 47 ± 17 years; range, 19 to 69 years; New York Heart Association [NYHA] functional class II, n = 3; class III, n = 38; class IV, n = 24) were reassessed 13 to 48 months (mean, 27 months) after pulmonary thromboendarterectomy. Measurements are reported as mean ± standard deviation.

Results. All patients reported a significant improvement of symptoms: 46 patients were in NYHA functional class I, 16 patients in class II, and 3 patients in class III. Mean pulmonary vascular resistance was significantly reduced compared with preoperative and postoperative values (preoperative: 1,015 ± 454 dynes•s•cm^-5; post-operative: 322 ± 154 dynes•s•cm^-5; follow-up: 198 ± 72 dynes•s•cm^-5; p < 0.001 versus preoperative; p < 0.025 versus postoperative). Concomitantly, cardiac index was significantly increased compared with preoperative values (preoperative: 2.0 ± 0.7 L•min^-1•m^-2; follow-up: 2.9 ± 0.5 L•min^-1•m^-2; p < 0.001). Significant reductions of right ventricular dimensions and recovery of right ventricular function could be demonstrated radiologically and echocardiographically. In 3 patients (preoperative NYHA class IV, NYHA class III at follow-up) with proven coagulation abnormalities, pulmonary vascular resistance was moderately increased at follow-up compared with postoperative measurements.

Conclusions. In patients with chronic thromboembolic pulmonary hypertension, a persistent decrease of pulmonary vascular resistance and improvement of right ventricular function and NYHA functional status can be achieved by pulmonary thromboendarterectomy.

	Introduction

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
In patients with severe chronic pulmonary hypertension, right heart hypertrophy and dilatation followed by right ventricular failure develop over time. In selected cases with chronic thromboembolic pulmonary hypertension, acute and significant decreases of pulmonary artery pressure and pulmonary vascular resistance (PVR) can be achieved by pulmonary thromboendarterectomy (PTE) [1–6]. The reduction of right ventricular pressure overload results in an early decrease of right heart dimensions and in functional improvement [7, 8]. In addition, left ventricular diastolic function improves early after PTE because of a normalization of the interventricular septal position [9].

Because fewer than 1,000 PTE procedures have been performed worldwide [10], long-term experience is limited [4, 6, 11]. In this study, patients were reevaluated 13 to 48 months after successful PTE to address the following questions: (1) Is the marked decrease of PVR persis-tent? and (2) Is the severe right ventricular dysfunction reversible?

	Material and Methods

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
From June 1989 to June 1995, 119 consecutive patients were treated by PTE at our institution. The perioperative mortality rate was high (29 of 119; 24%). Thirteen to 48 months (mean, 27 months) after operation, 65 of 90 long-term survivors were reassessed at our institution (31 women and 34 men; mean age, 47 years; range, 19 to 69 years). Twenty-five patients were not reinvestigated: 12 patients had had the procedure within the last 12 months, 6 patients declined to have a reassessment, and 7 patients were lost to follow-up.

Preoperative Patient Data
Preoperatively, 24 patients were in New York Heart Association (NYHA) functional class IV, 38 patients were in class III, and 3 patients were in class II. Mean pulmonary artery pressures were 49 ± 19 mm Hg, and cardiac index was 2.0 ± 0.7 L•min^-1•m^-2. Mean PVR was calculated as 1,015 ± 454 dynes•s•cm^-5. The mean interval between the onset of typical symptoms of venous thrombosis or pulmonary embolism and the operation was 4.8 years (range, 1 to 15 years). In 18 patients (28%), coagulation or fibrinolysis abnormalities were found preoperatively: antithrombin III deficiency (n = 7), protein C deficiency (n = 4), protein S deficiency (n = 3), lupus anticoagulant (n = 6), and heparin-induced thrombocytopenia (n = 6). Thirty-one patients (48%) gave a history of deep venous thrombosis or pulmonary embolism.

Operation
The first consecutive 89 patients were operated on by one surgeon (S.I.) with a standardized technique [6, 12] as developed by Daily and associates [1, 13], using extracorporeal circulation and intermittent periods of circulatory arrest under deep hypothermia. In the following 30 patients, the modified techniques as described by Jamieson and colleagues [2] were applied (E.M.). In addition, tricuspid annuloplasty was performed in 79 patients, closure of an atrial septal defect or persistent foramen ovale in 13 patients, and coronary artery bypass operations in 6 patients. Among 65 patients with follow-up investigations, tricuspid annuloplasty had been performed in 54 patients, closure of an atrial septal defect or persistent foramen ovale in 8 patients, and coronary bypass operations in 4 patients.

Long-Term Medical Treatment
An inferior vena cava filter (LGM; Fa. Braun, Melsungen, Germany) was placed in 18 patients before operation and in 39 patients after operation. Eight patients with documented upper-extremity or cardiac sources of embolism did not receive a vena cava filter. All patients received anticoagulation therapy with warfarin (international normalized ratio, 2.5 to 3.5) postoperatively.

Reassessment
At the time of reassessment, 13 to 48 months (mean, 27 months) after operation, all 65 patients were examined clinically and their NYHA functional status was identified. Arterial blood gas analyses at rest under room-air conditions were obtained in 63 patients. All patients had anteroposterior and lateral chest roentgenograms done. Furthermore, the following investigations were performed: (1) right heart catheterization (n = 54), (2) pulmonary angiography (n = 41), and (3) echocardiography (n = 59). Results obtained from these investigations were compared with preoperative and postoperative data (arterial blood gas and hemodynamic indices after 5 ± 8 days; echocardiography after 16 ± 9 days).

Right Heart Catheterization
Using a Swan-Ganz thermodilution catheter, we measured the following indices at rest: right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output. Cardiac index and PVR were determined using standardized calculations.

Pulmonary Angiography
Large-plate film angiography was performed in the first 15 patients; for the following 26 cases, angiographic digital subtraction techniques were used.

Echocardiography
Fifty-nine patients were investigated by transthoracic echocardiography (Hewlett Packard [Böblingen, Germany] Sonos 1500 or Vingmed [Wiesbachen, Germany] CFM 800). Using a transthoracic apical four-chamber view, we measured end-diastolic and end-systolic right ventricular areas by planimetry. All determinations were made from three consecutive cardiac cycles.

Statistics
Values are expressed as mean ± standard deviation. Paired t test statistical analysis was applied to compare follow-up with either preoperative or postoperative results. Values of p less than 0.025 were considered statistically significant according to the Bonferroni adjustment, which considers the multiple-level to be 5%.

	Results

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Clinical Examinations
All patients reported a marked improvement of their symptoms compared with their preoperative status. At follow-up, 46 patients were in NYHA class I, 16 patients were in class II, and 3 patients were in class III (Fig 1). All patients in class III had been in NYHA class IV preoperatively, and all 3 patients had coagulation abnormalities (antithrombin III deficiency, n = 1; protein C deficiency, n = 1; lupus anticoagulant, n = 1). All 3 patients in NYHA class II preoperatively were identified as class I at reassessment.

View larger version (14K): [in this window] [in a new window]   Fig 1. . Preoperative versus follow-up New York Heart Association (NYHA) functional status.

View larger version (74K): [in this window] [in a new window]   Fig 2. . Chest roentgenograms of a 28-year-old patient before (A) and 24 months after (B) pulmonary thromboendarterectomy.

View larger version (86K): [in this window] [in a new window]   Fig 3. . "Normalization" of angiographic pulmonary artery morphology 20 months after pulmonary thromboendarterectomy in a 51-year-old patient.

Hemodynamic Indices
At the time of reassessment, mean pulmonary artery pressure was significantly decreased compared with preoperative and postoperative values (preoperative: 49 ± 19 mm Hg; postoperative: 31 ± 8 mm Hg; follow-up: 23 ± 10 mm Hg; p < 0.001 versus preoperative; p < 0.025 versus postoperative) (Fig 4A). Mean cardiac index was significantly increased compared with preoperative values, whereas the difference between postoperative and follow-up measurements was not statistically significant (preoperative: 2.0 ± 0.7 L•min^-1•m^-2; postoperative: 2.6 ± 0.5 L•min^-1•m^-2; follow-up: 2.9 ± 0.5 L•min^-1•m^-2; p < 0.001 versus preoperative) (Fig 4B). Mean calculated PVR values at follow-up were significantly decreased compared with preoperative and postoperative values (preoperative: 1,015 ± 454 dynes•s•cm^-5; postoperative: 322 ± 154 dynes•s•cm^-5; follow-up: 198 ± 72 dynes•s•cm^-5; p < 0.001 versus preoperative; p < 0.025 versus postoperative) (Fig 4C). At follow-up, in all 3 patients with NYHA class III, a moderate increase of PVR could be detected between the postoperative and follow-up measurements (patient 1: from 382 to 527 dynes•s•cm^-5; patient 2: from 343 to 430 dynes•s•cm^-5; patient 3: from 265 to 345 dynes•s•cm^-5).

View larger version (50K): [in this window] [in a new window]   Fig 4. . Hemodynamic indices (n = 54). Mean pulmonary artery pressure (mPAP) at follow-up is significantly decreased compared with preoperative and postoperative values (A). Mean cardiac index (CI) is significantly increased (B). Pulmonary vascular resistance (PVR) at follow-up is significantly decreased compared with preoperative and postoperative calculations (C).

	Comment

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Pulmonary thromboendarterectomy has proven to be an effective therapy for patients with chronic thromboembolic pulmonary hypertension [1–6, 10, 11]. Early and marked decreases of PVR after operation have been reported [3, 5, 6, 10]. Early postoperative improvement of right heart dimensions and function also has been demonstrated by echocardiography [7, 8]. However, there is little information in the literature about whether the effects of the procedure on PVR are persistent-especially in patients with coagulopathies-and whether further or lasting improvement of right heart function and clinical status can be expected. In patients with chronic right heart dysfunction due to mitral valve stenosis, long-term improvement of right ventricular function after mitral valve replacement or valvuloplasty has been reported [14, 15]. In patients with primary pulmonary hypertension, an early and significant improvement of right heart function could be achieved by lung transplantation [16–18]. The long-term effects of lung transplantation on right ventricular function in these patients are not sufficiently known because the number of patients having transplantation for pulmonary hypertension is limited, and the long-term survival after lung transplantation for pulmonary hypertension is worse than that for other transplantation indications (unpublished results: International Lung Transplant Registry, St. Louis, MO).

The results obtained in our series demonstrated a marked improvement of clinical, hemodynamic, radiologic, and echocardiographic indices in all patients after primary successful operation. Long-term results of the only therapeutic alternative-lung or heart-lung transplantation-are limited by the development of bronchiolitis obliterans in almost 50% of these patients 3 years after transplantation [19]. After PTE, only 3 of 65 patients were in NYHA functional class III at follow-up examination. All 3 patients had been in NYHA class IV preoperatively, and operative endarterectomy was incomplete for technical reasons. At the time of reassessment, PVR in these patients was still decreased compared with preoperative values, but was increased compared with values obtained postoperatively. This might be due to partial rethrombosis of pulmonary artery branches based on incomplete endarterectomy and coagulation abnormalities. Therefore, life-long strict anticoagulation therapy seems to be mandatory for these patients, and inferior vena cava filters might provide additional safety.

In patients with chronic pulmonary embolism, a perfusion-ventilation mismatch and concomitant decrease of cardiac output and venous oxygen saturation are the most important reasons for marked hypoxemia [20, 21]. By endarterectomy of pulmonary artery branches, perfusion of nonperfused lung areas is reestablished and cardiac output is increased. Therefore, oxygenation can be normalized [21]. Mean arterial oxygen tension was increased significantly in our patients, and none of them required continuous oxygen therapy after operation.

The hemodynamic effects of successful PTE are characterized by an acute postoperative decrease of pulmonary artery pressures and PVR and a subsequent increase of cardiac output [1–3, 5]. A further improvement of pulmonary hemodynamic indices within the first year after operation also has been reported [3, 6, 11, 12]. Positive-pressure ventilation, pulmonary reperfusion edema, and slow adaptation of reopened pulmonary artery branches to a different pressure and flow situation are possible reasons for the further improvement in PVR between postoperative and follow-up measurements [11]. In this study, a significant decrease of PVR was demonstrated between the postoperative period and the follow-up measurements, except for the 3 patients in NYHA class III mentioned earlier.

Reperfusion of occluded lobar, segmental, and subsegmental pulmonary arteries could be visualized well by pulmonary angiography. Complete restoration of pulmonary artery blood flow was even possible in patients with long-standing symptoms and distinct central and peripheral pulmonary artery obstructions.

In this study, the effects of reduction of right heart pressure overload could be demonstrated as a decrease of right heart dimensions on chest roentgenograms and echocardiography. Other studies have also shown acute improvements in right ventricular function and reversibility of right heart failure after reduction of pressure overload by PTE [7, 8], lung transplantation [16–18], and mitral valve procedures [14, 15]. In this series, right ventricular dimensions measured by echocardiography were significantly reduced postoperatively compared with preoperative values, and a further significant reduction was shown at the time of reassessment. Because the percentage decrease of end-systolic right ventricular areas was even greater than that of end-diastolic areas, an improvement of right ventricular contractility is likely. However, this assumption is speculative because preoperative and postoperative measurements of end-systolic right ventricular dimensions can be difficult in patients with pulmonary hypertension. Nevertheless, the data obtained in our patients strongly indicate an acute and persistent improvement of right heart function after operative reduction of PVR.

We conclude that in patients with severe chronic thromboembolic pulmonary hypertension, a persistent improvement of NYHA functional status, decrease of PVR, and recovery of right ventricular function can be achieved by PTE. These benefits persisted at the time of follow-up, suggesting that a longer life expectancy can be anticipated in these patients.

	Acknowledgments

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
We thank Dr John D. Puskas, Emory University Clinic, Atlanta, Georgia, for helpful suggestions regarding the manuscript, and Dr Frank Krummenauer, University Hospital Mainz, for statistical consultation.

	Footnotes

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Address reprint requests to Dr Mayer, Department for Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Hospital, Langenbeckstr 1, 55131 Mainz, Germany.

	References

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 

1. Daily PO, Dembitsky WP, Peterson KL, Moser KM. Modifications of techniques and early results of pulmonary thromboendarterectomy for chronic pulmonary embolism. J Thorac Cardiovasc Surg 1987;93:221–33.[Abstract]
2. Jamieson SW, Auger WR, Fedullo PF, et al. Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg 1993;106:116–27.[Abstract]
3. Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation 1990;81:1735–43.[Free Full Text]
4. Moser KM, Auger WR, Fedullo PF, Jamieson SW. Chronic thromboembolic hypertension-clinical picture and surgical treatment. Eur Respir J 1992;5:334–42.[Abstract]
5. Iversen S, Hake U, Gerharz E, et al. Pulmonale Thrombendarteriektomie bei thromboembolischer pulmonaler Hypertonie. Dtsch Med Wochenschr 1992;117:1087–92.[Medline]
6. Iversen S, Mayer E, Oelert H. Thromboendarterectomy for thromboembolic pulmonary hypertension. In: Yacoub M, Pepper J, eds. Annual of cardiac surgery. London: Current Science Ltd, 1994:161-8.
7. Dittrich HC, Nicod PH, Chow LC, Chappuis FP, Moser KM, Peterson KL. Early changes of right heart geometry after pulmonary thromboendarterectomy. J Am Coll Cardiol 1988;11:937–43.[Abstract]
8. Dittrich HC, McCann HA, Blanchard DG. Cardiac structure and function in chronic thromboembolic pulmonary hypertension. Am J Cardiac Imag 1994;8:18–27.[Medline]
9. Dittrich HC, Chow LC, Nicod PH. Early improvement in left ventricular diastolic function after relief of chronic right ventricular pressure overload. Circulation 1989;80:823–30.[Abstract/Free Full Text]
10. Jamieson SW. Treatment of pulmonary hypertension due to chronic pulmonary thromboembolism. Jpn J Phlebol 1995;6:1–12.
11. Moser KM, Daily PO, Peterson K, et al. Thromboendarterectomy for chronic major-vessel thromboembolic pulmonary hypertension: immediate and long-term results in 42 patients. Ann Intern Med 1987;107:560–5.
12. Iversen S, Mayer E, Schmiedt W, Oelert H. Das chirurgische Konzept der pulmonalen Thrombendarteriektomie. Z Herz Thorax Gefäßchir 1993;7:23–8.
13. Daily PO, Dembitsky WP, Iversen S. Technique of pulmonary thromboendarterectomy for chronic pulmonary embolism. J Cardiac Surg 1989;4:10–24.[Medline]
14. Burger W, Illert S, Teupe C, Kneissl GD, Kober G, Schrader R. Rechtsventrikuläre Funktion bei Patienten mit rheumatischer Mitralstenose. Effekt der Ballon-Mitralvalvuloplastie. Z Kardiol 1993;82:545–51.[Medline]
15. Hirata N, Sakakibara T, Shimazaki Y, et al. Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis. J Thorac Cardiovasc Surg 1992;104:1029–34.[Abstract]
16. Bando K, Armitage JM, Paradis IL, et al. Indications for and results of single, bilateral, and heart-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1994;108:1056–65.[Abstract/Free Full Text]
17. Kramer MR, Valantine HA, Starnes SE, Theodore J. Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension. Am J Cardiol 1994;73:494–500.[Medline]
18. Pasque MK, Trulock EP, Kaiser LR, Cooper JD. Single lung transplantation for pulmonary hypertension: three month hemodynamic follow up. Circulation 1991;84:2275–9.[Abstract/Free Full Text]
19. Sundaresan S, Trulock EP, Mohanakumar T, Cooper JD, Patterson GA. Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation. Ann Thorac Surg 1995;60:1341–7.[Abstract/Free Full Text]
20. Kapitan KS, Buchbinder M, Wagner PD, Moser KM. Mechanisms of hypoxemia in chronic thromboembolic pulmonary hypertension. Am Rev Respir Dis 1989;139:1149–54.[Medline]
21. Kapitan KS, Clausen JL, Moser KM. Gas exchange in chronic thromboembolism after pulmonary thromboendarterectomy. Chest 1990;98:14–9.[Abstract/Free Full Text]

This article has been cited by other articles:

				K. Ishida, M. Masuda, H. Tanaka, M. Imamaki, M. Katsumata, T. Maruyama, and M. Miyazaki Mid-term results of surgery for chronic thromboembolic pulmonary hypertension Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 626 - 629. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Torbicki, A. Perrier, S. Konstantinides, G. Agnelli, N. Galie, P. Pruszczyk, F. Bengel, A. J.B. Brady, D. Ferreira, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur. Heart J., September 2, 2008; 29(18): 2276 - 2315. [Full Text] [PDF]

				D. H. Freed, B. M. Thomson, S. S.L. Tsui, J. J. Dunning, K. K. Sheares, J. Pepke-Zaba, and D. P. Jenkins Functional and haemodynamic outcome 1 year after pulmonary thromboendarterectomy Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 525 - 530. [Abstract] [Full Text] [PDF]

				K. Ishida and M. Masuda Thromboendarterectomy for Severe Chronic Thromboembolic Pulmonary Hypertension Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): 229 - 233. [Abstract] [Full Text] [PDF]

				M. Hardziyenka, H. J. Reesink, B. J. Bouma, H.A.C.M. R. de Bruin-Bon, M. E. Campian, M. W.T. Tanck, R. B.A. van den Brink, J. J. Kloek, H. L. Tan, and P. Bresser A novel echocardiographic predictor of in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension Eur. Heart J., April 1, 2007; 28(7): 842 - 849. [Abstract] [Full Text] [PDF]

				H. J. Reesink, M. N. van der Plas, N. E. Verhey, R. P. van Steenwijk, J. J. Kloek, and P. Bresser Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 510 - 516. [Abstract] [Full Text] [PDF]

				H. J. Reesink, J. T. Marcus, I. I. Tulevski, S. Jamieson, J. J. Kloek, A. V. Noordegraaf, and P. Bresser Reverse right ventricular remodeling after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: Utility of magnetic resonance imaging to demonstrate restoration of the right ventricle J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 58 - 64. [Abstract] [Full Text] [PDF]

				A. M. D'Armini, G. Zanotti, S. Ghio, G. Magrini, M. Pozzi, L. Scelsi, G. Meloni, C. Klersy, and M. Vigano Reverse right ventricular remodeling after pulmonary endarterectomy J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 162 - 168. [Abstract] [Full Text] [PDF]

				H. Matsuda, H. Ogino, K. Minatoya, H. Sasaki, N. Nakanishi, S. Kyotani, J. Kobayashi, T. Yagihara, and S. Kitamura Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann. Thorac. Surg., October 1, 2006; 82(4): 1338 - 1343. [Abstract] [Full Text] [PDF]

				E. Mayer and W. Klepetko Techniques and Outcomes of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 589 - 593. [Abstract] [Full Text] [PDF]

				M. Sato, M. Ando, A. Muto, Y. Kondo, R. Hoshino, T. Nishibe, and M. Yamashita Two cases of chronic pulmonary thromboembolism saved by postoperative use of a percutaneous cardiopulmonary support device. Ann. Thorac. Surg., July 1, 2006; 82(1): 314 - 316. [Abstract] [Full Text] [PDF]

				G. Casaclang-Verzosa, R. B. McCully, J. K. Oh, F. A. Miller Jr, and C. G. A. McGregor Effects of Pulmonary Thromboendarterectomy on Right-Sided Echocardiographic Parameters in Patients With Chronic Thromboembolic Pulmonary Hypertension Mayo Clin. Proc., June 1, 2006; 81(6): 777 - 782. [Abstract] [Full Text] [PDF]

				M. M. Hoeper, E. Mayer, G. Simonneau, and L. J. Rubin Chronic Thromboembolic Pulmonary Hypertension Circulation, April 25, 2006; 113(16): 2011 - 2020. [Full Text] [PDF]

				K.-F. J. Kreitner, S. Ley, H.-U. Kauczor, E. Mayer, T. Kramm, M. B. Pitton, F. Krummenauer, and M. Thelen Chronic Thromboembolic Pulmonary Hypertension: Pre- and Postoperative Assessment with Breath-hold MR Imaging Techniques Radiology, August 1, 2004; 232(2): 535 - 543. [Abstract] [Full Text] [PDF]

				R. L. Doyle, D. McCrory, R. N. Channick, G. Simonneau, and J. Conte Surgical Treatments/Interventions for Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines Chest, July 1, 2004; 126(1_suppl): 63S - 71S. [Abstract] [Full Text] [PDF]

				W. Klepetko, E. Mayer, J. Sandoval, E. P. Trulock, J.-L. Vachiery, P. Dartevelle, J. Pepke-Zaba, S. W. Jamieson, I. Lang, and P. Corris Interventional and surgical modalities of treatment for pulmonary arterial hypertension J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 73S - 80S. [Abstract] [Full Text] [PDF]

				P. Dartevelle, E. Fadel, S. Mussot, A. Chapelier, P. Herve, M. de Perrot, J. Cerrina, F.L. Ladurie, D. Lehouerou, M. Humbert, et al. Chronic thromboembolic pulmonary hypertension Eur. Respir. J., April 1, 2004; 23(4): 637 - 648. [Abstract] [Full Text] [PDF]

				E. Fadel, R. P. Michel, S. Eddahibi, R. Bernatchez, G.-M. Mazmanian, B. Baudet, P. Dartevelle, and P. Herve Regression of postobstructive vasculopathy after revascularization of chronically obstructed pulmonary artery J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1009 - 1017. [Abstract] [Full Text] [PDF]

				T. Kramm, B. Eberle, F. Krummenauer, S. Guth, H. Oelert, and E. Mayer Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy Ann. Thorac. Surg., September 1, 2003; 76(3): 711 - 718. [Abstract] [Full Text] [PDF]

				A. M Fabricius, M. Kruger, M. Hanke, and F. W Mohr Caught in the Act: Impending Paradoxical Embolism Asian Cardiovasc Thorac Ann, December 1, 2002; 10(4): 342 - 343. [Abstract] [Full Text] [PDF]

				P. A. Thistlethwaite, M. Mo, M. M. Madani, R. Deutsch, D. Blanchard, D. P. Kapelanski, and S. W. Jamieson Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1203 - 1211. [Abstract] [Full Text]

				M. Ono, Y. Sawa, K. Matsumoto, T. Nakamura, Y. Kaneda, and H. Matsuda In Vivo Gene Transfection With Hepatocyte Growth Factor via the Pulmonary Artery Induces Angiogenesis in the Rat Lung Circulation, September 24, 2002; 106(12_suppl_1): I-264 - I-269. [Abstract] [Full Text] [PDF]

				M C Zoia, A M D'Armini, M Beccaria, A Corsico, P Fulgoni, C Klersy, F Piovella, M Vigano, and I Cerveri Mid term effects of pulmonary thromboendarterectomy on clinical and cardiopulmonary function status Thorax, July 1, 2002; 57(7): 608 - 612. [Abstract] [Full Text] [PDF]

				K. Laczika, I. M. Lang, P. Quehenberger, C. Mannhalter, M. Muhm, W. Klepetko, and P. A. Kyrle Unilateral Chronic Thromboembolic Pulmonary Disease Associated With Combined Inherited Thrombophilia Chest, January 1, 2002; 121(1): 286 - 289. [Abstract] [Full Text] [PDF]

				P. F. Fedullo, W. R. Auger, K. M. Kerr, and L. J. Rubin Chronic Thromboembolic Pulmonary Hypertension N. Engl. J. Med., November 15, 2001; 345(20): 1465 - 1472. [Full Text] [PDF]

				British Cardiac Society Guidelines and Medical Pra Recommendations on the management of pulmonary hypertension in clinical practice Heart, September 1, 2001; 86(90001): i1 - 13. [Full Text] [PDF]

				P. A. Thistlethwaite, W. R. Auger, M. M. Madani, S. Pradhan, D. P. Kapelanski, and S. W. Jamieson Pulmonary thromboendarterectomy combined with other cardiac operations: indications, surgical approach, and outcome Ann. Thorac. Surg., July 1, 2001; 72(1): 13 - 18. [Abstract] [Full Text] [PDF]

				N. Tanabe, O. Okada, Y. Abe, M. Masuda, N. Nakajima, and T. Kuriyama The influence of fractional pulse pressure on the outcome of pulmonary thromboendarterectomy Eur. Respir. J., April 1, 2001; 17(4): 653 - 659. [Abstract] [Full Text] [PDF]

				J. A. Feinstein, S. Z. Goldhaber, J. E. Lock, S. M. Ferndandes, and M. J. Landzberg Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension Circulation, January 2, 2001; 103(1): 10 - 13. [Abstract] [Full Text] [PDF]

				E. Mayer, J. Kriegsmann, A. Gaumann, H. U. Kauczor, M. Dahm, U. Hake, F. X. Schmid, and H. Oelert Surgical treatment of pulmonary artery sarcoma J. Thorac. Cardiovasc. Surg., January 1, 2001; 121(1): 0077 - 82. [Abstract] [Full Text] [PDF]

				A. M. D'Armini, B. Cattadori, C. Monterosso, C. Klersy, V. Emmi, F. Piovella, G. Minzioni, and M. Vigano Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes Eur. J. Cardiothorac. Surg., December 1, 2000; 18(6): 696 - 702. [Abstract] [Full Text] [PDF]

				E. FADEL, G.-M. MAZMANIAN, B. BAUDET, H. DETRUIT, J.-P. VERHOYE, J. CRON, S. FATTAL, P. DARTEVELLE, and P. HERVE Endothelial Nitric Oxide Synthase Function in Pig Lung after Chronic Pulmonary Artery Obstruction Am. J. Respir. Crit. Care Med., October 1, 2000; 162(4): 1429 - 1434. [Abstract] [Full Text] [PDF]

				P. Mares, T. B. Gilbert, E. M. Tschernko, M. Hiesmayr, M. Muhm, A. Herneth, S. Taghavi, W. Klepetko, I. Lang, and W. Haider Pulmonary Artery Thromboendarterectomy: A Comparison of Two Different Postoperative Treatment Strategies Anesth. Analg., February 1, 2000; 90(2): 267 - 267. [Abstract] [Full Text] [PDF]

				M. Mo, D. P. Kapelanski, S. N. Mitruka, W. R. Auger, P. F. Fedullo, R. N. Channick, K. Kerr, C. Archibald, and S. W. Jamieson Reoperative pulmonary thromboendarterectomy Ann. Thorac. Surg., November 1, 1999; 68(5): 1770 - 1776. [Abstract] [Full Text] [PDF]

				T. Kramm, E. Mayer, M. Dahm, S. Guth, T. Menzel, M. Pitton, and H. Oelert Long-term results after thromboendarterectomy for chronic pulmonary embolism Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 579 - 584. [Abstract] [Full Text] [PDF]

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eckhard Mayer Manfred Dahm Ulrich Hake Stein Iversen Hellmut Oelert Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mayer, E. Articles by Oelert, H. Search for Related Content PubMed PubMed Citation Articles by Mayer, E. Articles by Oelert, H.