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Interventional and surgical modalities of treatment for pulmonary arterial hypertension

Walter Klepetko, MD^*,*, Eckhard Mayer, MD, Julio Sandoval, MD, Elbert P. Trulock, MD, Jean-Luc Vachiery, MD^||, Phillippe Dartevelle, MD^¶, Joanna Pepke-Zaba, MD, Stuart W. Jamieson, MD^**, Irene Lang, MD and Paul Corris, MD

^* Department of Cardio-Thoracic Surgery, Vienna University Hospital, Vienna, Austria
Department of Cardio-Thoracic Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
Cardio-Thoracic Department, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
^|| Department of Cardiology, Erasme University Hospital, Brussels, Belgium
^¶ Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital, Paris, France
Department of Respiratory Medicine, Papworth Hospital NHS Trust, Cambridge, United Kingdom
^** Division of Cardiovascular and Thoracic Surgery, University of California, San Diego Medical Center, San Diego, California, USA
Department of Cardiology, University Hospital of Vienna, Vienna, Austria
Regional Pulmonary Hypertension Clinic, William Leech Centre for Lung Research, Freeman Hospital, Cambridge, United Kingdom

View larger version (137K): [in a new window]   Figure 1 Angiography depicts stenoses, complete obstructions, partial recanalization, and intraluminal webs and bands as classical signs of chronic thromboembolic pulmonary hypertension.

View larger version (28K): [in a new window]   Figure 2 Postoperative and long-term follow-up hemodynamic changes after pulmonary endarterectomy (data from Johannes Gutenberg University, Mainz, Germany, n = 50). CI = cardiac index; mPAP = mean pulmonary artery pressure; PVR = pulmonary vascular resistance.

View larger version (126K): [in a new window]   Figure 3 Cardiac magnetic resonance imaging before (A) and two weeks after pulmonary endarterectomy (B): Right heart dimensions are significantly decreased, and the left ventricle shows improved filling.