Longitudinal analysis of perfusion lung scintigrams of patients with unoperated chronic thromboembolic pulmonary hypertension

 

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Summary

Chronic thromboembolic pulmonary hypertension (CTEPH) is the result of single or recurrent pulmonary thromboemboli that are thought to develop into organized pulmonary arterial obstructions by recurrent embolism and in situ thrombosis. Radioisotopic ventilation-perfusion scanning (V/Q scan) is a safe and highly sensitive test for pulmonary thromboembolic disease. The aim was to assess the natural history of thrombus expansion. We performed a prospective quantitative evaluation of ventilation/perfusion scintigrams (V/Q scans) in 20 patients with severe unoperated CTEPH. The baseline V/Q scan of each patient served as a reference for the second scan 21.7 ± 8.2 months later. Planar images with intravenous 99mTc-labeled human albumin macroaggregates were reconstructed in six standard projections. Perfusion scans were analyzed by a semiquantitative evaluation. In parallel, hemodynamics and clinical condition were prospectively observed. Lung perfusion scintigrams analyzed by a semi-quantitative method in patients with severe unoperated CTEPH show an apparent decrease of segmental flow abnormalities over time, paralleling right ventricular decline.

• References

• 1 Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation 1990; 81: 1735-43.
  CrossrefPubMedGoogle Scholar
• 2 Moser KM, Auger WR, Fedullo PF. et al. Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment. Eur Respir J 1992; 05: 334-42.
  PubMedGoogle Scholar
• 3 Ribeiro A, Lindmarker P, Johnsson H. et al. Pulmonary embolism: one-year follow-up with echocardiography doppler and fiveyear survival analysis. Circulation 1999; 99: 1325-30.
  CrossrefPubMedGoogle Scholar
• 4 Fedullo PF, Auger WR, Kerr KM. et al. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001; 345: 1465-72.
  CrossrefPubMedGoogle Scholar
• 5 Jamieson SW, Kapelanski DP, Sakakibara N. et al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003; 76: 1457-62 discussion 1462-4.
  CrossrefPubMedGoogle Scholar
• 6 Fuster V, Steele PM, Edwarts ED. et al. Primary pulmonary hypertension: natural history and the importance of thrombosis. Circulation 1984; 70: 580-87.
  CrossrefPubMedGoogle Scholar
• 7 Daily PO, Dembitzsky WP, Iversen S. et al. Current early results of pulmonary thromboendarterectomy for chronic pulmonary embolism. Eur J Cardiothorac Surg 1990; 04: 117-21.
  CrossrefPubMedGoogle Scholar
• 8 Thistlethwaite PA, Mo M, Madani MM. et al. Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2002; 124: 1203-11.
  CrossrefPubMedGoogle Scholar
• 9 Machherndl S, Kneussl M, Baumgartner H. et al. Long-term treatment of pulmonary hypertension with aerosolized Iloprost. Eur Resp J 2001; 17: 8-13.
  CrossrefPubMedGoogle Scholar
• 10 Lisbona R, Kreisman H, Novales-Diaz J. et al. Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension. Am J Roentgenol 1985; 144: 27-30.
  CrossrefPubMedGoogle Scholar
• 11 Gray. In: Sharp PF, Gemmell HG, Smith FW. eds. Practical Nuclear Medicine. New York: Oxford Medical Publications; 1998
  Google Scholar
• 12 Gottschalk A, Sostman HD, Coleman RE. et al. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 1993; 34: 1119-26.
  PubMedGoogle Scholar
• 13 Palla A, Formichi B, Santolicandro A. et al. From not detected pulmonary embolism to diagnosis of chronic thromboembolic pulmonary hypertension: a retrospective study. Respiration 1993; 60: 9-14.
  CrossrefPubMedGoogle Scholar
• 14 Morris TA, Auger WR, Ysrael MZ. et al. Parenchymal scarring is associated with restrictive spirometric defects in patients with chronic thromboembolic pulmonary hypertension. Chest 1996; 110: 399-403.
  CrossrefPubMedGoogle Scholar
• 15 Jamieson SW, Nomura K. Indications for and the results of pulmonary thromboendarterectomy for thromboembolic pulmonary hypertension. Semin Vasc Surg 2000; 13: 236-44.
  PubMedGoogle Scholar
• 16 Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg 2000; 37: 165-252.
  CrossrefPubMedGoogle Scholar
• 17 Klepetko W, Moritz A, Burghuber OC. et al. [Chronic thromboembolic pulmonary hypertension and its treatment with pulmonary thrombendarterectomy]. Wien Klin Wochenschr 1995; 107: 396-402.
  PubMedGoogle Scholar
• 18 Dartevelle P, Fadel E, Chapelier A. et al. [Pulmonary thromboendarterectomy with video-angioscopy and circulatory arrest: an alternative to cardiopulmonary transplantation and post-embolism pulmonary artery hypertension]. Chirurgie 1998; 123: 32-40.
  CrossrefPubMedGoogle Scholar
• 19 Meyer G, Collignon MA, Guinet F. et al. Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism. Eur J Nucl Med 1990; 17: 315-9.
  CrossrefPubMedGoogle Scholar
• 20 Ryan KL, Fedullo PF, Davis GB. et al. Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest 1988; 93: 1180-5.
  CrossrefPubMedGoogle Scholar
• 21 Fishman AJ, Moser KM, Fedullo PF. Perfusion lung scans vs pulmonary angiography in evaluation of suspected primary pulmonary hypertension. Chest 1983; 84: 679-83.
  CrossrefPubMedGoogle Scholar
• 22 Olman MA, Auger WR, Fedullo PF. et al. Pulmonary vascular steal in chronic thromboembolic pulmonary hypertension. Chest 1990; 98: 1430-4.
  CrossrefPubMedGoogle Scholar
• 23 The urokinase pulmonary embolism trial. A national cooperative study. Circulation 1973; 47: II1-108.
  CrossrefPubMedGoogle Scholar
• 24 Hall RJ, Sutton GC, Kerr IH. Long-term prognosis of treated acute massive pulmonary embolism. Br Heart J 1977; 39: 1128-34.
  CrossrefPubMedGoogle Scholar
• 25 Paraskos JA, Adelstein SJ, Smith RE. et al. Late prognosis of acute pulmonary embolism. N Engl J Med 1973; 289: 55-8.
  CrossrefPubMedGoogle Scholar
• 26 Wartski M, Collignon MA. Incomplete recovery of lung perfusion after 3 months in patients with acute pulmonary embolism treated with antithrombotic agents. THESEE Study Group. Tinzaparin ou Heparin Standard: Evaluation dans l’Embolie Pulmonaire Study. J Nucl Med 2000; 41: 1043-8.
  PubMedGoogle Scholar
• 27 Simonneau G, Sors H, Charbonnier B. et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l’Embolie Pulmonaire. N Engl J Med 1997; 337: 663-9.
  CrossrefPubMedGoogle Scholar
• 28 Kim H, Yung GL, Marsh JJ. et al. Pulmonary vascular remodeling distal to pulmonary artery ligation is accompanied by upregulation of endothelin receptors and nitric oxide synthase. Exp Lung Res 2000; 26: 287-301.
  CrossrefPubMedGoogle Scholar
• 29 Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993; 103: 685-92.
  CrossrefPubMedGoogle Scholar