Cenk KIRAKLI, Pınar ÇİMEN, Yelda VAROL, Nuran KATGI, İsmail KAYAALP, Fatma ÜÇSULAR DEMİRCİ, Mehmet ÜNLÜ, Salih Zeki GÜÇLÜ, Oktay ERGENE

The incidence o f chronic thromboembolic p ulmonary h yp ertension secondary to acute p ulmonary thromboembolism

Giriş : Kronik tromboembolik pulmoner h ipertansiyon (KTEPH) ciddi morbidite ve mortaliteye ne den olan az ımsanma yacak sıklıktage lişen, tedavi e dilebilir, kısmen de ön lenebilir bir komplikasyon dur. Ça lışmamızda; tan ıda ventilasyon/perfüzyon (V/Q) sintigrafisiile çok dede ktörlü bilgisayarlı tomografi (ÇDBT) pulmoner anjiyografi gibi noninvaziv tetkikler kullan ılarak a kut pulmoner tromboem-boli (PTE) sonrasın da gelişen KTEPH s ıklı ğının saptanmas ı amaçlanmıştır.Materyal ve Metod: Ocak 2010 ile Aralık 2012 tarihleri arasın da ilk kez pulmoner emboli tan ısı konulan 99 h asta çalışmaya dah iledildi. En az üç ay antikoa gülan te davi a lmış h astalara transtorasik ekokardiyografi (TTE) uygulan dı (n= 85). TTEde, SPAP de ğeri >30 mmH g olarak ölçülen ve/veya sa ğkalp işlev bozukluğu bulgusu saptanan 31 (%34.4) olguya, ÇDBT pulmoner an jiyografi ilebirlikte V/Q sintigrafisi yapıldı. ÇDBT pulmoner anjiyografide rezidüe l kronik trombüs bulguları ve/veya V/Q sintigrafisin de segmentalperfüzyon defe kti ya da defe ktleri olan olgulara, sa ğkalp kateterizasyonu (SKK) yapıldı (n= 7). Ortalama PAB ölçüldü ve vazoreak-tivite testi yapıldı. SKK esnasın da nonkontrast madde pulmoner arterlere verilerek pulmoner arteriyo grafi görüntüleri a lın dı.Bulg ular: PTE tan ılı h astaların 44ü erke k, 55i kadın dı. Olguların ya ş orta laması 60 ± 17 ve me dian yaş 49 (38-67)' du. Olguların%63.6s ın da en az bir tane olmak üzere ek h astalık anamnezi, %91.9un da en az bir tane PTE risk faktörü mevcuttu. Tanı an ın da 24olgu masif, 61 olgu submasif ve 14 olgu nonmasif PTE olarak de ğerlen dirildi. On dokuz (%19.1) olguya trombolitik te davi uygulan dı.Diğer 80 (%80.8) olguya INR de ğeri terapötik aralıkta olacak şekilde stan dart antikoa gülan tedavi verildi. Olguların %79.8in detromboemboli yaygın lı ğı bilateral, %21.8in de unilateraldi. Minumum 1 maksimum 2 yıl takip sonrasın da 5 (%5.5) h asta KTEPHtanısı aldı. KTEPH gelimi ile yaş , PTE etiyolojik risk faktörü, trombolitik te davi almak, PTE tipi ve yaygın lı ğı arasın da univaryan analiz -de istatistiksel anlamlılık sa ptanmadı.Sonuç: PTEnin önlene bilir bir kom plikasyonu olan KTEPH takip edilen h asta larda oldukça yükse k bir insidansta sa ptanmıştır.

Akut pulmoner tromboemboli sonrası gelişen kronik tromboembolik pulmoner hipertansiyon sıklığı

In troductio n : Ch ronic th rom b oem b o lic pu lmonary hypertension (CTEPH) is a cura ble an d partia lly preventa ble com plication, w ithwa su b stantia l incidence, lea ding to severe morb idity an d morta lity. T h e aim of th e present stu dy was to fin d out th e inciden cce of cCTEPH secon dary to acute pu lmonary th rom b oem b o lism (PTE) usin g non-invasive proce dures such as ventilation/perfusion (V/Q)Vscintigraphy and pulmonary multidetector CT (MDCT) an gio graphy in determining the dia gnosis of CTEPH.Materials and Methods: T h e stu dy inc lu de d a tota l of 99 patients dia gnose d with initia l PTE b etween January 2010 an d Dece mmb er m2012. T h e patients w h o receive d anticoa gu lant th erapy at least for th ree month s un derwent transth oracic ech ocardio graph y (T TE) (T(n= 85). T h irty one patients with a SPAP va lue > 30 mmHg an d/or an evidence of righ t ventricu lar dysfunction in TTE un de rwen trwM DCT pu lmonary angiograph y an d V/Q scintigraph y. T h e patients with an evidence of residua l ch ronic th romb oem b o lic sign s in gnM DCT pulmonary angio graphy and/or se gmental perfusion defect(s) in V/Q scintigraphy underwent right heart catheteriza tiona(RHC) (n= 7). The mean PAP was measured, and a vasoreactivity test was performed. Durin g RHC, a non-contrast mediu m was mde livere d to th e pu lmonary arteries for pu lmonary arterio graphy ima gin g.Resu lts: Amon g patients dia gnose d with PTE, 44 were ma le an d 55were female. The mean a ge was 60 ± 17 years. Of these patients,6 3.6% h a d h istory of at least one a dditiona l disease an d at leastone risk factor for PTE. During dia gnosis, 24 sub jects were consid-ere d h avin g massive, 61 su b massive an d 14 non-massive PTE.Nineteen (19.1%) patients receive d th rom b o lyth ic th erapy. Other 80 (80.8%) patients received stan dard anticoagulant th erapy with an INR value with in th e th erapeutic range. In 79.8% of patients,th romboembolism was bilateral, and it was unilatera l in 21.8%. After a minimum of 1 year, an d maximum of 2 years follow u p fivesub jects (5.5%) were diagnosed with CTEPH. Th e univariate analysis s h owed no association between th e development of CTEPHan d factors like; a ge, etiologic risk factors for PTE, receivin g th rombolytic treatment, prevalence an d type of PTE.Conclusion: Potentia lly preventa bl complication of pulmonary embolism; CTEPH, h ad a substantial incidence durin g follow-up.

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