Rıza Doğan, Murat Biçer, Selim İspir, Mehmed Yanartaş, Cihangir Kaymaz, Tahir Yağdı, Mustafa Şırlak, Gökçen Orhan, Bahadır Gültekin, Tankut Akay, Ümit Kervan, Ahmet Rüçhan Akar, Serpil Gezer Taş

Kronik tromboembolik pulmoner hipertansiyon tedavisinde çıtayı ultradisipliner iş birliğine yükseltmek

Kronik tromboembolik pulmoner hipertansiyon, yetersiz oranda tanı konulan ve tedavi edilmez ise potansiyel olarak ölümcül olabilen bir pulmoner hipertansiyon alt grubudur. Klinik bulguları efor dispnesi ve spesifik olmayan semptomlardır. Tanı için, multimodal görüntüleme ve kalp kateterizasyonu gerekmektedir. Bir açık kalp ameliyatı olan pulmoner endarterektomi, uzman merkezlerde seçilmiş hastalar için uygulanan altın standart tedavi şeklidir. Hedeflenmiş tıbbi tedavi ve balon pulmoner anjiyoplasti, belirgin komorbiditeleri olan yüksek riskli hastalarda, distal pulmoner vasküler tıkanıklıklarda veya pulmoner endarterektomi sonrası nüks eden veya inatçı pulmoner hipertansiyonda etkili olabilir. Günümüzde kronik tromboembolik pulmoner hipertansiyonlu hastalarda yeni koronavirüs-2019 enfeksiyonuna ve hastalığın pandemi sırasında değişen spektrumuna ilişkin veriler sınırlıdır. Bu pandemi sırasında sağlık hizmetleri krizi nedeniyle yaşanan zor zamanlar ve göreceli olarak artmış ölüm oranları, birleşmeyi, diğer bir deyişle, disiplinler arası ve sektörel sınırları geçerek, birleşik bilgileri ve yeni paradigmaları geliştirebilmek için ultradisipliner iş birliğini zorunlu kılmaktadır. ‘’Yeni normal’’ dönemde sanal bakım, daha ileri tehditler için hazırlıklı olma, yeniden düzenlenen standartlar, spesifik önerilerin tekrar değerlendirilmesi ve kronik tromboembolik pulmoner hipertansiyon hastaları için en iyi kararı verebilmek üzere çevrimiçi iş birlikleri gibi tedavi stratejileri, kötü prognozu değiştirebili

Raising the bar to ultradisciplinary collaborations in management of chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension is an underdiagnosed and potentially fatal subgroup of pulmonary hypertension, if left untreated. Clinical signs include exertional dyspnea and non-specific symptoms. Diagnosis requires multimodality imaging and heart catheterization. Pulmonary endarterectomy, an open heart surgery, is the gold standard treatment of choice in selected patients in specialized centers. Targeted medical therapy and balloon pulmonary angioplasty can be effective in high-risk patients with significant comorbidities, distal pulmonary vascular obstructions, or recurrent/persistent pulmonary hypertension after pulmonary endarterectomy. Currently, there is a limited number of data regarding novel coronavirus-2019 infection in patients with chronic thromboembolic pulmonary hypertension and the changing spectrum of the disease during the pandemic. Challenging times during this outbreak due to healthcare crisis and relatively higher case-fatality rates require convergence; that is an ultradisciplinary collaboration, which crosses disciplinary and sectorial boundaries to develop integrated knowledge and new paradigms. Management strategies for the “new normal” such as virtual care, preparedness for further threats, redesigned standards and working conditions, reevaluation of specific recommendations, and online collaborations for optimal decisions for chronic thromboembolic pulmonary hypertension patients may change the poor outcomes

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