Oğuzhan OKUTAN, Ömer AYTEN, Tuba Nihal URSAVAŞ, Turgut ÖZTUTGAN, Zafer KARTALOĞLU, Bedrettin YILDIZELİ, Ersin DEMİRER

Kronik tromboembolik pulmoner hipertansiyon tedavisinde pulmoner tromboendarterektominin yeri: Olgu sunumu

Pulmoner tromboendarterektomi (PEA), seçilmiş kronik tromboembolik pulmoner hipertansiyon (KTEPH) hastalarının tek tedavi seçeneğidir. Pulmoner trom- boendarterektomi, artmış pulmoner vasküler direnç (PVR) ve pulmoner arterlerde proksimal segment hastalığı olan hastalarda hayat kurtarıcı olabilir. Yetmişiki yaşında erkek olguda, kronik tromboemboliye bağlıpulmoner arter dallarında %50-80 oranında tıkanma var idi. Ekokardiyografide pulmoner arter basıncı (PAB)110 mmHg, sağ kalp kateterizasyonunda ortalama PAB 43 mmHg ve PVR 850 dyn/s/cm-5 idi. Kronik tromboembolik pulmoner hipertansiyon tanısı konulan hastayaPEA yapıldı. Pulmoner arter basıncı ameliyat sonrası15. günde 40 mmHg’ya indi. Hasta 22. günde ani gelişen kardiyak arrest nedeni ile kaybedildi. Kronik trombo- embolik pulmoner hipertansiyon olgularında en etkili tedavi yaklaşımı cerrahidir. Ameliyat sonrası mortalite- yi azaltmak için tüm risk faktörleri dikkatlice değerlen- dirilmelidir. Bu makalede, başarılı geçen PEA ameliyatısonrası kaybedilen bir KTEPH olgusu sunuldu.

The role of pulmonary thromboendarterectomy in management of chronic thromboembolic pulmonary hypertension: a case report

Pulmonary thromboendarterectomy (PEA) is a single treatment of choice in selected patients with chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary thromboendarterectomy may be life- saving for patients with increased pulmonary vascular resistance (PVR) and proximal segment disease of the pulmonary arteries. A 72-year-old male case had a 50-80% occlusion in pulmonary artery branches due to chronic thromboembolism. Echocardiography revealed a pulmonary artery pressure (PAP) of 110 mmHg, while right heart catheterization showed a mean PAP of 43 mmHg and PVR of 850 dyn/s/cm-5. The patient who was diagnosed with CTPEH underwent PEA. Pulmonary artery pressure was reduced to 40 mmHg at postoperative day 15. The patient died on postoperative day 22 due to a sudden cardiac arrest. Surgery is the most effective treatment approach for CTPEH cases. All risk factors should be carefully evaluated to reduce postoperative mortality. In this article, we present a case of CTEPH patient who underwent a successful PEA and died following surgery.

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