Hipertensión pulmonar tromboembólica crónica

Abstract

Chronic thromboembolic pulmonary hypertension (CTPH) is caused by chronic occlusion of the pulmonary arteries due to the presence of organized thrombi. The possibility of this disease should be considered in patients with a history of venous thromboembolic and persistent dyspnoea, as well as in those with echocardiographic data of pulmonary hypertension, since up to 25[%] of patients with HPTEC have no previous history of thromboembolic event . If pulmonary hypertension is suspected with echocardiography, then a pulmonary ventilation-perfusion scan should be performed. If signs suggestive of HPTEC are evident in such examination, multidetector computed tomography angiography, right cardiac catheterization, and pulmonary arteriography should be indicated to confirm pulmonary hypertension, quantify its severity, define surgical accessibility of thrombotic lesions, and confirm that an acceptable component of elevated pulmonary vascular resistance is due to the existence of a surgically accessible disease and does not correspond to a distal obstruction or secondary arteriopathy. Pulmonary thromboendarterectomy (TEA) is the treatment of choice. In patients with CTPH who cannot undergo TEA or who have residual pulmonary hypertension after performing this procedure, medical treatment with riociguat may be indicated or balloon angioplasty of the pulmonary arteries may be assessed.