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Volumen 20. Número 1. Enero-Marzo 2017Hipertensión pulmonar tromboembólica crónica
A. Cerezo Lajas1, C.A. Quezada Loaiza2, J. de Miguel Díez1, R. del Pozo Rivas2
1Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid. 2Unidad Multidisciplinar de Hipertensión Pulmonar. Servicio de Neumología. Hospital Universitario 12 de Octubre. Madrid.
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.
Hipertensión pulmonar; Tromboembolismo pulmonar; Hipertensión pulmonar tromboembólica crónica; Tromboendarterectomía pulmonar; Angioplastia con balón de arterias pulmonares; Riociguat.
Pulmonary hypertension; Pulmonary embolism; Chronic thromboembolic pulmonary hypertension; Pulmonary thromboendarterectomy; Angioplasty with balloon of pulmonary arteries; Riociguat.