ulmonary Hypertension Dr Dolores Taboada MD Consultant Cardiologist Pulmonary Vascular Disease Unit Papworth Hospital Cambridge UK My disclosures I have received honoraria from Actelion Bayer ID: 812281
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Chronic Thromboembolic Pulmonary Hypertension
Dr Dolores Taboada MDConsultant CardiologistPulmonary Vascular Disease UnitPapworth Hospital, Cambridge, UK
Slide2My disclosuresI have received honoraria from Actelion, Bayer, GSK, Lilly and Pfizer
Slide3Pulmonary hypertension is a haemodynamic stateMean PAP ≥ 25 mmHgAssessed by RHC
Pulmonary Hypertension European Guidelines. Eur Heart Journal 2009; 30, 2493-2537
Slide4Classification of Pulmonary Hypertension
Kiely et al, BMJ 2013;346:f2028 doi: 10.1136/bmj.f2028 (Published 16 April 2013)
Slide5Classification of Pulmonary Hypertension
Kiely et al, BMJ 2013;346:f2028 doi: 10.1136/bmj.f2028 (Published 16 April 2013)
Slide6Chronic thromboembolic pulmonary hypertension
Inappropriate thrombus resolution
2-10%
Slide7Vascular
remodeling pulmonary hypertension
right
ventricular
failure
Chronic
thromboembolic
pulmonary
hypertension
Slide8BreathlessnessChest tightnessFatiguePalpitationsSyncope on exertionSymptoms are
unspecific
Slide9Signs of PHLoud P2Pansystolic murmurRight ventricular heave
Signs of RV failureElevated JVPPeripheral edemaHepatomegalyAscites Examination
Slide10Recurrent VTESplenectomyInflammatory bowel diseaseVA shuntsInfected PPMRisk factors
Slide11ESC, European Society of Cardiology; ERS, European Respiratory Society.Galiè N et al. Eur Heart J 2016;37:67–119.
11
Slide12Echocardiogram shows ‘pulmonary hypertension’
Slide13Sheffield
Newcastle
Glasgow
London
Cambridge
Dublin
Mater
Missericordiae
Hospital
Golden Jubilee National
Freeman Hospital
Royal
Hallamshire
Hospital
Hammersmith Hospital
Royal Free Hospital
Royal Brompton Hospital
Papworth Hospital
CTEPH expert centre
The Association of Pulmonary
Hypertension Centres
UK and Ireland
Slide14Right Atrium
Right Ventricle
Wedged PA Trace
Main Pulmonary Artery
Right heart catheterisation
confirms
PH
Slide15Imaging confirms CTEPH
Slide16Slide17Pulmonary Endarterectomy Surgical removal of occlusive thromboembolic material
Under deep hypothermic circulatory arrestPotentially cure for CTEPH
Slide18Assessment of suitability for PEA
Symptoms and functional limitationCoexistent medical conditions
Location of thromboembolic material
EP
Severity of pulmonary hypertension
Slide19Pepke-Zaba et al. Circulation 2011;24:1973-81
1
/3
Non - operable
Slide20Targeted medical therapyLai et al. Circulation Research June 20, 2014
Slide21CTEPH – 2 compartments
Organized thromboemboli
OCCLUDED
Changes similar to one seen in the PAH
Slide22Balloon pulmonary angioplasty - BPA
Slide23CTEPHA complication of pulmonary embolismLifelong anticoagulationOnly potentially curable form of PHOperability assessment at CTEPH expert centre
Slide24Pulmonary Endarterectomy
Balloon Pulmonary AngioplastyMedical Therapy
CTEPH – treatment options
Slide25Surgeons
Mr
David Jenkins
Mr Choo Ng
Mr J Dunning
Mr S Tsui
Interventional
Cardiologist
Stephen
Hoole
Gerry
Coghlan
M
ultidisciplinary CTEPH team -Papworth Hospital
Chest Physicians
Dr J Pepke Zaba
Dr K Sheares
Dr J Cannon
Dr M Toshner
Prof N
Morrell
Cardiologist
Dr D Taboada
Radiologists
Dr N
Screaton
Dr A Ruggiero
PEA Anaesthetists
Dr G Martinez
Dr J
Arrowsmith
Dr A Klein
Dr K
Valchanov
Dr A
Rubino
Dr K
Salaunkey
Papworth ICU team
MDT
coordinator
Karin Johnson
PEA
Specialist
Nurses
Anie
Ponaberanam
Liliana
Almeida
Slide26Thanks