FIVE-YEAR RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC POSTEMBOLIC PULMONARY HYPERTENSION

Between 2004 and April 2014, in the aortic, coronary and peripheral arteries surgery centre surgery pulmonary thromboendarterectomy (TAE) was performed in 169 patients with chronic postembolic pulmonary hypertension. Operation was performed by the developed technique using hypothermia and circulatory arrest. For the assessment of dynamic of clinical and functional status underwent the following: test with 6-minute walk, right ventricular echocardiographic parameters (ejection fraction, end-diastolic volume, end-diastolic dimension), mean pulmonary artery pressure and vascular resistance, pulmonary circulation (according to right heart catheterization) and the diameter of the pulmonary artery trunk (PA) (according to the MSCT-angiography of the pulmonary artery). The distance of 6-minute walk indicated the functional class of chronic heart failure classification NYHA. The results of studies presents that pulmonary TAE operation is direct at the main causes of pulmonary hypertension - thrombotic obstruction of the pulmonary arteries which leads to the normalization of the pulmonary circulation, reduce the load on the right ventricle and a significant improvement in functional status of patients. The TAE operation in the branches of PA leads to improved clinical and functional status of patients with chronic postembolic pulmonary hypertension during hospital stay and more lately after surgery. This evidenced by an increase of distance in 6-minute walk test more than 2.5 times, reduction of CHF FC (by NYHA). Reducing the size of the right heart, the increase in right ventricular ejection fraction, decreased vascular resistance, pulmonary circulation from 539.66 ± 120.59 dyn∙sec∙cm^-5 (before surgery) to 101.39 ± 89.20 dyn∙sec∙cm^-5 in the remote period indicates right ventricular remodeling and distal arterioles of the pulmonary circulation. Reducing of the diameter of PA 35.10 ± 5.25 mm before surgery and up to 30.30 ± 8.65 mm in the remote period according to MSCT-angiography of PA indicate the restructuring of pulmonary bloodstream with a tendency towards normalization and the effectiveness of the surgical treatment.

легочная тромбэндартерэктомия, хроническая постэмболическая легочная гипертензия, тест 6-минутной ходьбы, катетеризация правых отделов сердца, МСКТ-ангиография легочных артерий, pulmonary thromboendarterectomy, chronic postembolic pulmonary hypertension, test with 6-minute walk, right heart catheterization, MSCT-angiography of the pulmonary artery

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