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Perfusion Scan Findings Understate the Severity of Angiographic and Hemodynamic Compromise in Chronic Thromboembolic Pulmonary Hypertension
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METHODS
The medical records, ventilation and perfusion scans, and angiograms of 25 consecutive patients with chronic TEPH, whose scans and angiograms were available, were reviewed. All patients had chronic large vessel TEPH diagnosed by right heart catheterization and pulmonary angiography; all subsequently underwent pulmonary artery thromboendarterectomy at the University of California, San Diego (UCSD) Medical Center between March 1984 and June 1986.
Right heart catheterization was performed
RESULTS
The study included 18 men and 7 women with a mean age of 44 years (range, 19 to 73 years). Mean PA pressure for the group was 45 mm Hg (range, 30 to 65 mm Hg). Mean pulmonary vascular resistance (PVR) for the group was 797 dynes•s•cm−5 (range, 311 to 1900 dynes•s•cm−5). Hemodynamic, angiographic, and perfusion scanning data are presented in Table 1.
The perfusion scans revealed two or more segmental-sized defects in all cases. In all, ventilation scans were normal (ie, ventilation/perfusion
DISCUSSION
The perfusion lung scan, the pulmonary angiogram, and direct hemodynamic measurement during right heart catheterization each provides invaluable information in the assessment of patients with known or suspected pulmonary hypertension. However, the data provided by each approach are quite distinct, and assumptions that one technique will reflect findings revealed by the others should be made cautiously, if at all. In chronic major vessel thromboembolic pulmonary hypertension, our analysis
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Cited by (0)
Supported in part by NHLBI Pulmonary Training Grant (HL 07022-11), UCSD SCOR Grant (23584-09), and NIH Grant (RR-00827) to the UCSD General Clinical Research Center.
Manuscript received September 8; revision accepted December 1.