Figures
- FIGURE 1.
Diagnostic imaging algorithm for chronic thromboembolic pulmonary hypertension (CTEPH). CT: computed tomography; MR: magnetic resonance. #: pulmonary angiography is usually performed in conjunction with right heart catheterisation and should be performed at centres experienced with CTEPH and pulmonary endarterectomy. Reproduced from [1] with permission from the publisher.
- FIGURE 2.
a) Ventilation and b) perfusion scintigraphy of the lungs of a patient with chronic thromboembolic pulmonary hypertension. The dark areas indicate regions of the lung with good ventilation or perfusion, respectively.
- FIGURE 3.
a) Conventional angiography and b) magnetic resonance angiography of the lungs of a patient with chronic thromboembolic pulmonary hypertension, showing webs and occlusions.
- FIGURE 4.
Multi-scan computed tomography showing mosaic perfusion in the lungs of a patient with chronic thromboembolic pulmonary hypertension. The darker areas indicate regions of poor perfusion.
Tables
- Table. 1—
Recommendations for the diagnosis and pre-operative assessment of chronic thromboembolic pulmonary hypertension (CTEPH)
Statement Class# Level¶ The diagnosis of CTEPH is based on the presence of pre-capillary PH (P̄pa ≥25 mmHg, PWP ≤15 mmHg, PVR >2 Wood units) in patients with multiple chronic/organised occlusive thrombi/emboli in the elastic pulmonary arteries (main, lobar, segmental, subsegmental) I C Once perfusion scanning and/or CT angiography show signs compatible with CTEPH, the patient should be referred to a centre with expertise in surgical pulmonary endarterectomy IIa C The selection of patients for surgery should be based on the extent and location of the organised thrombi, on the degree of PH and on the presence of comorbidities IIa C PH: pulmonary hypertension; P̄pa: mean pulmonary arterial pressure; PWP: pulmonary wedge pressure; PVR: pulmonary vascular resistance; CT, computed tomography. #: I: evidence and/or general agreement that a given treatment or procedure is beneficial, useful or effective; II: conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure (IIa, weight of evidence/opinion is in favour of usefulness/efficacy); ¶: C: consensus of opinion of the experts and/or small studies, retrospective studies or registries. Modified from [14].
