Clinical Features and Management of Chronic Thromboembolic Pulmonary Hypertension in Thai
Suree Sompradeekul MD*, Monsawan Minipan MD*
Affiliation : *Department of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
Background : The incidence and clinical features of chronic thromboembolic pulmonary hypertension (CTEPH)
in Thailand are unknown. This may be due to the difficulties in diagnosis, poor disease recognition and non-
specific presenting symptoms and signs. With the new revolution of diagnostic tools and advanced knowledge
about this condition, CTEPH is now discovered much more often.
Study design: Retrospective cross-sectional study
Objective : To evaluate common risk factors, symptoms, signs, commonly used investigations, treatment and
results of treatment in Thai patients with CTEPH.
Material and Method: All patients with confirmed CTEPH diagnoses were selected for analysis in this study.
We evaluated characteristics of patients with CTEPH at Siriraj hospital. All CTEPH patients’ data included
demographics, symptoms, signs, investigations, treatments, outcome and risk factors such as malignancy;
previous deep vein thrombosis, immobilization, and congenital thrombophilia were recorded.
Statistical analysis: The descriptive statistics were used in this study. Categorical data and continuous data
presented in term of percent and mean with standard deviation respectively.
Results : fourteen patients had confirmed diagnoses of CTEPH, five patients were male and 9 were female. The
age of patients varied from 28 to 79 years old. Mean age was 55 years old. The most common presenting
symptoms and signs were dyspnea (100%), followed by leg edema (78.6%), tachypnea (71.4%) and accentua-
tion of pulmonic component of second heart sound (loud P2) (57.1%). At the time of diagnosis, four out of 14
patients were in NYHA class II, ten were in NYHA class III, and none of them was in NYHA class IV. Idiopathic
CTEPH was found in 54.1% of patients. Congenital and acquired thrombophilia were the frequent risk factors
found in our series. The most frequent radiographic abnormalities included enlarged pulmonary trunk, right
atrium/right ventricle (RA/RV) dilatation, and cardiomegaly followed by prominent pulmonary trunk.
Echocardiography findings were elevated right ventricular systolic pressure (RVSP); ranges varied from 60
mmHg to 137 mmHg (mean was 107.48 mmHg). The most common finding of arterial blood gas in APE patients
was respiratory alkalosis with hypoxemia. The most frequent diagnostic tool used was ventilation-perfusion
lung scan. Treatment of CTEPH patients was by anticoagulant, pulmonary thromboendarterectomy and infe-
rior vena cava filter insertion. The success rate of surgical thromboendarterectomy in our institute was about
80%
Conclusion : Characteristics of CTEPH patients are unique and different from acute pulmonary embolism in
aspects of clinical presentations, risk factors, investigation, common findings, treatment and outcome.
Keywords : Clinical features, CTEPH, Pulmonary embolism, Thromboendarterectomy
