Chronisch thromboembolische pulmonale Hypertonie

Die chronisch thromboembolische pulmonale Hypertonie (CTEPH) ist eine seltene Erkrankung, aber gut behandelbare Spätfolge nach einer akuten Lungenembolie. Daher wird eine Nachuntersuchung nach einer ausreichenden Antikoagulation von mindestens 3 Monaten empfohlen. Es stehen 3 Behandlungsmethoden zur Verfügung: die pulmonale Endarteriektomie, die pulmonale Ballonangioplastie und Medikamente, die auf die pulmonale Hypertonie wirken. Die Entscheidung über die Behandlung sollte von einem erfahrenen multidisziplinären Team in spezialisierten CTEPH-Zentren getroffen werden.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease, but an important late sequela after acute pulmonary embolism. Therefore, follow-up after at least three months of sufficient anticoagulation is recommended. Patients with suspected CTEPH should be referred to specialized CTEPH centers for further evaluation and treatment.

Three treatment modalities are available: pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and pulmonary hypertension-targeted drugs. The indication for surgery depends mainly on the localization of the pulmonary arterial obstructions. Severe comorbidities as well as advanced age need individual evaluation, but do not present strict exclusion criteria. Multimodal treatments are common practice in inoperable CTEPH. However, treatment decision making in an experienced multidisciplinary team is mandatory.

Kernaussagen

• CTEPH ist eine wichtige Komplikation nach überstandener Lungenembolie.

• Diagnostik und Therapie der CTEPH sollten in entsprechend spezialisierten Zentren erfolgen.

• Es gibt 3 etablierte Therapiemodalitäten: die pulmonale Endarteriektomie, die medikamentöse Therapie und die pulmonale Ballonangioplastie.

• Das therapeutische Konzept hängt maßgeblich von der Lokalisation der pulmonalarteriellen Obstruktionen und der pulmonalen Hämodynamik ab.

• Patienten mit CTEPH sollen langfristig (mindestens jährlich) verlaufskontrolliert werden.

Schlüsselwörter

CTEPH - CTEPD - pulmonale Hypertonie - PEA - BPA

Keywords

CTEPH - CTEPD - pulmonary hypertension - PEA - BPA

Publication History

Article published online:
10 November 2023

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