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Pneumologie 2025; 79(10): 808-818
DOI: 10.1055/a-2625-4950
DOI: 10.1055/a-2625-4950
Übersicht
Chronisch thromboembolische pulmonale Hypertonie
Chronic Thromboembolic Pulmonary HypertensionAuthors
Zusammenfassung
Die chronisch thromboembolische pulmonale Hypertonie (CTEPH) tritt als Spätkomplikation von akuten Lungenembolien (LE) auf. Narbige Verengungen der Lungenstrombahn infolge insuffizienter Thrombolyse und eine variable Mikrovaskulopathie erhöhen den pulmonalen Gefäßwiderstand. Eine frühestmögliche Erkennung ist von besonderer Bedeutung, da effektive potenziell kurative Therapieoptionen bestehen.
Zur Diagnose und Therapieplanung wird eine hochwertige Bildgebung in Kombination mit hämodynamischer Evaluation durch Rechtsherzkatheter benötigt, die an spezialisierten Zentren mit multidisziplinären Teams erfolgen sollten. Wenn möglich sollten Patient*innen mittels chirurgischer pulmonaler Endarteriektomie behandelt werden. Ist diese nicht möglich, werden bei geeigneten Zielläsionen wiederholte Ballonangioplastien angewandt und beide mechanischen Verfahren bei konkomitierender distaler Komponente mit medikamentöser Therapie ergänzt. Mit multimodalen Therapiekonzepten lassen sich exzellente Ergebnisse mit einer 3-Jahres-Überlebensrate von über 90 % erreichen.
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) occurs as a late complication of acute pulmonary embolism (PE). Scar-like narrowing of the pulmonary circulation resulting from insufficient thrombolysis and variable microvasculopathy increase the pulmonary vascular resistance. Early detection is particularly important because effective, potentially curative treatment options exist. Diagnosis and treatment planning require high-quality imaging combined with hemodynamic evaluation via right heart catheterization, which should be performed at specialized centers with multidisciplinary teams. If possible, patients should be treated with surgical pulmonary endarterectomy. If this is not possible, repeated balloon angioplasties are used for suitable target lesions, and both mechanical procedures are supplemented with medical therapy if the distal component is concomitant. Multimodal treatment concepts can achieve excellent results with a 3-year survival rate of over 90 %.
Schlüsselwörter
CTEPH - pulmonale Endarteriektomie - pulmonale Ballonangioplastie - pulmonale HypertonieKeywords
chronic thromboembolic pulmonary hypertension - pulmonary endarterectomy - balloon pulmonary angioplastyPublikationsverlauf
Artikel online veröffentlicht:
06. Oktober 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
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