Therapie der chronisch thromboembolischen pulmonalen Hypertonie

Zusammenfassung

Die chronisch thromboembolische pulmonale Hypertonie (CTEPH) ist eine wichtige und oft gut behandelbare Form der pulmonalen Hypertonie. Es stehen aktuell 3 Therapiemodalitäten zur Verfügung: die pulmonale Endarteriektomie, die pulmonale Ballonangioplastie und die gezielte medikamentöse Behandlung. Das therapeutische Konzept hängt maßgeblich von der Lokalisation der zugrunde liegenden pulmonalarteriellen fibrösen Obstruktionen ab. Die pulmonale Endarteriektomie ist der Goldstandard in der Behandlung der CTEPH. Für inoperable Patienten stehen mittlerweile 2 zugelassene Substanzen (Riociguat und Treprostinil) zur Verfügung. Daneben wird bei Vorhandensein entsprechender Zielgebiete die interventionelle Therapie empfohlen. Evaluation und Behandlung von CTEPH-Patienten sollte in entsprechend erfahrenen Zentren erfolgen.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important form of pulmonary hypertension. Nowadays, three treatment modalities are available: pulmonary endarterectomy, pulmonary balloon angioplasty, and targeted medical treatment. The therapeutic concept depends mainly on the exact localization of the underlying pulmonary arterial obstructions. Pulmonary endarterectomy is the gold standard in the treatment of CTEPH. For inoperable patients, two approved drugs (riociguat and treprostinil) are available. In addition, interventional therapy is recommended if there are appropriate target lesions. Evaluation and treatment of CTEPH patients in experienced centers is mandatory.

Was ist wichtig?

In den aktuellen europäischen PH-Leitlinien werden für operable Patienten die pulmonale Endarteriektomie (I B), für inoperable Patienten und für Patienten mit residueller/rezidivierender pulmonaler Hypertonie (PH) nach pulmonaler Endarteriektomie (PEA) die medikamentöse PH-Therapie (I B) sowie die pulmonale Ballonangioplastie bei Vorhandensein entsprechender Zielgebiete (I B) empfohlen.

Schlüsselwörter

chronisch thromboembolische pulmonale Hypertonie - pulmonale Endarteriektomie - pulmonale Ballonangioplastie

Keywords

chronic thromboembolic pulmonary hypertension - pulmonary endarterectomy - balloon pulmonary angioplasty

Publication History

Article published online:
09 February 2023

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