Clinical Analysis Of18Patients With Chronic Thromboembolic Pulmonary Hypertension And A Case Report Of6Patients With Pulmonary Hypertension

Objective:This paper through to18cases diagnosed as chronic thromboembolic pulmonary hypertension (CTEPH) and6cases with different types of pulmonary hypertension clinical data were analyzed and summarized, aiming at analysis of the features of CTEPH and the clinical diagnostic process.Methods:Retrospective analysis method to analyze the characteristics in18CTEPH cases of the patients’history, including clinical symptoms, signs, diagnosis time, the WHO function classification, blood tests, ECG, echocardiography, CTPA, pulmonary ventilation perfusion isotopic scan imaging and treatment programs, and to analyze the other6cases of the patients’history, diagnosis and treatment.Results:1. Average onset time of18patients diagnosed with chronic thromboembolic pulmonary hypertension was14.8±16.2months, The male to female ratio of all patients was1:0.64, and mean age was61.8±13.6years old.2.The main symptoms of all patients was dyspnea (72.2%); the main signs were the jugular vein filling and lower extremity edema (respectively22.2%); The ratio of WHO functional class I to IV was5.6%,22.2%,22.2%and50%, respectively.44.4%of the patients had deep vein thrombosis.3. Echocardiography measuring average PASP was67.44±18.29mmHg, average ratio of the pulmonary artery and ascending aorta diameter was1.08±0.24. The proportion of type1to4classified by CTPA and isotope pulmonary ventilation perfusion imaging was61.1%,11.1%,11.1%and16.7%, respectively.4. NT-proBNP was elevated in all patients with an average of2924.90±2988.64pg/ml.5. All patients have taken warfarin as the main anticoagulant with good and continued compliance, while11.1%of the patients underwent pulmonary endarterectomy and both of them were the type1CTEPH.6. The diagnosis of the other6cases with different pulmonary hypertension types mainly relied on right heart catheterization, but they were lack of functional evaluation.Conclusion:1. It is difficult to early diagnosis and easy to missed diagnosis and misdiagnosis because of lack of specificity in clinical manifestations of CTEPH.2. Most patients had cardiac function level III/IV at the time of diagnosis and the NT-proBNP level was an important indicator of right ventricular dysfunction in patients with CTEPH.3. Besides good compliance to anticoagulant therapy and strong surgical indication of type1CTEPH, targeted medicine also could improve symptoms to some extent in patients with CTEPH.4. Clear etiologic is important for the diagnosis of pulmonary hypertension and hemodynamic examination has significant value for this disease.