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Vol. 40. Issue 7.
Pages 326-328 (July 2004)
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Vol. 40. Issue 7.
Pages 326-328 (July 2004)
Case Reports
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Iloprost for Chronic Thromboembolic Pulmonary Hypertension
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V. Roig Figueroa
Corresponding author
vroig@usuarios.retecal.es

Correspondence: Dr. V. Roig Figueroa. Hernando de Acuña, 41 bis, 2.° A. 47014 Valladolid. España
, A. Herrero Pérez, N. de la Torre Ferrera, E. Hernández García, J.L. Aller Álvarez, J. Para Cabello
Servicio de Neumología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Chronic thromboembolic pulmonary hypertension (CTPH) is an uncommon complication of pulmonary embolism. The treatment of choice is thromboendarterectomy, a safe and effective surgical procedure in expert hands. However, a fair number of patients are not considered candidates for thromboendarterectomy or do not accept the risk involved. Such patients may respond well to prostacyclin or its derivatives. In recent years new vasodilator drugs administered by a variety of routes have appeared on the market. These drugs have been studied mainly for their effects on primary pulmonary hypertension or hypertension associated with connective-tissue diseases. Few trials have assessed their efficacy in patients with CTPH, however.

We report 2 cases of CTPH in which thromboendarterectomy was rejected. Neither of the patients responded to the conventional treatment of anticoagulants, diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors, but they did respond very well clinically, hemodynamically, and functionally to an inhaled prostacyclin analog, iloprost. We discuss the effects of iloprost in patients with CTPH, its mechanism of action, and its use as a potential pharmacological alternative to thromboendarterectomy. We also discuss new pulmonary vasodilators in general.

Key Words:
Iloprost
Chronic thromboembolic pulmonary hypertension
Thromboendarterectomy

La hipertensión pulmonar tromboembólica crónica (HTPTC) es una complicación infrecuente de la embolia pulmonar. El tratamiento de elección es la tromboendarterectomía, proceder quir úrgico seguro y eficaz en manos expertas. Un número no despreciable de pacientes, sin embargo, no se consideran candidatos a tromboendarterectomía o no aceptan los riesgos de la intervención. Estos pacientes pueden presentar una evolución favorable con prostaciclina o sus derivados. En los últimos años han aparecido nuevos fármacos vasodilatadores que actúan por diversas vías y cuyos efectos se han estudiado fundamentalmente en la hipertensión pulmonar arterial primaria o asociada a conectivopatías; sin embargo, son escasas las referencias en cuanto a su eficacia en la HTPTC.

Se presentan 2 casos de HTPTC en los que se desestimó la tromboendarterectomía y que no respondieron al tratamiento convencional con anticoagulantes, diuréticos, anta-gonistas del calcio e inhibidores de la enzima de conversión de la angiotensina; en cambio, presentaron una excelente respuesta clínica, hemodinámica y funcional al análogo de la prostaciclina iloprost por vía inhalatoria. Se comentan los efectos de los nuevos fármacos vasodilatadores pulmonares en general y del iloprost en particular en la HTPTC, su mecanismo de acción y su papel como posible alternativa farmacológica a la tromboendarterectomía.

Palabras clave:
Iloprost
Hipertensión pulmonar tromboembólica crónica
Tromboendarterectomía
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REFERENCES
[1]
PF Fedullo, WR Auger, KM Kera, LJ Rubin.
Chronic thromboembolic pulmonary hypertension.
N Engl J Med, 345 (2001), pp. 1465-1472
[2]
SW Jamieson, DP Kapelanski.
Pulmonary endarterectomy.
Curr Probl Surg, 37 (2000), pp. 165-252
[3]
PF Fedullo, WR Auger, RN Channick, KM Kerr, LJ Rubin.
Chronic thromboembolic pulmonary hypertension.
Clin Chest Med, 22 (2001), pp. 561-581
[4]
T Kramm, E Mayer, M Dahm, S Guth, T Menzel, M Pitton, et al.
Long-term results after thromboendarterectomy for chronic pulmonary embolism.
Eur J Cardiothoracic Surg, 15 (1999), pp. 579-583
[5]
SP Bradley, WR Auger, KM Moser.
Right ventricular pathology in chronic pulmonary hypertension.
Am J Cardiol, 78 (1996), pp. 584-587
[6]
H Olchewsky, G Simmoneau, N Galié, T Higenbottam, R Naeije, LJ Rubin, et al.
Inhaled iloprost for severe pulmonary hypertension.
N Engl J Med, 347 (2002), pp. 322-329
[7]
LJ Rubin, DB Badesc, RJ Barst, N Galié, CM Black, A Keogh, et al.
Bosentan therapy for pulmonary arterial hypertension.
N Engl J Med, 346 (2002), pp. 896-903
[8]
N Nagaya, N Sasaki, M Ando, H Ogino, F Sakamaki, S Kyotany, et al.
Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension.
Chest, 123 (2003), pp. 338-343
[9]
F Ono, N Nagaya, H Okumura, Y Shimizu, S Kyotani, N Nakanishi, et al.
Effect of orally active prostacyclin analogue on survival in patients with chronic thromboembolic pulmonary hypertension without major vessel obstruction.
Chest, 123 (2003), pp. 1583-1588
[10]
HA Ghofrani, R Wiedemann, F Rose, H Olchewsky, RT Schemuly, N Weissmann, et al.
Combination therapy with oral sildenafil and inhaled Iloprost for severe pulmonary hypertension.
Ann Intern Med, 136 (2002), pp. 515-522
[11]
SA Webb, S Stott, PV van Heerden.
The use of inhaled aerosolized prostacyclin in the treatment of pulmonary hypertension secondary to pulmonary embolism.
Intensive Care Med, 22 (1996), pp. 353-355
[12]
MA Gómez Sánchez, M Lázaro Salvador, P Escribano Subias, JF Delgado Jiménez, R Tello de Meneses, I Cea Calvo, et al.
Nuevos tratamientos médicos en la hipertensión pulmonar.
Arch Bronconeumol, 38 (2002), pp. 29-32
[13]
H Wilkens, M Bauer, N Forestier, J Konig, A Eichler, S Schneider, et al.
Influence of inhaled iloprost transpulmonary gradient of big endothelin patients with pulmonary hypertension.
Circulation, 107 (2003), pp. 1509-1523
[14]
CF Optiz, R Wensel, M Bettmann, R Schaffarzyk, M Linscheid, R Hetzer, et al.
Assessment of the vasodilator response in primary pulmonary hypertension. Comparing prostacyclin and iloprost administered by either infusion or inhalation.
Eur Heart J, 24 (2003), pp. 356-365
[15]
JA Barberá.
Nueva nomenclatura y clasificación de la hipertensión pulmonar.
Arch Bronconeumol, 38 (2002), pp. 3-9
Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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