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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Although surgical pulmonarythromboendarterectomy is the treatment of choice forpulmonary hypertension due to chronic thrombotic and&#47;orembolic disease&#44; minimally invasive endovasculartechniques such as angioplasty or placement of a metallicstent can provide acceptable results when surgery is notindicated or has been refused by the patient&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Eight patients &#40;5 men&#44; 3 women&#59;mean age&#44; 62&#46;6 years&#41; were treated&#46; The patients were in New York Heart Association &#40;NYHA&#41; class III or IV andhad a mean pulmonary artery pressure of 40 mm Hg ormore&#44; a capillary wedge pressure of 15 mm Hg or less&#44; and a Miller index greater than 0&#46;5&#46; In all cases&#44; diagnosis was based on Doppler echocardiography&#44; pulmonaryangiography&#44; hemodynamic evaluation&#44; and ventilation-perfusion scintigraphy&#46; All patients received fibrinolytictherapy and underwent angioplasty&#46; A metallic stent wasimplanted in 3 patients&#46; Follow-up echocardiographicassessment and ventilation-perfusion scans were scheduledat 1&#44; 3&#44; 6&#44; and 12 months&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The procedures were technically successful in allcases&#46; The mean follow-up period was 18&#46;7 months&#46; Minorcomplications were extrasystoles &#40;3 cases&#41;&#44; slight bruising atthe site of puncture &#40;1 case&#41;&#44; and rectal bleeding thatresolved without treatment &#40;1 case&#41;&#46; One patient died froman unknown cause 24 hours after the procedure&#46; In all othercases&#44; improvements were noted in NYHA functional class&#44; in hemodynamics demonstrated by echocardiography&#44; andin vascular structure as shown by arteriography andscintigraphy&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Minimally invasive endovascularinterventions can help improve pulmonary arterialhypertension due to chronic thrombotic and&#47;or embolicdisease in patients for whom medical or surgical treatmentis not possible&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Aunque la tromboendarterectom&#237;a pulmonarquir&#250;rgica es el tratamiento de elecci&#243;n en la hipertensi&#243;narterial cr&#243;nica de origen tromboemb&#243;lico&#44; cuando no hayindicaci&#243;n quir&#250;rgica o el paciente rechaza la cirug&#237;a sepuede recurrir a t&#233;cnicas endovasculares de m&#237;nima inva-si&#243;n &#40;angioplastia y pr&#243;tesis met&#225;lica&#41; con aceptables resul-tados&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se trat&#243; a 8 pacientes &#40;5 varones y3 mujeres&#41; con una media de edad de 62&#44;6 a&#241;os&#44; en clase IIIo IV de la clasificaci&#243;n de la New York Heart Association&#40;NYHA&#41;&#44; con presi&#243;n arterial pulmonar media de 40 mmHgo superior&#44; presi&#243;n capilar enclavada de 15 mmHg o menore &#237;ndice de Miller mayor de 0&#44;5&#46; En todos los casos el diag-n&#243;stico se estableci&#243; por ecograf&#237;a Doppler card&#237;aca&#44; angio-graf&#237;a pulmonar&#44; estudio hemodin&#225;mico y gammagraf&#237;a deventilaci&#243;n-perfusi&#243;n&#46; Se realiz&#243; tratamiento fibrinol&#237;tico se-guido de angioplastia en todos los casos&#44; y se coloc&#243; una pr&#243;-tesis met&#225;lica en 3&#46; Se realizaron revisiones cl&#237;nicas al cabode 1&#44; 3&#44; 6 y 12 meses mediante ecograf&#237;a y gammagraf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El &#233;xito t&#233;cnico del procedimiento fue del100&#37;&#46; El seguimiento medio fue de 18&#44;7 meses&#46; Como com-plicaciones menores se produjeron extras&#237;stoles en 3 casos&#59;hematoma leve en la zona de punci&#243;n en un caso&#44; y rectorra-gia&#44; que remiti&#243; sin tratamiento&#44; en otro&#46; Una paciente mu-ri&#243; por causa desconocida al cabo de 24 h&#46; En todos los casosrevisados se observaron una mejor&#237;a en la clasificaci&#243;n de laNYHA&#44; mejora hemodin&#225;mica evidenciada por ecograf&#237;a ymejora morfol&#243;gica objetivada por arteriograf&#237;a y gamma-graf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Las t&#233;cnicas endovasculares de m&#237;nimainvasi&#243;n pueden contribuir a mejorar la hipertensi&#243;n arte-rial pulmonar cr&#243;nica debida a tromboembolia en la que noes posible otro tratamiento &#40;farmacol&#243;gico o quir&#250;rgico&#41;&#46;</p>"
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Vol. 44. Issue 6.
Pages 312-317 (January 2008)
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Vol. 44. Issue 6.
Pages 312-317 (January 2008)
Original Articles
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Image-Guided Minimally Invasive Treatment of Pulmonary Arterial Hypertension Due to Embolic Disease
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Miguel Ángel de Gregorioa,
Corresponding author
mgregori@unizar.es

Correspondence: Dr M.A. de Gregorio Unidad de Cirugía Mínimamente Invasiva Guiada por Imagen Hospital Clínico Universitario Lozano Blesa. Juan Bosco, 1550006 Zaragoza. Spain
, Alicia Labordaa, Rosario Ortasa, Teresa Higuerab, Javier Gómez-Arruea, Joaquín Medranoa, Antonio Mainara
a Unidad de Cirugía Mínimamente Invasiva Guiada por Imagen, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Unidad de Hemodinámica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Article information
Objective

Although surgical pulmonarythromboendarterectomy is the treatment of choice forpulmonary hypertension due to chronic thrombotic and/orembolic disease, minimally invasive endovasculartechniques such as angioplasty or placement of a metallicstent can provide acceptable results when surgery is notindicated or has been refused by the patient.

Patients and methods

Eight patients (5 men, 3 women;mean age, 62.6 years) were treated. The patients were in New York Heart Association (NYHA) class III or IV andhad a mean pulmonary artery pressure of 40 mm Hg ormore, a capillary wedge pressure of 15 mm Hg or less, and a Miller index greater than 0.5. In all cases, diagnosis was based on Doppler echocardiography, pulmonaryangiography, hemodynamic evaluation, and ventilation-perfusion scintigraphy. All patients received fibrinolytictherapy and underwent angioplasty. A metallic stent wasimplanted in 3 patients. Follow-up echocardiographicassessment and ventilation-perfusion scans were scheduledat 1, 3, 6, and 12 months.

Results

The procedures were technically successful in allcases. The mean follow-up period was 18.7 months. Minorcomplications were extrasystoles (3 cases), slight bruising atthe site of puncture (1 case), and rectal bleeding thatresolved without treatment (1 case). One patient died froman unknown cause 24 hours after the procedure. In all othercases, improvements were noted in NYHA functional class, in hemodynamics demonstrated by echocardiography, andin vascular structure as shown by arteriography andscintigraphy.

Conclusions

Minimally invasive endovascularinterventions can help improve pulmonary arterialhypertension due to chronic thrombotic and/or embolicdisease in patients for whom medical or surgical treatmentis not possible.

Key words:
Minimally invasive surgical procedures
Chronicpulmonary embolic disease
Pulmonary artery hypertension
Objetivo

Aunque la tromboendarterectomía pulmonarquirúrgica es el tratamiento de elección en la hipertensiónarterial crónica de origen tromboembólico, cuando no hayindicación quirúrgica o el paciente rechaza la cirugía sepuede recurrir a técnicas endovasculares de mínima inva-sión (angioplastia y prótesis metálica) con aceptables resul-tados.

Pacientes y métodos

Se trató a 8 pacientes (5 varones y3 mujeres) con una media de edad de 62,6 años, en clase IIIo IV de la clasificación de la New York Heart Association(NYHA), con presión arterial pulmonar media de 40 mmHgo superior, presión capilar enclavada de 15 mmHg o menore índice de Miller mayor de 0,5. En todos los casos el diag-nóstico se estableció por ecografía Doppler cardíaca, angio-grafía pulmonar, estudio hemodinámico y gammagrafía deventilación-perfusión. Se realizó tratamiento fibrinolítico se-guido de angioplastia en todos los casos, y se colocó una pró-tesis metálica en 3. Se realizaron revisiones clínicas al cabode 1, 3, 6 y 12 meses mediante ecografía y gammagrafía.

Resultados

El éxito técnico del procedimiento fue del100%. El seguimiento medio fue de 18,7 meses. Como com-plicaciones menores se produjeron extrasístoles en 3 casos;hematoma leve en la zona de punción en un caso, y rectorra-gia, que remitió sin tratamiento, en otro. Una paciente mu-rió por causa desconocida al cabo de 24 h. En todos los casosrevisados se observaron una mejoría en la clasificación de laNYHA, mejora hemodinámica evidenciada por ecografía ymejora morfológica objetivada por arteriografía y gamma-grafía.

Conclusiones

Las técnicas endovasculares de mínimainvasión pueden contribuir a mejorar la hipertensión arte-rial pulmonar crónica debida a tromboembolia en la que noes posible otro tratamiento (farmacológico o quirúrgico).

Palabras clave:
Mínima invasión
Embolia pulmonar crónica
Hipertensión arterial pulmonar
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Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
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