Pulmonary endarterectomy increased regional pulmonary blood flow in the total lung from 32.7 to 54.2 mL/min/100 mL (P=0.0002), with adjusted improvements remaining in the lower lobes.
Observational (n=20)
Does pulmonary endarterectomy improve MR imaging-derived regional pulmonary parenchymal perfusion and cardiac function in patients with chronic thromboembolic pulmonary hypertension?
Cardiopulmonary MRI demonstrates that pulmonary endarterectomy improves regional pulmonary blood flow predominantly in the lower lobes, which correlates with improved exercise capacity.
Absolute Event Rate: 54.2% vs 32.7%
p-value: p=.0002
Purpose To evaluate surgical success after pulmonary endarterectomy (PEA) by means of cardiopulmonary magnetic resonance (MR) imaging. Materials and Methods In this institutional review board-approved study, 20 patients with chronic thromboembolic pulmonary hypertension were examined at 1.5 T with a dynamic contrast material-enhanced three-dimensional fast low-angle shot sequence before and 12 days after PEA (25th-75th percentile range, 11-16 days). Lung segments were evaluated visually before PEA for parenchymal hypoperfused segments. Pulmonary blood flow (PBF), first-pass bolus kinetic parameters, and biventricular mass and function were determined. Mean pulmonary artery pressure (mPAP) and 6-minute walking distance were measured before and after PEA. The Shapiro-Wilk test, paired two-sided Wilcoxon rank sum test, Spearman ρ correlation, and multiple linear regression analysis were performed. Results Two weeks after PEA, regional PBF increased 66% in the total lung from 32.7 to 54.2 mL/min/100 mL (P = .0002). However, after adjustment for cardiac output, this change was not evident anymore (increase of 7% from 7.03 to 7.54 mL/min/100 mL/L/min, P = .1). Only in the lower lobes, a significant increase in PBF after cardiac output adjustment remained: a 16% increase in the right lower lobe from 7.53 to 8.71 mL/min/100 mL (P = .01) and a 14% increase in the left lower lobe from 7.42 to 8.47 mL/min/100 mL/L/min (P < .05). Right ventricular mass and function also improved. mPAP decreased from 46 to 24 mm Hg (P < .0001). Six-minute walking distance increased from 390 to 467 m (P = .02) 5 months after PEA. Percentage change of mPAP and PBF in the lower lobe tended to be significant predictors of percentage change in 6-minute walking distance (β = -1.79 P = .054 and β = 0.45 P = .076, respectively) in multiple linear regression analysis. Conclusion Improvement of PBF after PEA was observed predominantly in the lower lungs, and the magnitude of improvement of PBF in the lower lobes correlated with the improvement in exercise capacity, reflecting surgical success. (©) RSNA, 2016.
Schoenfeld et al. (2016) conducted an observational in Chronic thromboembolic pulmonary hypertension (n=20). Pulmonary endarterectomy vs. Before pulmonary endarterectomy was evaluated on Regional pulmonary blood flow (PBF) in the total lung (p=.0002). Pulmonary endarterectomy increased regional pulmonary blood flow in the total lung from 32.7 to 54.2 mL/min/100 mL (P=0.0002), with adjusted improvements remaining in the lower lobes.