이달의 증례
| Programmed Follow-up and Quality Control of Treatment Techniques Enhance Chronic Thromboembolic Pulmonary Hypertension Management: Lessons From a Multidisciplinary Team | |||
|---|---|---|---|
| 년도 | 2024년 7월 | ||
| 카테고리 | 이달의 kcj Hot Article | ||
| 저자 | Taek Kyu Park, MD, PhD,1 Sung-A Chang, MD, PhD,1 Jeong Hoon Yang, MD, PhD,1 Woochan Kwon, MD,1 Min Yeong Kim, MD, PhD,2 Young Seok Cho, MD, PhD,3 Hye Yun Park, MD, PhD,4 Dong Seop Jeong, MD, PhD,5 Hojoong Kim, MD, PhD,4 and Duk kyung Kim, MD, PhD6 | ||
| 소속 | 1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Division of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 4Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5Division of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 6Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. | ||
| 첨부파일 1 | KCJ-24-021 GA.jpg | ||
- 관리자
- 등록일 : 2024.07.17
- Hit 233
Background and Objectives
The recent developments in chronic thromboembolic pulmonary hypertension (CTEPH) are emphasizing the multidisciplinary team. We report on the changes in clinical practice following the development of a multidisciplinary team, based on our 7 years of experience.
Methods
Multidisciplinary team was established in 2015 offering both balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) with technical upgrades by internal and external expertise. For operable cases, PEA was recommended as the primary treatment modality, followed by pulmonary angiography and right heart catheterization after 6 months to evaluate treatment effect and identify patients requiring further BPA. For patients with inoperable anatomy or high surgical risk, BPA was recommended as the initial treatment modality. Patient data and clinical outcomes were closely monitored.
Results
The number of CTEPH treatments rapidly increased and postoperative survival improved after team development. Before the team, 38 patients were treated by PEA for 18 years; however, 125 patients were treated by PEA or BPA after the team for 7 years. The number of PEA performed was 64 and that of BPA 342 sessions. World Health Organization functional class I or II was achieved in 93% of patients. The patients treated with PEA was younger, male dominant, higher pulmonary artery pressure, and smaller cardiac index, than BPA-only patients. In-hospital death after PEA was only 1 case and none after BPA.
Conclusions
The balanced development of BPA and PEA through a multidisciplinary team approach proved synergistic in increasing the number of actively treated CTEPH patients and improving clinical outcomes.
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