Some patients may have repeated episodes of blood clots travelling to the lungs and developing severe lung artery abnormalities. These results in elevated lung pressures. We call this chronic thromboembolic pulmonary hypertension or CTEPH. Patients have to undergo a right heart catheterization study, a pulmonary angiogram (contrast injection of the arteries) as well as a ventilation perfusion scan ( radioisotope scan) for the diagnosis to be confirmed. Some patients may benefit from surgery. In those who have smaller, distal vessel disease, balloon pulmonary angioplasty may be considered.
A catheter is introduced in the lung arteries and contrast is administered to highlight the diseased areas (webs, slits and obstruction). These lesions are crossed with a very fine wire. A small size balloon is inflated to break up the webs and obstruction. No stents are required. As most patients have many obstructed lesions, repeat dilation of the blocked vessels are needed. Medical treatment may also be offered for some selected patients to improve their symptoms.
Irene Lang, Bernhard C. Meyer, Takeshi Ogo, Hiromi Matsubara, Marcin Kurzyna, Hossein-Ardeschir Ghofrani, Eckhard Mayer, Philippe Brenot
European Respiratory Review 2017 26: 160119; DOI: 10.1183/16000617.0119-2016
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Dr Jeremy Chow is an electrophysiologist specialising in the implantation and management of electronic cardiac devices.
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Dr Cliff Wong is an echocardiologist trained in imaging of the heart.
He specializes in cardiac imaging (echocardiography and cardiovascular computed tomography). Experienced in managing cardiomyopathy, heart failure, valvular heart diseases and cardio-oncology.
Dr Goh Ping Ping is an echocardiologist trained in imaging of the heart.
She is a strong advocate of preventive cardiology and awareness for women’s heart health. She manages a broad spectrum of cardiovascular disease including heart attack patients.
Dr Liew Boon Wah Matthew is a cardiologist who specialises in coronary artery interventional procedures.
He is experienced in the assessment of chest pain syndromes and both diagnostic and interventional coronary artery procedures.
Dr Edgar Tay is an interventional cardiologist specialised in structual heart disease, adult congenital and pulmonary hypertension.
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