Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary Hypertension

In: Pulmonary function

11 Feb 2013

Pulmonary Vascular Steal in Chronic Thromboembolic Pulmonary HypertensionSeveral groups have now shown that chronic, large vessel thromboembolic pulmonary hypertension is potentially correctable by surgical thromboendarterectomy.’ However, the postoperative course of these patients is complex, presenting management problems, including reperfusion edema, persistent hypoxemia, pericardial effusion, and psychiatric disturbances. One unusual postoperative observation, seen in a significant number of our patients, has been the appearance of new perfusion defects in the postoperative lung scan. To our knowledge, this phenomenon has not been reported previously.

These new defects appeared to occur, most commonly, in areas of the lung served by segmental and lobar arteries that had not been entered at surgical thromboendarterec-tomy. The analysis that follows was undertaken to determine the incidence of this phenomenon and its potential basis. The findings suggest that these new perfusion scan defects are due to postoperative redistribution of regional pulmonary vascular resistance, a phenomenon we have labeled pulmonary blood flow steal.

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