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Pulmonale Endarteriektomie bei chronisch-thrombembolischer pulmonaler Hypertonie

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

  • Operative Techniken
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die pulmonale Endarteriektomie ist die Therapie der Wahl mit kurativer Intention bei Patienten mit chronisch-thrombembolischer pulmonaler Hypertonie. Ziel ist es, die narbigen Stenosen und Verschlüsse, die die verbliebenen Reste akuter Lungenembolien darstellen, aus den Pulmonalarterien herauszuschälen. Hierzu wird der Patient mithilfe eines kardiopulmonalen Bypasses abgekühlt, um im tiefen hypothermen Kreislaufstillstand die arterielle Lungenstrombahn, ausgehend von den zentralen Pulmonalarterien, zu endarteriektomieren. Der vorliegende Beitrag beschreibt die wesentlichen Details dieses Verfahrens.

Abstract

Pulmonary endarterectomy (PEA) is the treatment of choice with curative intent in patients suffering from chronic thromboembolic pulmonary hypertension. The aim of PEA is removal of the fibrotic material causing the stenosis and occlusions from the pulmonary vasculature. Using a cardiopulmonary bypass patients are cooled down and dissection is performed during periods of deep hypothermic circulatory arrest. The important details of this procedure are described.

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Abbreviations

CTEPH:

chronisch-thrombembolische pulmonale Hypertonie

DHCA:

„deep hypothermic circulatory arrest“ (tiefer hypothermer Kreislaufstillstand)

ECMO:

„extracorporeal membrane oxygenation“ (extrakorporale Membranoxygenierung)

mPAP:

„mean pulmonary arterial pressure“ (mittlerer pulmonalarterieller Druck)

PA:

Pulmonalarterie

PEA:

pulmonale Endarteriektomie

PAOP:

„pulmonary artery occlusion pressure“ (pulmonalarterieller Verschlussdruck, Wedge-Druck)

PVR:

„pulmonary vascular resistance“ (pulmonalvaskulärer Widerstand)

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Guth, T. Kramm und E. Mayer haben Vortragshonorare der Firmen Actelion, Bayer und Pfizer erhalten. C. Wiedenroth: kein Interessenkonflikt. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Herz- und Lungenzentrum, Benekestr. 2–8, 61231, Bad Nauheim, Deutschland

    S. Guth, T. Kramm, C. Wiedenroth & E. Mayer

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  1. S. Guth
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  2. T. Kramm
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  3. C. Wiedenroth
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  4. E. Mayer
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Correspondence to S. Guth.

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Guth, S., Kramm, T., Wiedenroth, C. et al. Pulmonale Endarteriektomie bei chronisch-thrombembolischer pulmonaler Hypertonie. Z Herz- Thorax- Gefäßchir 28, 178–184 (2014). https://doi.org/10.1007/s00398-014-1071-1

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  • DOI: https://doi.org/10.1007/s00398-014-1071-1

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