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Perfusion lung scan after pulmonary artery endarterectomy in patients with chronic thromboembolic pulmonary hypertension

Alaa Alduraibi, Ahmed Fathala

Background: The gold standard screening test for Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is the Ventilation/Perfusion Lung (VQ) scan. Pulmonary Artery Endarterectomy (PEA) is the treatment of choice for CTEPH. The appearance of VQ scan post-PEA is unknown Objective: The main aim of this study was to investigate the rule of the VQ scan and its correlation with other clinical parameters before and after PEA. Methods: In total, 42 consecutive patients aged over 18 years with definitive CTEPH with and high-probability VQ scan and mean pulmonary artery pressure of more than 25 mm HG who underwent PEA. Results: The mean age was 40 ± 10 years, and mean of total perfusion defects before and after PEA was 40 ± 9% and 17 ± 14% (p=0.0001), respectively. Patients with NYHA class 1 were considered respondents, but patient with NYHA class 2 and higher were considered non-respondents. There was no significant correlation between VQ perfusion between respondents and non-respondents (p=0.2414) after PEA. Patients with a 50% or greater improvement in the 6MWD after PEA were considered respondents, but patients with a less than 50% improvement in the 6MWD after PEA were considered non-respondents, and there was a significant correlation between respondents and non-respondents (p=0.0004). Conclusions: PEA for patients with CTEPH results in a significant improvement in lung perfusion abnormalities, the 6MWD, and NYHA functional class. There was a strong correlation between postoperative improvements of the lung perfusion abnormalities and the 6MWD, but no correlation with NYHA functional class.