Chronic thromboembolic pulmonary hypertension in young woman with history of caesarian section

  • Nitia A. Asbarinsyah Department of Cardiology and Vascular, Faculty of Medicine, Universitas Indonesia, Jakarta
  • Rarsari S. Soerarso Department of Cardiology and Vascular, Faculty of Medicine, Universitas Indonesia, Jakarta
  • Nani Hersunarti Department of Cardiology and Vascular, Faculty of Medicine, Universitas Indonesia, Jakarta
  • Bambang B. Siswanto Department of Cardiology and Vascular, Faculty of Medicine, Universitas Indonesia, Jakarta
Keywords: CTEPH, CTPA, lung perfusion scan, oral anticoagulant, pulmonary hypertension
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Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of subgroups of pulmonary hypertension. This is a serious medical condition that severely under diagnosed. CTEPH is commonly underdiagnosed due to non specific symptoms and lack of diagnostic tools. The aim of this presentation is to discuss the etiology, risk factors, diagnosis and management of CTEPH. A 36-year-old woman presented with easily fatigue and dyspneu on effort since two years ago. The symptom occured about three months after she gave birth with caesarian section due to preeclampsia. Further history taking, physical examination, electrocardiography (ECG) and echocardiography were highly suggestive of pulmonary hypertension. No deep vein thrombosis (DVT) was found on vascular femoral sonography. It was found after the lung perfusion scintigraphy performed that she actually had CTEPH. This patient was categorized as inoperable because CT pulmonary angiography showed no thrombus. The patient got pulmonary vasodilator and oral anticoagulant for lifelong.

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Author Biography

Nitia A. Asbarinsyah, Department of Cardiology and Vascular, Faculty of Medicine, Universitas Indonesia, Jakarta
Resident in Department of Cardiology and Vascular medicine, Faculty of Medicine, Universitas Indonesia.

References

  1. Jenkins D, Mayer E, Screaton N, Madani M. State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management. Eur Respir Rev. 2012;21(123):32-9. http://dx.doi.org/10.1183/09059180.00009211

  2. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery J-L, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30(20):2493-537. http://dx.doi.org/10.1093/eurheartj/ehp297

  3. Tanabe N, Sugiura T, Tatsumi K. Recent progress in the diagnosis and management of chronic thromboembolic pulmonary hypertension. Respir Investig. 2013;51(3):134-46. http://dx.doi.org/10.1016/j.resinv.2013.02.005

  4. Klok FA, Huisman MV. Epidemiology and management of chronic thromboembolic pulmonary hypertension. Neth J Med. 2010;68(9):347–51.

  5. Moraca RJ, Kanwar M. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2012;8(3):475-83. http://dx.doi.org/10.1016/j.hfc.2012.04.003

  6. Pepke-Zaba J, Delcroix M, Lang I, Mayer E, Jansa P, Ambroz D, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124(18):1973-81. http://dx.doi.org/10.1161/CIRCULATIONAHA.110.015008

  7. McNeil K, Dunning J. Chronic thromboembolic pulmonary hypertension (CTEPH). Heart. 2007;93(9):1152-8. http://dx.doi.org/10.1136/hrt.2004.053603

  8. Ho YK, Wang CP, Wu YL, Lee TH, Ying TH, Lee MS. Pulmonary embolism after cesarean section and successful treatment with early application of extracorporeal membrane oxygenation system and anticoagulant agents. Taiwan J Obstet Gynecol. 2014;53(2):273-5. http://dx.doi.org/10.1016/j.tjog.2013.04.041

  9. Van Walraven C, Mamdani M, Cohn A, Katib Y, Walker M, Rodger MA. Risk of subsequent thromboembolism for patients with pre-eclampsia. BMJ. 2003;326(7393):791-2. http://dx.doi.org/10.1136/bmj.326.7393.791

  10. Bonderman D, Wilkens H, Wakounig S, Schäfers H-J, Jansa P, Lindner J, et al. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir J. 2009;33(2):325-31. http://dx.doi.org/10.1183/09031936.00087608

  11. Forfia PR, Trow TK. Diagnosis of pulmonary arterial hypertension. Clin Chest Med. 2013;34(4):665-81. http://dx.doi.org/10.1016/j.ccm.2013.09.001

  12. McLaughlin VV, Davis M, Cornwell W. Pulmonary arterial hypertension. Curr Probl Cardiol. 2011;36(12):461-517. http://dx.doi.org/10.1016/j.cpcardiol.2011.08.002

  13. Rich S. Pulmonary Hypertension. In: Bonow RO, Mann DL, et al., editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadephia: Elsevier Saunders; 2012. p. 1696-717.

  14. Marshall PS, Kerr KM, Auger WR. Chronic thromboembolic pulmonary hypertension. Clin Chest Med. 2013;34(4):779-97. http://dx.doi.org/10.1016/j.ccm.2013.08.012

  15. Frazier AA, Burke AP. The imaging of pulmonary hypertension. Semin Ultrasound CT MR. 2012;33(6):535-51. http://dx.doi.org/10.1053/j.sult.2012.06.002

  16. Forfia PR, Vachiéry JL. Echocardiography in pulmonary arterial hypertension. Am J Cardiol. 2012;110(6 Suppl):16S-24S. http://dx.doi.org/10.1016/j.amjcard.2012.06.012

  17. Kim NH, Delcroix M, Jenkins DP, Channick R, Dartevelle P, Jansa P, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(25Suppl): D92-9. http://dx.doi.org/10.1016/j.jacc.2013.10.024

  18. Auger WR, Kim NH, Trow TK. Chronic thromboembolic pulmonary hypertension. Clin Chest Med. 2010;31(4):741-58. http://dx.doi.org/10.1016/j.ccm.2010.07.006

  19. McLaughlin VV, Langer A, Dragomir A, Cassanova A, Tan M, Clements PJ, et al. Contemporary trends in the diagnosis and management of PAH: an initiative to close the care gap. Chest. 2010;138(4_MeetingAbstracts):351A.

  20. Mehta S, Helmersen D, Provencher S, Hirani N, Rubens FD, De Perrot M, et al. Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension : a clinical practice guideline. Can Respir J. 2010;17(6):301-34.

  21. Willemink MJ, van Es HW, Koobs L, Morshuis WJ, Snijder RJ, van Heesewijk JPM. CT evaluation of chronic thromboembolic pulmonary hypertension. Clin Radiol. 2012;67(3):277-85. http://dx.doi.org/10.1016/j.crad.2011.09.012

Published
2015-01-27
How to Cite
1.
Asbarinsyah NA, Soerarso RS, Hersunarti N, Siswanto BB. Chronic thromboembolic pulmonary hypertension in young woman with history of caesarian section. Med J Indones [Internet]. 2015Jan.27 [cited 2019Aug.23];23(4):232-8. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1067
Section
Case Report