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Therapie der chronischen Thromboembolie (CTEPH)

Therapy for chronic thromboembolism

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Die chronisch thromboembolische pulmonale Hypertonie (CTEPH) gehört zu den häufigsten Ursachen einer schweren pulmonalen Hypertonie und wird zu selten diagnostiziert, dabei sind bis zu 4% aller Patienten nach Lungenembolie betroffen. Wachsende Einsichten in die Pathophysiologie zeigen Gemeinsamkeiten von CTEPH und pulmonal arterieller Hypertonie (PAH). Therapie der Wahl ist die pulmonale Endarterektomie, hierdurch lässt sich eine Senkung des pulmonalen Widerstandes bis hin zur Normalisierung der Hämodynamik erreichen. Wichtig bei der Indikationsstellung ist die sorgfältige Abschätzung von hämodynamischer Beeinträchtigung und angiographisch nachweisbarem Ausmaß der Obstruktion. Möglicherweise kann eine spezifische medikamentöse Therapie bei peripherer CTEPH genauso wirksam wie bei PAH sein. Für nicht operable Patienten und in bestimmten Situationen auch für Patienten vor und nach PEA kann eine medikamentöse Therapie sinnvoll sein, es sind jedoch weitere Studien erforderlich, um Kriterien für die spezifische Therapie der CTEPH zu erarbeiten.

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a frequent cause of pulmonary hypertension, however, it still is underdiagnosed. Up to 4% of all individuals that survive pulmonary embolism develop CTEPH. Increasing insights into the pathophysiology of CTEPH indicate a distinct overlap with pulmonary arterial hypertension (PAH). Pulmonary endarterectomy (PEA), which lowers pulmonary resistance and can lead to normalization of hemodynamics, is the treatment of choice for eligible patients, however, only a proportion of patients fulfill the criteria for surgical intervention. Patients who are not eligible for PEA may benefit from specific medical therapy for pulmonary hypertension, as do patients before and after PEA with significant peripheral involvement of the pulmonary vasculature. Direct evidence from clinical trials in CTEPH is promising, but is to date limited. Further studies are necessary to define criteria for specific medical therapy for CTEPH.

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Interessenkonflikt

HW hat für Vorträge von Schering, Pfizer und Actelion Pharmaceuticals Honorare erhalten und war als Beraterin für Schering und Pfizer tätig.

Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Abteilung Innere V, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland

    H. Wilkens

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Wilkens, H. Therapie der chronischen Thromboembolie (CTEPH). Pneumologe 4, 30–38 (2007). https://doi.org/10.1007/s10405-006-0131-y

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